Urinary incontinence in women is a common problem. These US authors conducted a systematic review of randomized controlled trials addressing nonsurgical treatment for this condition. They identified 96 randomized, controlled trials (RCTs) and 3 systematic reviews published in English from 1990 through May 2007. They extracted data using standardized protocols.
They found: “Compared with regular care, pelvic floor muscle training plus bladder training resolved urinary incontinence (pooled risk difference, 0.13). Pelvic floor muscle training alone resolved or improved urinary incontinence compared with regular care, although the effect size was inconsistent across studies. Different injectable bulking agents and medical devices were associated with similar continence and improvement rates. Electrical stimulation failed to resolve urinary incontinence. Oral hormone administration increased rates of urinary incontinence compared with placebo in most RCTs (1243 women). Transdermal or vaginal estrogen resulted in inconsistent improvement of urinary incontinence. Adrenergic drugs did not resolve or improve urinary incontinence. Oxybutynin or tolterodine resolved urinary incontinence compared with placebo (pooled risk difference, 0.18). Duloxetine compared with placebo improved (pooled risk difference, 0.11) but did not resolve urinary incontinence, with no significant dose-response association.”
The authors concluded:”Moderate levels of evidence suggest that pelvic floor muscle training and bladder training resolved urinary incontinence in women. Anticholinergic drugs resolved urinary incontinence, with similar effects from oxybutynin or tolterodine. Duloxetine improved but did not resolve urinary incontinence. The effects of electrostimulation, medical devices, injectable bulking agents, and local estrogen therapy were inconsistent.”
A helpful summary.
Ann Intern Med 2008;148(6), 18 March 2008. © 2008 American College of Physicians.
Systematic Review: Randomized, Controlled Trials of Nonsurgical Treatments for Urinary Incontinence in Women, Tatyana A. Shamliyan, Robert L. Kane, Jean Wyman, and Timothy J. Wilt. Correspondence to Dr. Kane: kanex001@umn.edu
Category U. Urinary. Keywords: urinary incontinence, therapy, women, pelvic floor muscle training, bladder training, drugs therapy, systematic review of randomized controlled trials
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 27 February 2008
