human
***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: Forty patients with the unstable bladder syndrome have been treated in a double-blind crossover trial of baclofen 5 mg qds versus placebo . Baclofen significantly improved diurnal and nocturnal frequency of micturition and the severity of incontinence . Considerable improvement was also obtained with placebo Introduction The aim of this study was to examine the efficacy of transcutaneous electrical tibial nerve stimulation ( TTNS ) to treat urge urinary incontinence ( UUI ) in older women . Material and methods The study design was a r and omized clinical trial conducted on 51 elderly women ( > 60 years ) with UUI . All were treated with 12 weeks of bladder retraining and pelvic floor muscle exercises , and 25 were r and omly selected to receive TTNS in addition to the st and ard therapy . The cases were evaluated at the baseline and after the end of therapy by 3-day bladder diary , quality of life question naires ( QoL ) , and subjective response . Results Of the patients , 68.0 % in TTNS group reported cure or improvement vs. 34.6 % in the control group ( P = 0.017 ) . TTNS showed significant improvement in most areas of QoL and in UUI parameters when compared with the control group . Conclusion TTNS is efficacious to treat UUI in older women AIMS To evaluate the clinical outcomes of two different doses of BTX-A in patients with I-OAB . METHODS This investigator initiated , r and omized trial was design ed to evaluate clinical differences in outcomes for 100 versus 150 U BTX-A in patients with I-OAB . Patients with OAB-Wet and OAB-Dry were r and omized to receive 100 or 150 U BTX-A intra-detrusor injection . For patients with OAB-Wet , the primary outcome of interest was change in daily UUI episodes , and for those with OAB-Dry the primary outcome measure was change in number of daily voids as determined by 3-VD . Statistical comparisons were made both pre- and post-injection and also between different treatment groups to assess the superiority of one dose versus the other . RESULTS Forty-four patients enrolled in the study ; 10 OAB-Dry and 12 OAB-Wet patients received 100 U and another 10 OAB-Dry and 12 OAB-Wet patients received 150 U. No significant differences in outcome measure were noted between those receiving 100 versus 150 U. Patients with OAB-Wet tended to be completely dry more frequently if they received the 150 U dose , but this was not statistically significant . No differences in urodynamics outcomes were noted between the groups . QOL was significantly improved in both groups with no difference between the different doses . CONCLUSIONS In patients with I-OAB , preliminary results indicate that 100 U BTX-A and 150 U BTX-A are equivalent in terms of symptom reduction and QOL improvement PURPOSE We studied the effect of surface neuromodulation on cystometric pressure and volume parameters in women with detrusor instability or sensory urgency .  Electrical current was delivered to the suprapubic region and third sacral foramina via a transcutaneous electrical nerve stimulator with sham neuromodulation control . MATERIAL S AND METHODS A consecutive series of women with proved detrusor instability or sensory urgency were r and omized to 3 surface neuromodulation groups .  Volume and pressure parameters were the main outcomes of transcutaneous electrical nerve stimulation applied during second cystometric fill . RESULTS Sham transcutaneous electrical nerve stimulation did not alter the outcome measures . However , neuromodulation delivered across the suprapubic and sacral skin effected a reduction in mean maximum height of detrusor contraction . A current which inhibits motor activity was not superior to that which inhibits sensory perception in reducing detrusor pressure . Response in sensory urgency was poor . CONCLUSIONS Results from our sham controlled study suggest that short-term surface neuromodulation via transcutaneous electrical nerve stimulation may have a role in the treatment of detrusor instability . Future studies must examine the clinical effect of long-term surface neuromodulation In a prospect i ve , r and omised , double-blind , placebo-controlled study 40 women with sensory urgency or detrusor instability r and omly received either magnesium hydroxide ( group A ) or placebo ( group B ) . Pre- and post-treatment symptoms , frequency-volume charts and cystometry results were compared . Eleven of 20 patients receiving magnesium ( 55 % ) reported a subjective improvement of their urinary symptoms , compared with five patients taking placebo ( 20 % ) . In both study groups there was no statistically significant difference in pre- and post-treatment urodynamic parameters in those reporting symptomatic improvement . Magnesium was well tolerated by patients in group A , and no side effects were reported . These results suggest that magnesium hydroxide may be beneficial for detrusor instability or sensory urgency in women AIMS To assess the hypothesis that resiniferatoxin ( RTX ) can be useful in women with urgency incontinence and idiopathic detrusor overactivity ( IDO ) , we conducted a prospect i ve , double-blind , r and omized , placebo-controlled , parallel trial comparing the effects of RTX and placebo . MATERIAL S AND METHODS Fifty-eight patients were r and omly assigned to receive a single intravesical dose of 100 ml of either RTX 50 nM or placebo .  Safety and efficacy were evaluated over 4 weeks . The primary efficacy endpoints were voiding symptoms evaluated through the voiding diary . Secondary efficacy endpoint was urodynamic response . Quality of life was measured by the Kings ' Health Question naire RESULTS Although improving trends were seen in both groups after the instillations , no statistically significant differences were found between the groups in any of the clinical or urodynamic parameters .  RTX instillations were well tolerated with few and self-limited side-effects . CONCLUSION A single 50 nM intravesical dose of RTX was not better than placebo for the treatment of women with IDO and urgency incontinence 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 The purpose of this study is to compare the effectiveness of oxybutynin , functional electrostimulation ( FES ) , and pelvic floor training ( PFT ) for treatment of women with detrusor overactivity . Sixty-four subjects were r and omized to oxybutynin ( n = 22 ) , FES ( n = 21 ) , or PFT ( n = 21 ) . Women were evaluated before and after completion of 12 weeks of treatment by subjective response , voiding diary , and urodynamic test . There was subjective symptomatic improvement in 77 % of the women treated with oxybutynin , 52 % with FES , and 76 % with PFT .  Urgency resolved in 64 % of women treated with oxybutynin , 52 % with FES , and in 57 % with PFT .  Urodynamic evaluation was normal in 36 % treated with oxybutynin , 57 % with FES , and 52 % with PFT .  Maximum detrusor involuntary contraction pressure decreased in all groups ( p < 0.05 ) . All treatments were equally effective . Subjective reduction of urge-incontinence episodes was associated with symptomatic improvement PURPOSE We evaluated the use of botulinum toxin-A in treating patients with idiopathic detrusor overactivity refractory to anticholinergics . MATERIAL S AND METHODS This double-blind , placebo controlled trial r and omized participants to intradetrusor injections of 200 U botulinum toxin-A ( 16 patients ) or placebo ( 18 patients ) . The primary outcome measure was change in maximum cystometric capacity . Secondary outcome measures included changes in overactive bladder symptoms , post-void residual , maximum detrusor pressure during filling cystometry and reflex detrusor volume . Quality of life was assessed using the Incontinence Impact Question naire short form 7 and Urogenital Distress Inventory short form 6 . Followup occurred at 4 and 12 weeks after injection , at which point the study was unblinded . Further followup in the botulinum toxin-A group occurred at 24 weeks . RESULTS Significant increases in maximum cystometric capacity were observed at 4 weeks ( difference 144.69 ml , 95 % CI 100.95 to 215.75 , p < 0.0001 ) and 12 weeks ( difference 95.71 ml , 95 % CI 47.47 to 172.45 , p = 0.001 ) in patients treated with botulinum toxin-A compared to placebo . Botulinum toxin-A reduced frequency ( p < 0.001 , p = 0.003 ) and urgency urinary incontinence ( p = 0.03 , p = 0.008 ) episodes at 4 and 12 weeks , respectively . Urgency was reduced at 4 weeks ( p = 0.005 ) in the botulinum toxin-A group . In patients receiving botulinum toxin-A , post-void residual increased at 4 weeks ( p = 0.024 ) but became insignificant by 12 weeks ( p = 0.406 ) . Of these patients 6 required intermittent self-catheterization . Significant improvements in quality of life were observed following botulinum toxin-A. The extension study suggests that the beneficial effects of botulinum toxin-A are maintained for at least 24 weeks . CONCLUSIONS Botulinum toxin-A at 200 U is safe and effective for idiopathic detrusor overactivity and the beneficial effects persist for at least 24 weeks 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 
    Output:
    
agent
Pelvic floor exercises are more effective in subjective and objective outcomes with biofeedback or verbal feedback .
Weight loss with diet and exercise , caffeine reduction , 25 - 50 % reduction in fluid intake , and pelvic floor muscle exercises with verbal instruction and or biofeedback were all efficacious .
Botulinum toxin A improves urge incontinence episodes , urgency , frequency , quality of life , nocturia , and urodynamic testing parameters .
Acupuncture  improves quality of life and urodynamic testing parameters .
Extracorporeal magnetic stimulation improves urodynamic parameters .
Mirabegron improves daily incontinence episodes , nocturia , number of daily voids , and urine volume per void , whereas solabegron improves daily incontinence episodes .
Short-term posterior tibial nerve stimulation is more efficacious than pelvic floor muscle training exercises and behavioral therapy for improving : urgency , urinary incontinence episodes , daily voids , volume per void , and overall quality of life .
Sacral neuromodulation is more efficacious than antimuscarinic treatment for subjective improvement of overactive bladder and quality of life .
Transvaginal electrical stimulation demonstrates subjective improvement in overactive bladder symptoms and urodynamic parameters .
Multiple therapies , including physical therapy , behavioral therapy , botulinum toxin A , acupuncture , magnetic stimulation , mirabegron , posterior tibial nerve stimulation , sacral neuromodulation , and transvaginal electrical stimulation , are efficacious in the treatment of overactive bladder
***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: Forty patients with the unstable bladder syndrome have been treated in a double-blind crossover trial of baclofen 5 mg qds versus placebo . Baclofen significantly improved diurnal and nocturnal frequency of micturition and the severity of incontinence . Considerable improvement was also obtained with placebo Introduction The aim of this study was to examine the efficacy of transcutaneous electrical tibial nerve stimulation ( TTNS ) to treat urge urinary incontinence ( UUI ) in older women . Material and methods The study design was a r and omized clinical trial conducted on 51 elderly women ( > 60 years ) with UUI . All were treated with 12 weeks of bladder retraining and pelvic floor muscle exercises , and 25 were r and omly selected to receive TTNS in addition to the st and ard therapy . The cases were evaluated at the baseline and after the end of therapy by 3-day bladder diary , quality of life question naires ( QoL ) , and subjective response . Results Of the patients , 68.0 % in TTNS group reported cure or improvement vs. 34.6 % in the control group ( P = 0.017 ) . TTNS showed significant improvement in most areas of QoL and in UUI parameters when compared with the control group . Conclusion TTNS is efficacious to treat UUI in older women AIMS To evaluate the clinical outcomes of two different doses of BTX-A in patients with I-OAB . METHODS This investigator initiated , r and omized trial was design ed to evaluate clinical differences in outcomes for 100 versus 150 U BTX-A in patients with I-OAB . Patients with OAB-Wet and OAB-Dry were r and omized to receive 100 or 150 U BTX-A intra-detrusor injection . For patients with OAB-Wet , the primary outcome of interest was change in daily UUI episodes , and for those with OAB-Dry the primary outcome measure was change in number of daily voids as determined by 3-VD . Statistical comparisons were made both pre- and post-injection and also between different treatment groups to assess the superiority of one dose versus the other . RESULTS Forty-four patients enrolled in the study ; 10 OAB-Dry and 12 OAB-Wet patients received 100 U and another 10 OAB-Dry and 12 OAB-Wet patients received 150 U. No significant differences in outcome measure were noted between those receiving 100 versus 150 U. Patients with OAB-Wet tended to be completely dry more frequently if they received the 150 U dose , but this was not statistically significant . No differences in urodynamics outcomes were noted between the groups . QOL was significantly improved in both groups with no difference between the different doses . CONCLUSIONS In patients with I-OAB , preliminary results indicate that 100 U BTX-A and 150 U BTX-A are equivalent in terms of symptom reduction and QOL improvement PURPOSE We studied the effect of surface neuromodulation on cystometric pressure and volume parameters in women with detrusor instability or sensory urgency .  Electrical current was delivered to the suprapubic region and third sacral foramina via a transcutaneous electrical nerve stimulator with sham neuromodulation control . MATERIAL S AND METHODS A consecutive series of women with proved detrusor instability or sensory urgency were r and omized to 3 surface neuromodulation groups .  Volume and pressure parameters were the main outcomes of transcutaneous electrical nerve stimulation applied during second cystometric fill . RESULTS Sham transcutaneous electrical nerve stimulation did not alter the outcome measures . However , neuromodulation delivered across the suprapubic and sacral skin effected a reduction in mean maximum height of detrusor contraction . A current which inhibits motor activity was not superior to that which inhibits sensory perception in reducing detrusor pressure . Response in sensory urgency was poor . CONCLUSIONS Results from our sham controlled study suggest that short-term surface neuromodulation via transcutaneous electrical nerve stimulation may have a role in the treatment of detrusor instability . Future studies must examine the clinical effect of long-term surface neuromodulation In a prospect i ve , r and omised , double-blind , placebo-controlled study 40 women with sensory urgency or detrusor instability r and omly received either magnesium hydroxide ( group A ) or placebo ( group B ) . Pre- and post-treatment symptoms , frequency-volume charts and cystometry results were compared . Eleven of 20 patients receiving magnesium ( 55 % ) reported a subjective improvement of their urinary symptoms , compared with five patients taking placebo ( 20 % ) . In both study groups there was no statistically significant difference in pre- and post-treatment urodynamic parameters in those reporting symptomatic improvement . Magnesium was well tolerated by patients in group A , and no side effects were reported . These results suggest that magnesium hydroxide may be beneficial for detrusor instability or sensory urgency in women AIMS To assess the hypothesis that resiniferatoxin ( RTX ) can be useful in women with urgency incontinence and idiopathic detrusor overactivity ( IDO ) , we conducted a prospect i ve , double-blind , r and omized , placebo-controlled , parallel trial comparing the effects of RTX and placebo . MATERIAL S AND METHODS Fifty-eight patients were r and omly assigned to receive a single intravesical dose of 100 ml of either RTX 50 nM or placebo .  Safety and efficacy were evaluated over 4 weeks . The primary efficacy endpoints were voiding symptoms evaluated through the voiding diary . Secondary efficacy endpoint was urodynamic response . Quality of life was measured by the Kings ' Health Question naire RESULTS Although improving trends were seen in both groups after the instillations , no statistically significant differences were found between the groups in any of the clinical or urodynamic parameters .  RTX instillations were well tolerated with few and self-limited side-effects . CONCLUSION A single 50 nM intravesical dose of RTX was not better than placebo for the treatment of women with IDO and urgency incontinence 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 The purpose of this study is to compare the effectiveness of oxybutynin , functional electrostimulation ( FES ) , and pelvic floor training ( PFT ) for treatment of women with detrusor overactivity . Sixty-four subjects were r and omized to oxybutynin ( n = 22 ) , FES ( n = 21 ) , or PFT ( n = 21 ) . Women were evaluated before and after completion of 12 weeks of treatment by subjective response , voiding diary , and urodynamic test . There was subjective symptomatic improvement in 77 % of the women treated with oxybutynin , 52 % with FES , and 76 % with PFT .  Urgency resolved in 64 % of women treated with oxybutynin , 52 % with FES , and in 57 % with PFT .  Urodynamic evaluation was normal in 36 % treated with oxybutynin , 57 % with FES , and 52 % with PFT .  Maximum detrusor involuntary contraction pressure decreased in all groups ( p < 0.05 ) . All treatments were equally effective . Subjective reduction of urge-incontinence episodes was associated with symptomatic improvement PURPOSE We evaluated the use of botulinum toxin-A in treating patients with idiopathic detrusor overactivity refractory to anticholinergics . MATERIAL S AND METHODS This double-blind , placebo controlled trial r and omized participants to intradetrusor injections of 200 U botulinum toxin-A ( 16 patients ) or placebo ( 18 patients ) . The primary outcome measure was change in maximum cystometric capacity . Secondary outcome measures included changes in overactive bladder symptoms , post-void residual , maximum detrusor pressure during filling cystometry and reflex detrusor volume . Quality of life was assessed using the Incontinence Impact Question naire short form 7 and Urogenital Distress Inventory short form 6 . Followup occurred at 4 and 12 weeks after injection , at which point the study was unblinded . Further followup in the botulinum toxin-A group occurred at 24 weeks . RESULTS Significant increases in maximum cystometric capacity were observed at 4 weeks ( difference 144.69 ml , 95 % CI 100.95 to 215.75 , p < 0.0001 ) and 12 weeks ( difference 95.71 ml , 95 % CI 47.47 to 172.45 , p = 0.001 ) in patients treated with botulinum toxin-A compared to placebo . Botulinum toxin-A reduced frequency ( p < 0.001 , p = 0.003 ) and urgency urinary incontinence ( p = 0.03 , p = 0.008 ) episodes at 4 and 12 weeks , respectively . Urgency was reduced at 4 weeks ( p = 0.005 ) in the botulinum toxin-A group . In patients receiving botulinum toxin-A , post-void residual increased at 4 weeks ( p = 0.024 ) but became insignificant by 12 weeks ( p = 0.406 ) . Of these patients 6 required intermittent self-catheterization . Significant improvements in quality of life were observed following botulinum toxin-A. The extension study suggests that the beneficial effects of botulinum toxin-A are maintained for at least 24 weeks . CONCLUSIONS Botulinum toxin-A at 200 U is safe and effective for idiopathic detrusor overactivity and the beneficial effects persist for at least 24 weeks 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 
    Output:
    