Table 26.6

Table 26.6—Efficacy of Behavioral and Pharmacologic Treatments for Stress and for Mixed Urge and Stress Incontinence

Treatment	Target Population	Efficacy	Evidence*
Behavioral
PME	Women	56%–95% decrease in episodes	A
PME and biofeedback	Women Men, postprostatectomy	50%–87% improvement RR for continued UI vs no treatment 0.74 [0.6 to 0.93]	A A–C
PME and vaginal cones	Women	No data in postmenopausal women	—
Electrical stimulation	Women, stress ± urge UI	No marginal benefit over behavioral therapy alone	A
Bladder retraining	Mixed UI, cognitively intact	≥ 50% decrease in episodes in 75% of patients	A
Prompted voiding	Mixed UI, dependent, cognitively impaired	Average reduction 0.8–1.8 episodes daily	A
Habit training	Mixed UI, voiding record available	≥ 25% decrease in episodes in one third of patients	B
Scheduled toileting	Mixed UI, unable to toilet independently	30%–80% decrease in episodes	C
Pharmacologic
Duloxetine^OL	Women	All UI episodes reduced 64% versus 41% with placebo	A
Estrogens	Women	Oral ineffective, especially when combined with a progestin; scant data on topical forms	A–B

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

NOTE: PME = pelvic muscle exercises; UI = urinary incontinence.

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); Goode PS, Burgio KL, Locher JL, et al. Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women. JAMA. 2003;290:345–352.