Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review.
BACKGROUND
Urinary incontinence (UI) in women adversely affects quality of life.


OBJECTIVE
To conduct a systematic literature review of drugs for urgency UI in women.


METHODS
MEDLINE, the Cochrane Central Register of Controlled Trials, SCIRUS, and Google Scholar were searched for articles published from 1966 to November 2011.


METHODS
Randomized, controlled trials (RCTs) reported in English.


METHODS
Rates of outcomes and risk of bias were extracted by using a standardized form to pool absolute risk differences and calculate the number of attributable events per 1000 patients treated, with 95% CIs.


RESULTS
94 RCTs were eligible. Pooled analyses showed that among drugs for urgency UI, per 1000 treated women, continence was restored in 130 with fesoterodine (CI, 58 to 202), 85 with tolterodine (CI, 40 to 129), 114 with oxybutynin (CI, 64 to 163), 107 with solifenacin (CI, 58 to 156), and 114 with trospium (CI, 83 to 144). Rates of treatment discontinuation due to adverse effects were 31 per 1000 treated with fesoterodine (CI, 10 to 56), 63 with oxybutynin (CI, 12 to 127), 18 with trospium (CI, 4 to 33), and 13 with solifenacin (CI, 1 to 26). The studies' inconsistent definitions of reduction in UI and quality of life hampered synthesis of evidence.


CONCLUSIONS
Evidence for quality-of-life improvements and comparative effectiveness with drugs was limited, and evidence for the effects of race, baseline severity of UI, and comorbid conditions on treatment success was insufficient.


CONCLUSIONS
Overall, drugs for urgency UI showed similar small benefit. Therapeutic choices should consider the harms profile. Evidence for long-term adherence and safety of treatments is lacking.
University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware Street SE, Minneapolis, MN 55455, USA. shaml005@umn.edu
Tatyana
T
Shamliyan
Jean F
JF
Wyman
Rema
R
Ramakrishnan
François
F
Sainfort
Robert L
RL
Kane
D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000627:therapeutic use; D001561:Benzilates; D001572:Benzofurans / Q000009:adverse effects / Q000627:therapeutic use; D057186:Comparative Effectiveness Research; D003408:Cresols / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008333:Mandelic Acids / Q000009:adverse effects / Q000627:therapeutic use; D018727:Muscarinic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D009662:Nortropanes / Q000009:adverse effects / Q000627:therapeutic use; D010665:Phenylpropanolamine / Q000009:adverse effects / Q000627:therapeutic use; D011759:Pyrrolidines / Q000009:adverse effects / Q000627:therapeutic use; D011788:Quality of Life; D011812:Quinuclidines / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000069464:Solifenacin Succinate; D044005:Tetrahydroisoquinolines / Q000009:adverse effects / Q000627:therapeutic use; D000068737:Tolterodine Tartrate; D014549:Urinary Incontinence / Q000188:drug therapy*
D001559:Benzhydryl Compounds; D001561:Benzilates; D001572:Benzofurans; D003408:Cresols; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D009662:Nortropanes; D011759:Pyrrolidines; D011812:Quinuclidines; D044005:Tetrahydroisoquinolines; C003330:trospium chloride; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C526675:fesoterodine; C101207:darifenacin; C005419:oxybutynin; D000069464:Solifenacin Succinate