Behavioral vs. Drug Treatment for Urge Urinary Incontinence in Older Women. A Randomized Controlled Trial

Burgio, Kathryn L.; Locher, Julie L.; Goode, Patricia S.; Hardin, J. Michael; McDowell, B. Joan; Dombrowski, Marianne; Candib, Dorothy

doi:10.1016/s0022-5347(05)68903-3

Cited by 66 publications

(100 citation statements)

References 24 publications

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“…Regarding the urodynamic evaluation, our findings suggest that the three interventions may operate by different mechanisms, which is in agreement with previous studies [11,12,13]. Hence, these different treatment effects may result in better outcomes when used in combination.…”

Section: Discussionsupporting

confidence: 91%

“…In the oxybutynin group, the significant increase for first desire to void and in maximum cystometric capacity supports the hypothesis that these urodynamic changes might mediate clinical improvements, as reported by other authors [11,14]. However, recent studies have suggested that oxybutynin may additionally act via afferent pathways, mitigating the sensation of urgency [15].…”

Section: Discussionsupporting

confidence: 80%

“…According to Burgio et al [11,12] and Goode et al [18], improvement of bladder control with PFT does not require an increase in bladder capacity, and patients can learn to better manage the capacity they have. This is in agreement with our findings.…”

Section: Discussionmentioning

confidence: 99%

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Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women

et al. 2008

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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 randomized 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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 80%

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Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women

et al. 2008

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“…Im Vergleich ist die Verhaltenstherapie mit Toilettentraining und Beckenbodengymnastik gegenüber der alleinigen medikamentösen Therapie bei der Dranginkontinenz erfolgreicher [5]. Am erfolgreichsten erscheint aber eine Kombination aus medikamentöser Therapie mit verhaltenstherapeutischen Maßnahmen bei der Dranginkontinenz [1].…”

Section: Verhaltenstherapieunclassified

“…Das Beckenbodengymnastik wird erfolgreich bei der Stress-und Dranginkontinenz und nachfolgend bei der radialen Prostatektomie durchgeführt [2,3,5]. Da viele Frauen, und hier insbesondere die älteren, verlernt haben, Ihre Beckenbodenmuskulatur aktiv zu kontrahieren, muss die Untersuchung der Beckenbodenfunktion vor einem Beckenbodentraining obligat sein [22].Auch das Beckenbodentraining sollte anfänglich unter Anleitung und Überwachung einer ausgebildeten Physiotherapeutin durchgeführt werden.…”

Section: Verhaltenstherapieunclassified

Therapieoptionen bei Blasenfunktionsst�rungen im Alter

Füsgen

Welz-Barth

2004

Der Urologe A

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Urinary incontinence in the elderly is caused primarily by multiple factors such as physiologic changes of old age connected with multimorbidity and functional deficiencies, polypharmacology, psychosociological influences as well as conditions of the milieu. All these factors have to be carefully considered for therapy to be effective. Continence should be the goal of such therapy. Active participation in daily life can also be achieved by using auxiliary devices to improve the impaired quality of life. Temporary incontinence demands the search for its cause, while chronic incontinence calls for a differentiated form of therapy according to the kind of incontinence encountered. Conservative treatment consists of behavior therapy, such as toilet-(habit)-training and pelvic floor exercises. The use of drugs and auxiliary devices are equally important.

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Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy for Apical Vaginal Prolapse

Barber

Brubaker

Burgio

et al. 2014

JAMA

368

236

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IMPORTANCE Over 300,000 surgeries are performed annually in the United States for pelvic organ prolapse. Sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are commonly performed transvaginal surgeries to correct apical prolapse. Little is known about their comparative efficacy and safety, and it is unknown whether perioperative behavioral therapy with pelvic floor muscle training (BPMT) improves outcomes of prolapse surgery. OBJECTIVE To compare outcomes between 1) SSLF and ULS and 2) perioperative BPMT and usual perioperative care in women undergoing surgery for vaginal prolapse and stress urinary incontinence. DESIGN, SETTING AND PARTICIPANTS Multi-center, 2×2 factorial randomized trial of 374 women undergoing surgery to treat both apical vaginal prolapse and stress urinary incontinence was conducted between 2008 and 2013 at 9 U.S. medical centers. Two-year follow-up rate was 84.5%. INTERVENTIONS Surgical intervention: Transvaginal surgery including mid-urethral sling with randomization to SSLF (n = 186) or ULS (n=188); Behavioral intervention: Randomization to perioperative BPMT (n = 186) or usual care (n=188). MAIN OUTCOME MEASURES The primary outcome for the surgical intervention (surgical success) was defined as: 1) no apical descent greater than one-third into vaginal canal or anterior or posterior vaginal wall beyond the hymen (anatomic success); 2) no bothersome vaginal bulge symptoms and 3) no retreatment for prolapse at 2 years. For the behavioral intervention, primary outcome at 6 months was urinary symptom scores (Urinary Distress Inventory; range 0–300, higher scores worse), and primary outcomes at 2 years were prolapse symptom scores (Pelvic Organ Prolapse Distress Inventory; range 0–300, higher scores worse) and anatomic success. RESULTS At 2 years, surgical group was not significantly associated with surgical success rates [ULS 59.2% (93/154) vs. SSLF 60.5% (92/152), OR 0.9 (95% CI 0.6, 1.5)] or serious adverse event rates [ULS 16.5% (31/188) vs. SSLF 16.7% (31/186), OR 0.9 (95% CI 0.5, 1.6)]. BPMT was not associated with greater improvements in urinary scores at 6 months [treatment difference −6.7 (95% CI −19.7, 6.2)], prolapse scores at 24 months [treatment difference −8.0 (95% CI −22.1, 6.1)] or anatomic success at 24 months. CONCLUSIONS AND RELEVANCE Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS nor SSLF was significantly superior to the other for anatomic, functional, and or adverse event outcomes. Perioperative BPMT did not improve urinary symptoms at 6 months or prolapse outcomes at 2 years.

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Behavioral vs. Drug Treatment for Urge Urinary Incontinence in Older Women. A Randomized Controlled Trial

Cited by 66 publications

References 24 publications

Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women

Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women

Therapieoptionen bei Blasenfunktionsst�rungen im Alter

Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy for Apical Vaginal Prolapse

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