Brain-Centered Therapy Versus Medication for Urgency Urinary Incontinence : Hypnotherapy Or Pharmacotherapy

Not Applicable

Completed

Conditions: Urinary Incontinence, Urge

Interventions: Drug: Anticholinergic medications
Behavioral: Hypnotherapy

Registration Number: NCT01829425

Lead Sponsor: University of New Mexico

Brief Summary: This study is randomized controlled trial in which urgency incontinent women (approximately 150-160) will be randomized to hypnotherapy or pharmacotherapy and evaluated at months 2, 6 \&12 Hypotheses: Among patients with urgency urinary incontinence (UUI), hypnotherapy will be non-inferior pharmacotherapy in diminishing UUI episodes. Hypnotherapy may be superior or may not differ from pharmacotherapy in diminishing symptoms or quality of life based on validated questionnaires and/or other diary parameters.

Detailed Description: Study Objectives Primary: To compare change in Urgency Urinary Incontinence (UUI) episodes at 2 month follow-up on voiding diaries between hypnotherapy and pharmacotherapy groups (to determine whether hypnotherapy is at least as effective and durable in treating UUI as pharmacotherapy)

Secondary Analyses:

* To determine whether hypnotherapy is at least as effective in treating UUI as pharmacotherapy comparing change in UUI episodes on voiding diary at 6 and 12 month follow-up

* To determine whether hypnotherapy differs from pharmacotherapy in treating UUI comparing change in questionnaire results and urinary frequency

* enrolled following administration of the Overactive Bladder (OAB) Awareness tool. Participants will keep voiding diaries then be randomized to either pharmacotherapy and conventional behavioral therapy or hypnotherapy and conventional behavioral therapy. Approximately 150-160 women will be randomized.

Randomization will occur using a computer-generated randomization scheme in varying permuted block sizes. Study personnel performing data entry will be masked to participants' treatment. Masking participants to treatment is not feasible. Participants will be followed at 2,6 \& 12 months. Measurements will be performed before treatment, following completion of treatment visits (approximately 8 weeks), and at 6 and 12 months. Primary analysis will be intention to treat. Exploratory analyses of secondary outcomes will also be performed.

Study Visits: UUI participant screening: Study information given. Screening questionnaire given. Visit 1 Enrollment: Formal screening for eligibility, voiding diary reviewed, if eligible, written consent obtained with administration of study questionnaires, demographic and past medical history administration forms, Pelvic Organ Prolapse Quantitation (POP-Q) exam \& hypnotic susceptibility testing scheduled. Pariticipants undergo hypnotic susceptibility testing prior to randomization. Participants randomized to treatment and contacted, treatments arranged. Hypnotherapy group: undergo weekly treatments over 8 weeks. Pharmacotherapy group: weekly counseling sessions over 8 week: Following hypnotherapy or medication counseling completion, f/u voiding diaries collected \& study questionnaires administered. One of two long acting anti-cholinergic medications offered (Long acting Tolterodine or Extended Release Oxybutynin or equivalent generic substitutes).

6 \& 12 month follow-up: Pharmacotherapy subjects receive medications for 1 year and Hypnotherapy subjects encouraged to continue self-hypnosis for 1 year with assistance of audio-recordings, with 1 optional hypnotherapy session between 6-12 months..

Participants informed pharmacotherapy \& hypnotherapy sessions are audio-recorded and reviewed ensuring manual of procedures are followed.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 165

Inclusion Criteria

(For randomized trial)

Non-pregnant English-speaking women
18 yo or older
Overactive Bladder (OAB) Awareness scores ≥ 8
3 UUI episodes/week for ≥ 3 months

Exclusion Criteria

(For Randomized trial)

Women with a history of neurologic diseases such as Multiple Sclerosis, Parkinson's disease, stroke, or dementia
History of schizophrenia or untreated bipolar disorder or current drug or alcohol dependence
Women who have taken anticholinergic medications for UUI within the last 3 weeks (women who have taken anti-cholinergics for UUI but discontinued them > than 3 weeks ago may participate in the study) or have a sacral neuromodulator in place to treat UUI or have received Onabotulinum toxin A in the last 12 months to treat UUI
Contraindications to anticholinergic medications (untreated narrow angle glaucoma, significant urinary retention or gastric retention)
Pregnant women or lactating women, women who plan to become pregnant in the next year, or pre-menopausal women unwilling to use contraception if engaging in sexual relations during the year of study participation (hysterectomy is considered to be a form of contraception)
Untreated urinary tract infection
Prolapse which extends past the hymen (POP-Q points of ≥ 1+) which may be responsible for UUI symptoms
Women who cannot keep the majority of the study therapy appointments or those without reliable contact phone numbers or methods of communication with the study personnel.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Anticholinergic medications	Anticholinergic medications	Either of two standard, long acting anti-cholinergic medications (Long acting Tolterodine or Extended Release Oxybutynin)will be given. Subjects receive 8 weeks of medication counseling in conjunction with the medications. Medications will be continued for 1 year.
Hypnotherapy	Hypnotherapy	Subjects will receive approximately weekly hypnotherapy sessions over 8 weeks and will receive/download digital recordings for home practice. Subjects will be encouraged to practice self-hypnosis +/or listen to their recordings for 1 year.

Primary Outcome Measures

Name	Time	Method
Percent Change in Urgency Urinary Incontinence Episodes	Baseline and 2 month follow-up	Percent change in UUI episodes from baseline to 2 months with comparison made between hypnotherapy \& pharmacotherapy

Secondary Outcome Measures

Name	Time	Method
Percent Change in Urgency Urinary Incontinence Episodes	12 months	Percent change in median UUI episodes from baseline to 12 months with comparison made between hypnotherapy \& pharmacotherapy
Overactive Bladder Questionnaire Short Form Quality of Life	12 months	Overactive Bladder questionnaire-Short Form Quality of Life. Higher scores are better (higher quality of life) and lower scores are worse (poorer quality of life). score range 0-100.
Overactive Bladder Questionnaire Short Form Symptom Bother	12 months	Overactive Bladder Questionnaire Short Form symptom bother. Sub-scale range 0-100. Higher numbers are worse (more bother) and lower numbers are better (less bother)
Voids on Bladder Diary	12 months	number of voids on 3-day bladder diary