Overactive bladder (OAB) is a chronic condition, and its incidence increases with age. Anticholinergics and β3 agonists are often used and efficacious for OAB. Although withdrawal of OAB medications can lead to relapse or worsening of symptoms, some patients do not experience relapse of symptoms after withdrawal. Thus, this prospective study on resuming medications for OAB after discontinuation aimed to search for factors influencing maintenance of improvement.

Patients whose OAB symptoms were completely improved by anticholinergic or β3 agonist monotherapy were included. Patients with neurogenic OAB were excluded. OAB was diagnosed using the OAB symptoms score (OABSS). OAB was defined as an OABSS-Q3 (urgency) score of ≥2 and a total OABSS of ≥3, and vice versa, to indicate that OAB was improved. Patients were evaluated using the OABSS at 1, 3, 6, 12, 18, and 24 months after the discontinuation of OAB medications, and OAB medication therapy resumed in patients with worsening symptoms.

A total of 76 patients (male, n = 35; female, n = 41) were included. No differences in age and body mass index were found between men and women. Heart disease and diabetes were more common in men, whereas it was hypertension and dyslipidemia in women. All male patients were taking some type of benign prostatic hyperplasia (BPH) medication in addition to OAB medications. The discontinued medications included β3 agonists in 65% of patients and anticholinergics in 35% of patients. The duration before discontinuation was 15 months (range, 7–36) in men, and 14 months (range, 10–34) in women. The Kaplan–Meier curve showed a median time to OAB relapse of 6 (95% confidence interval [CI], 3–12) months after discontinuation and a median time to resuming medications of 12 (95% CI, 3-NA) months. In the analysis using the receiver operating characteristic, the OABSS for resuming OAB medications was 5 points. In the Cox proportional hazards model, the sex is the factor that affects the time to resume medications (HR 0.43, 95% CI 0.21–0.87, p = 0.02). The Kaplan–Meier curve showed a longer median time to resuming medications in male than female (p=0.131, Figure).

In previous studies on resumption of anticholinergics after discontinuation, female and the elderly were more likely to relapse. This is the first study of relapse after discontinuation of OAB medications, including β3 agonist. As in previous reports, OAB symptoms were more likely to recur in female. In male patients, long-term combined treatment of BPH may have had a positive effect on sustained improvement in OAB, even when OAB medications were discontinued. When OAB symptoms are completely controlled, discontinuation of OAB medications may be considered, especially with a view to avoiding polypharmacy.

If the OAB symptoms are adequately controlled with OAB medications, OAB medications can be discontinued without symptom recurrence, particularly in men.