***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 investigate associations between diet and non-dietary lifestyle factors and the onset of  overactive bladder ( OAB ) in men . SUBJECTS R and om sample of community-dwelling men aged 40 years plus . DESIGN AND METHODS Baseline data on  urinary symptoms and  diet  were collected from 5454 men using a postal question naire and a food-frequency question naire . Follow-up data on urinary symptoms were collected from 4887 men in a postal survey one year later .  Logistic regression analysis  was used to investigate diet and lifestyle factors associated with onset of OAB in the men without OAB at baseline . RESULTS There was a highly significant negative association between beer intake at baseline and subsequent OAB onset ( P=0.001 ) , with reduced risk at all levels of intake compared with those who seldom/never drank beer . Adjustment for total alcohol intake ( g ethanol day(-1 ) ) reduced the significance of the association ( P=0.02 ) . None of the food groups studied was associated with OAB onset , with the possible exception of potatoes ( P=0.05 ) , which showed an increased risk of onset at the highest level of consumption . Physical activity , smoking and obesity were not significantly associated . CONCLUSIONS While most diet and lifestyle factors were not associated with OAB onset , the evidence from this prospect i ve longitudinal study suggests that beer may have a protective role in the development of OAB . This could be due to a non-alcoholic ingredient as well as the alcohol content OBJECTIVES To investigate the effects of darifenacin controlled-release ( CR ) and oxybutynin extended-release ( ER ) on cognitive function ( particularly memory ) in older subjects . METHODS Healthy subjects ( n=150 ) > /=60 years were r and omised to darifenacin , oxybutynin ER or placebo in a multicentre , double-blind , double-dummy , parallel-group , 3-week study . Doses were administered according to US labels : oxybutynin ER 10 mg once daily ( od ) , increasing to 15 mg od then 20 mg od by week 3 ; darifenacin 7.5 mg od in weeks 1 and 2 , then 15 mg od in week 3 . The primary end point was accuracy on the Name-Face Association Test ( delayed recall ) at week 3 . RESULTS Results of the Name-Face Association Test at week 3 showed no significant difference between darifenacin and placebo on delayed recall ( mean difference , -0.06 , p=0.908 ) . In contrast , oxybutynin ER result ed in memory impairment , with significantly lower scores than placebo and darifenacin ( mean differences , -1.30 , p=0.011 and -1.24 , p=0.022 , respectively ) for delayed recall on the Name-Face Association Test at week 3 . Additional tests of delayed recall indicated significant memory impairment with oxybutynin ER versus placebo at certain time points , whereas darifenacin was similar to placebo . No between-treatment differences were detected in self-rated memory , demonstrating that subjects were unaware of memory deterioration . CONCLUSIONS While darifenacin had no significant effects on memory versus placebo , oxybutynin ER caused significant memory deterioration ( magnitude of effect comparable to brain aging of 10 years ) . The results also demonstrate that subjects may not recognise/report memory deterioration OBJECTIVE To evaluate the effect of a low‐intensity behavioral therapy program on urinary incontinence in older women . METHODS A r and omized clinical trial for community‐dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted . Women were r and omly assigned to a behavioral therapy group ( n = 77 ) or a control group ( n = 75 ) . The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules . The control group received no instruction but kept urinary diaries for 6 weeks . After this period , the control group underwent the behavioral therapy protocol . Using per‐ protocol analyses , t and χ2 tests were used to compare the treatment and control groups , and paired t tests were used to evaluate the efficacy of behavioral therapy for all women ( treatment and control groups before and after behavioral therapy ) . RESULTS Women in the treatment group experienced a 50 % reduction in mean number of incontinent episodes recorded on a 7‐day urinary diary compared with a 15 % reduction for controls ( P = .001 ) . After behavioral therapy , all women had a 40 % decrease in mean weekly incontinent episodes ( P = .001 ) , which was maintained over 6 months ( P < .004 ) . Thirty ( 31 % ) women were 100 % improved ( dry ) , 40 ( 41 % ) were at least 75 % improved , and 50 ( 52 % ) at least 50 % improved . There were no differences in treatment efficacy by type of incontinence ( stress , urge , mixed ) or group assignment ( treatment , control ) . CONCLUSION A low‐intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first‐line treatment for urinary incontinence in older women OBJECTIVES To evaluate in a 1 6-center , single-treatment study once-daily controlled-release oxybutynin ( Ditropan XL ) for  urinary urge incontinence .  METHODS Two hundred fifty-six participants with urge incontinence or mixed incontinence with a significant urge component were treated . After baseline measurements , participants converting from conventional oxybutynin started Ditropan XL at their previous oxybutynin dose ; others started at 5 mg/day . Doses were adjusted until participants reached a maintenance dose that produced continence or the best balance between continence and side effects . This dose was continued for 12 weeks . Effectiveness was assessed by urinary diaries . RESULTS Effectiveness was achieved across all doses studied ( 5 to 30 mg/day ) , with 70.8 % of participants using maintenance doses of 5 to 15 mg/day . Mean urge incontinence episodes per week decreased from 18.8 at baseline to 3.9 in maintenance week 1 , 2.7 in week 4 , and 2.8 at the end of the study . For those participants who reported urge incontinence episodes at baseline but were free of urge incontinence at maintenance week 1 , 31 % remained free of urge incontinence at every subsequent assessment . Participants who converted from other medications showed symptomatic improvement after conversion . At some time during the study , 58.6 % of participants reported dry mouth , with 23.0 % of participants rating it moderate or severe . Only 1.6 % of participants discontinued the medication because of dry mouth . CONCLUSIONS Ditropan XL treatment reduced the number of incontinence episodes . Maximum benefit was demonstrated by maintenance week 4 and was sustained through 12 weeks of maintenance therapy The efficacy of bladder training was evaluated in a r and omized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence . Subjects were urodynamically categorized as those with urethral sphincteric incompetence ( N = 88 ) and those with detrusor instability with or without concomitant sphincteric incompetence ( N = 35 ) . Bladder training reduced the number of incontinent episodes by 57 % ; the effect was similar for both urodynamic diagnostic groups . The quantity of fluid loss was reduced by 54 % . This was greater for patients with detrusor instability than for those without it . Diurnal and nocturnal voluntary micturitions were also reduced . The effect on nocturnal micturition , however , was not observed in subjects with unstable detrusor function . It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence . Provided prior comprehensive clinical evaluation is done , it can be prescribed without the need for urodynamic characterization PURPOSE We evaluated the efficacy and tolerability of higher dose oxybutynin chloride in patients with neurogenic bladder and multiple sclerosis , spinal cord injury or Parkinson 's disease . MATERIAL S AND METHODS The study design was a prospect i ve , 12-week dose titration trial of controlled release oxybutynin ( OXY-XL ) . A 7-day washout period was used before initiation of the starting dose of 10 mg OXY-XL . Doses of OXY-XL were increased by 5 mg at weekly intervals to a maximum dose of 30 mg per day guided by patient perception of efficacy versus side effect . Voiding diaries were completed at baseline , and weeks 6 and 12 . Post-void residuals were recorded . Criteria for study admission included post-void residual less than 200 ml . RESULTS Of the 39 patients enrolled in the study 22 had multiple sclerosis , 10 had spinal cord injury and 7 had Parkinson 's disease . There were 29 women ( 74 % ) and 10 men ( 26 % ) . Within 1 week a decrease in the number of voids per day was seen in greater than 50 % of the subjects . At the end of the study statistically significant decreases in the number of voids in 24 hours , episodes of nocturia and incontinence episodes were observed . Residual urine remained unchanged from 33.9 + /- 7.6 ml at baseline to 51.3 + /- 10.4 ml after 12 weeks at the final dose ( p = 0.17 ) . No patient experienced serious adverse events and none dropped out during the course of the 12-week study . At the end of the study 20.5 % of subjects remained on 30 mg , 15.4 % on 25 mg , 23.1 % on 20 mg , 15.4 % on 15 mg and 25.6 % on 10 mg OXY-XL . CONCLUSIONS Aggressive dosing of OXY-XL is safe and effective in patients with neurogenic bladder . Compared with nonneurogenic overactive bladder , higher doses of OXY-XL ( 15 mg daily or greater ) were requested by 74.4 % of the patients in our study . The onset of clinical efficacy can occur within 1 week , and doses up to 30 mg are well tolerated and effective in this population PURPOSE We determined the effect of caffeine restriction and fluid manipulation in the treatment of patients with urodynamic stress incontinence and detrusor overactivity . MATERIAL S AND METHODS This was a 4-week r and omized , prospect i ve , observational crossover study in 110 women with urodynamic stress incontinence ( USI ) or idiopathic detrusor overactivity ( IDO ) to determine the effect of caffeine restriction , and of increasing and decreasing fluid intake on urinary symptoms . Data were recorded in a urinary diary for the entire study period on urgency episodes , frequency , pad weight increase , wetting episodes and quality of life . RESULTS A total of 69 women with a mean age of 54.8 years completed the study , including 39 with USI and 30 with IDO . In the IDO group decreasing fluid intake significantly decreased voiding frequency , urgency and wetting episodes with improved quality of life . In the USI group there was a significant decrease in wetting episodes when fluid intake was decreased . Changing from caffeine containing to decaffeinated drinks produced no improvement in symptoms . CONCLUSIONS Conservative and life-style interventions are first line treatments in the management of incontinence and storage lower urinary tract symptoms . This study shows that a decrease in fluid intake improves some of these symptoms in patients with USI and IDO and , therefore , it should be considered when treating such patients In a multicentre placebo-controlled double-blind study 61 patients with spinal cord injuries and detrusor hyperreflexia were treated : 20 mg trospium chloride was given twice daily over a period of 3 weeks . Pre- and posttreatment urodynamic measurements demonstrated large improvements in maximum cystometric capacity ( mean = 138.1 ml ) , decreased maximum detrusor pressure ( mean = -37.8 cm H2O ) and an increase in compliance ( mean = 12.1 ml/cm H2O ) in the treatment group . Urodynamic parameters in the placebo group remained substantially unchanged . Comparisons between the two groups revealed highly significant differences for these parameters ( all , p less than 0.001 ) . No effect on maximum flow rate and residual urine was detected in either group . The incidence of spontaneously reported side-effects was extremely low and comparable for both groups PURPOSE An extended release formulation of trospium chloride was recently developed for the once daily treatment of overactive bladder . We investigated the safety , efficacy and tolerability of 60 mg trospium chloride once daily . MATERIAL S AND METHODS Subjects with overactive bladder were r and omized 1:1 to receive 60 mg trospium chloride once daily or placebo in this 12-week multicenter , parallel , double-blind , placebo controlled trial . Primary end points were calculated changes in diary recorded daily urinary frequency and daily urgency urinary incontinence episodes . Secondary end points were urgency severity , volume voided per void and the number of urgency voids per day . Safety was assessed by clinical examination , adverse event monitoring , clinical laboratory values and resting electrocardiograms . RESULTS Overall 601 subjects were prescribed  trospium once daily ( 298 ) or placebo ( 303 ) . Trospium once daily treatment result ed in significant improvements over placebo in all primary and key secondary efficacy outcomes at weeks 
    Output:
    
Based on available literature , management of OAB using a combination of behavioral therapy and drug intervention is the most efficacious in terms of patient satisfaction , perceived improvement , and reduction of bladder symptoms .
It is also the most practical and cost effective for optimal management of patients with OAB .