Behavioral therapies are better than drug therapy for urinary incontinence in women

Reference

Balk EM, Rofeberg VN, Adam GP, Kimmel HJ, Trikalinos TA, Jeppson PC. Pharmacologic and nonpharmacologic treatments for urinary incontinence in women. A systematic review and network meta-analysis of clinical outcomes. Ann Intern Med 2019;170(7):465-479.

Synopsis

These researchers searched 6 databases, including the Cochrane Central Register of Controlled Trials, to identify 84 randomized and nonrandomized controlled trials that evaluated the effectiveness of pharmacologic and nonpharmacologic treatments of urge, stress, or mixed urinary incontinence in women. Two researchers independently selected articles for inclusion. They used network meta-analysis, which is a means of evaluating treatments that were not directly compared. Most studies had low or moderate risk of bias. Although it's a useful method to get an overall picture of relative benefit, a network meta-analysis is complex, paints results with a broad brush, and requires a number of assumptions that can inflate the problems always present in statistical analysis. All interventions, except hormone treatment and injections designed to provide periurethral bulking, are effective at decreasing at least some symptoms. Behavioral therapy is more effective than pharmacologic treatments for producing cure or improvement in women with stress or urge incontinence. Neuromodulation (surgical implantation of a device to produce nerve stimulation) is more effective than no treatment to produce cure, improvement, and patient satisfaction in women with stress or urge incontinence. Botulinum toxin injection is also more effective than no treatment for urge incontinence.