Table 26.5

Table 26.5—Efficacy of Behavioral and Pharmacologic Treatments for Urge Incontinence

Treatment	Target Population	Efficacy	Evidence*
Behavioral
Bladder training	Cognitively intact	≥ 35% decrease in UI episodes over controls; patient’s perception of cure at 6 months RR 1.69 [1.21 to 2.34]	A
Prompted voiding	Dependent, cognitively impaired	Average reduction 0.8–1.8 episodes daily; cure rare	A
Habit training	Able to complete voiding record	≥ 25% decrease in episodes in one third of patients	B
Scheduled toileting	Unable to toilet independently	30%–80% decrease in episodes, study quality fair	C
Pelvic muscle exercises	Women	Up to 80% decrease in episodes; motivated patients	A
Pharmacologic
All antimuscarinics	Unresponsive to behavioral treatment alone	WMD in daily UI episodes 0.6 (95% CI, 0.4 to 0.8); RR dry mouth 2.56 (95% CI, 2.24 to 2.92)	A
Darifenacin	Unresponsive to behavioral treatment alone	7.5 or 15 mg daily: 68% and 73% respectively, median reduction in weekly UI episodes (vs 56% with placebo), dry mouth 19% and 31% respectively, constipation 14% (both doses)
Oxybutynin	Unresponsive to behavioral treatment alone	ER: 71% mean reduction weekly UI episodes, cure rate 23%, dry mouth 30%	A
Solifenacin	Unresponsive to behavioral treatment alone	5 or 10 mg daily: 61% and 52% respectively, mean reduction daily UI episodes (vs 28% with placebo), dry mouth 8% and 23% respectively, constipation 4% and 9% respectively
Tolterodine	Unresponsive to behavioral treatment alone	ER: 69% mean reduction weekly UI episodes, cure rate 17%, dry mouth 22%	A
Trospium	Unresponsive to behavioral treatment alone	20 mg bid: 59% mean reduction daily urge UI episodes (vs 44% with placebo), cure rate 21%, dry mouth 22%, constipation 10%

* Evidence strength: A = randomized controlled studies; B = case-control studies; C = case descriptions or expert opinion.

NOTE: CI = confidence interval; ER = extended release; RR = relative risk; UI = urinary incontinence; WMD = weighted mean difference.

SOURCES: Data from Fantl JA, Newman DK, Colling J, et al. Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline No. 2, 1996 Update. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; March 1996. AHCPR Pub. No. 96-0682; Abrams P, Cardozo L, Khoury S, et al., eds. 2nd International Consultation on Incontinence. Plymouth, UK: Health Publication Ltd; 2002; Cochrane Library (accessed July 2003); Diokno A, Appell RA, Sand PK, et al. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trail. Mayo Clin Proc. 2003;78:687–695; Zinner N, Gittelman M, Harris R, et al. Trospium chloride improves overactive bladder symptoms: a multicenter phase III trial. J Urol. 2004;171:2311–2315; Cardoza L, Lisec M, Millard R, et al. Randomized, double-blind placebo controlled trial of the once daily antimuscarinic agent solifenacin succinate in patients with overactive bladder. J Urol. 2004;172:1919–1924; Haab F, Stewart L, Dwyer P. Darifenacin, an M3 selective receptor antagonist, is an effective and well-tolerated once-daily treatment for overactive bladder. Eur Urol. 2004;45:420–429.