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Benefits and Harms of Pharmacologic Treatment for Urinary Incontinence in Women: A Systematic Review

Tatyana Shamliyan, MD, MS; Jean F. Wyman, PhD; Rema Ramakrishnan, MPH; François Sainfort, PhD; and Robert L. Kane, MD
[+] Article and Author Information

From the University of Minnesota School of Public Health, Minnesota Evidence-Based Practice Center, and University of Minnesota School of Nursing, Minneapolis, Minnesota.

Acknowledgment: The authors thank Dr. Thomas Trikalinos and Dr. Gerta Rücker for their statistical help in arcsine transformation of the data. They also thank the following individuals for their contributions to this project: Judy Stanke, MA, and Delbert Reed, PhD, for their contributions to the literature search; Shiyi Wang, MD, for his assistance with the literature search and data abstraction; Jeannine Ouellette for her help in writing the manuscript; Marilyn Eells for editing and formatting the report; and Nancy Russell, MLS, Yaminah Oliver, Christa Prodzinski, Michele Rockne, and Kirsten Johnson for assistance with data entry, quality control, and formatting tables.

Grant Support: This study is derived in part from work done for an evidence report commissioned by the Agency for Healthcare Research and Quality (contract 290-2007-10064-I).

Potential Conflicts of Interest: Drs. Wyman, Sainfort, and Kane: Grant: Agency for Healthcare Research and Quality. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1480.

Requests for Single Reprints: Tatyana Shamliyan, MD, MS, University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware Street SE, Minneapolis, MN 55455; e-mail, shaml005@umn.edu.

Current Author Addresses: Dr. Shamliyan: University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware Street SE, Minneapolis, MN 55455.

Dr. Wyman: University of Minnesota School of Nursing, 5-140 Weaver Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455.

Ms. Ramakrishnan: University of Minnesota School of Public Health, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455.

Dr. Sainfort: University of Minnesota School of Public Health, D376 Mayo (MMC 729), 420 Delaware Street SE, Minneapolis, MN 55455.

Dr. Kane: University of Minnesota School of Public Health, D351 Mayo (MMC 729), 420 Delaware Street SE, Minneapolis, MN 55455.

Author Contributions: Conception and design: T. Shamliyan, J.F. Wyman, F. Sainfort, R.L. Kane.

Analysis and interpretation of the data: T. Shamliyan, J.F. Wyman, R. Ramakrishnan, F. Sainfort, R.L. Kane.

Drafting of the article: T. Shamliyan, J.F. Wyman, F. Sainfort.

Critical revision of the article for important intellectual content: T. Shamliyan, J.F. Wyman, F. Sainfort, R.L. Kane.

Final approval of the article: T. Shamliyan, J.F. Wyman, R. Ramakrishnan, F. Sainfort, R.L. Kane.

Statistical expertise: T. Shamliyan, F. Sainfort.

Obtaining of funding: T. Shamliyan, R.L. Kane.

Administrative, technical, or logistic support: T. Shamliyan, F. Sainfort, R.L. Kane.

Collection and assembly of data: R. Ramakrishnan, F. Sainfort.


Ann Intern Med. 2012;156(12):861-874. doi:10.7326/0003-4819-156-12-201206190-00436
Text Size: A A A

Background: Urinary incontinence (UI) in women adversely affects quality of life.

Purpose: To conduct a systematic literature review of drugs for urgency UI in women.

Data Sources: MEDLINE, the Cochrane Central Register of Controlled Trials, SCIRUS, and Google Scholar were searched for articles published from 1966 to November 2011.

Study Selection: Randomized, controlled trials (RCTs) reported in English.

Data Extraction: Rates of outcomes and risk of bias were extracted by using a standardized form to pool absolute risk differences and calculate the number of attributable events per 1000 patients treated, with 95% CIs.

Data Synthesis: 94 RCTs were eligible. Pooled analyses showed that among drugs for urgency UI, per 1000 treated women, continence was restored in 130 with fesoterodine (CI, 58 to 202), 85 with tolterodine (CI, 40 to 129), 114 with oxybutynin (CI, 64 to 163), 107 with solifenacin (CI, 58 to 156), and 114 with trospium (CI, 83 to 144). Rates of treatment discontinuation due to adverse effects were 31 per 1000 treated with fesoterodine (CI, 10 to 56), 63 with oxybutynin (CI, 12 to 127), 18 with trospium (CI, 4 to 33), and 13 with solifenacin (CI, 1 to 26). The studies' inconsistent definitions of reduction in UI and quality of life hampered synthesis of evidence.

Limitation: Evidence for quality-of-life improvements and comparative effectiveness with drugs was limited, and evidence for the effects of race, baseline severity of UI, and comorbid conditions on treatment success was insufficient.

Conclusion: Overall, drugs for urgency UI showed similar small benefit. Therapeutic choices should consider the harms profile. Evidence for long-term adherence and safety of treatments is lacking.

Primary Funding Source: Agency for Healthcare Research and Quality.

Figures

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Appendix Figure 1.

Analytic framework.

BT = bladder training; PFMT = pelvic floor muscle training; UI = urinary incontinence.

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Appendix Figure 2.

Summary of evidence search and selection.

CSA = bibliographical database, formerly Cambridge Scientific Abstracts; RCT = randomized, controlled trail; SIP = Scientific Information Package; SRC = Scientific Resource Center; UI = urinary incontinence.

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Appendix Figure 3.

Risk of bias criteria in randomized, controlled trials.

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Figure 1.

Continence with drugs for urgency urinary incontinence (pooled with random effects from randomized, controlled trials).

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Figure 2.

Treatment discontinuation due to adverse effects from drugs for urgency urinary incontinence (pooled results from randomized, controlled trials by using rate arcsine transformation).

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