Treating urinary incontinence in the elderly-conservative measures that work: A systematic review

Objective: To evaluate the effectiveness of conservative treatment in the community-based elderly (aged ≥55 years) with stress, urge, and mixed urinary incontinence. Design: Systematic review of before-after studies or randomized controlled trials on the effect of exercise and drug therapy in urinary incontinence. Main outcomes measured: Reduction of urinary accidents, patient's perception, cystometric measurement, perineometry, and side effects. Search strategy: MEDLINE (1966-2001), EMBASE (1986-2001), Science Citation Index (1988-2001), The Cochrane Library, and PiCarta were searched. Results: Four before-after studies and 4 randomized controlled trials were identified. Drug therapy alone: no study of sufficient quality. Drug therapy compared with behavioral therapy, 3 studies: bladder-sphincter biofeedback reduced urinary accidents in cases of urge or mixed incontinence by 80.7%, significantly better than oxybutynin (68.5%) or placebo (39.4%). Adding drug to behavioral treatment or behavioral to drug treatment also resulted in significant reduction in urodynamic urge incontinence (57.5% - 88.5% vs 72.7 - 84.3%). Pelvic floor exercises alone reduced urinary accidents by 48% (compared with 53% for phenylpropanolamine) in patients with mixed or stress incontinence. Behavioral therapy, 5 studies: bladder-sphincter biofeedback in case of urge or mixed incontinence, bladder training in case of urge incontinence and pelvic floor exercises in case of stress incontinence reduced the urinary accidents with.68% to 94%. Conclusion: There are only a few studies of sufficient methodological quality on the effect of conservative treatment of urinary incontinence in the elderly. Behavioral therapy reduced urinary accidents; the effect of drug therapy is unclear. We recommend behavioral therapy as first choice.