Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women.

BACKGROUND Urinary incontinence in women is a common problem that adversely affects quality of life. PURPOSE To synthesize evidence of management of urinary incontinence in women. DATA SOURCES MEDLINE, CINAHL, and the Cochrane Library. STUDY SELECTION 96 randomized, controlled trials (RCTs) and 3 systematic reviews published in English from 1990 through May 2007. DATA EXTRACTION Using standardized protocols, reviewers abstracted cases of continence, improvement of urinary incontinence, and prevalence of urinary incontinence to calculate risk difference. DATA SYNTHESIS Compared with regular care, pelvic floor muscle training plus bladder training resolved urinary incontinence (pooled risk difference, 0.13 [95% CI, 0.07 to 0.20]). 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 [CI, 0.13 to 0.22]). Duloxetine compared with placebo improved (pooled risk difference, 0.11 [CI, 0.07 to 0.14]) but did not resolve urinary incontinence, with no significant dose-response association. LIMITATIONS Inconsistent measurements of outcomes limited the findings. Predictors of better effect have not been identified in RCTs. CONCLUSION 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.