Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

Balk, Ethan M; Adam, Gaelen P; Kimmel, Hannah J.; Rofeberg, Valerie; Saeed, Iman; Jeppson, Peter C.; Trikalinos, Thomas A

doi:10.23970/ahrqepccer212

Cited by 24 publications

(29 citation statements)

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“…& SUI, UUI, and MUI can be discussed and treated with telemedicine (EC). & Behavioral therapy including bladder training, pelvic floor physical therapy or Kegel exercises, weight loss, and yoga have demonstrated significant improvement and/or complete resolution of SUI and UUI symptoms [125].…”

Section: Urinary Incontinencementioning

confidence: 98%

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

et al. 2020

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Introduction and hypothesis The COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission.Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.

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Section: Urinary Incontinencementioning

confidence: 98%

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

et al. 2020

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“…Studies have reported that behavioral therapy generally resulted in better OAB outcomes (cure, improvement, and satisfaction) than medications. [29][30][31] In a large randomized controlled trial study using both generic (EQ-5D-5L) and OAB-specific (OAB-5D) preferencebased measured health status measures, OAB treatment was shown to be effective in improvement in the outcomes of OAB-specific measures compared with generic measures. 24 In our study, we also assessed if treatment for OAB was associated with specific attributes.…”

Section: F I G U R Ementioning

confidence: 99%

Patient preference elicitation instrument, OABCare, to facilitate shared decision‐making in the care of overactive bladder

Chhatre

Newman

Wein

et al. 2021

Neurourology and Urodynamics

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Aims: To describe the development and feasibility of a preference elicitation instrument, OABCare, using choice-based adaptive conjoint analysis (ACA) among patients with overactive bladder (OAB). Methods: This was a two-phase study. In Phase 1, an extensive literature review along with patient and provider focus groups yielded the attributes and levels for our OABCare instrument. The hierarchical Bayesian random-effects model generated utilities and mean relative importance scores of treatment attributes. Phase 2 consisted of a cohort study to assess the association between OAB treatment uptake and treatment attributes elicited from OABCare, using generalized linear models. Results: Literature review and provider and patient focus groups in Phase 1 yielded themes related to OAB management that were used to develop 11 attributes for the ACA instrument. For Phase 2 of the study, 108 patients were recruited who completed the OABCare instrument. Results showed that the top five attributes with the highest mean utility values were caregiver burden, impaired bladder function, social interaction constraints, treatment side effects, and use of pads. In addition, impaired bladder function (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.1, 2.1), disturbed sleep (OR = 1.24, 95% CI = 1.04, 1.47), social interaction constraints (OR = 1.12, 95% CI = 1.05, 1.32), and out-of-pocket costs (OR = 0.79, 95 % CI = 0.61, 0.94) were associated with OAB treatment uptake. Conclusions: Our ACA-based instrument, OABCare, is a feasible and acceptable tool for assessing preferences in OAB patients. Preference assessment can facilitate shared decision-making and may enhance the quality of OAB care. Future work will evaluate the OABCare instrument in different subgroups based on sociodemographic, clinical, and treatment characteristics, and its integration into clinical care settings.

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“…AHRQ and PCORI program officers provided comments on draft versions of the protocol and full evidence report. 7 PCORI and AHRQ did not directly participate in the literature search; determination of study eligibility criteria; data analysis or interpretation; or preparation, review, or approval of the manuscript for publication.…”

Section: Role Of the Funding Sourcementioning

confidence: 99%

“…2 We conducted a broad systematic review of the clinical effects and harms of all nonsurgical treatments for typical stress, urgency, and mixed UI in nonpregnant women. 7 Here we summarize findings regarding AEs. We have separately summarized comparative effectiveness for cure and improvement.…”

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confidence: 99%

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Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review

et al. 2019

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The Brown Evidence-based Practice Center (EPC) conducted this review based on a systematic review of the scientific literature, using established methodologies. 8 The PROSPERO registration number is CRD42017069903. The literature search and screening methodology, overall eligibility criteria, strength of evidence, and interpretation of findings are Electronic supplementary material The online version of this article (

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Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

Cited by 24 publications

References 0 publications

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

Patient preference elicitation instrument, OABCare, to facilitate shared decision‐making in the care of overactive bladder

Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review

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