Can incontinence be cured? A systematic review of cure rates.
Incontinence constitutes a major health problem affecting millions of people worldwide. The present study aims to assess cure rates from treating urinary (UI) or fecal incontinence (FI) and the number of people who may remain dependent on containment strategies.



Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PEDro were searched from January 2005 to June 2015. Supplementary searches included conference abstracts and trials registers (2013-2015). Included studies had patients ≥ 18 years with UI or FI, reported treatment cure or success rates, had ≥ 50 patients treated with any intervention recognized in international guideline algorithms, a follow-up ≥ 3 months, and were published from 2005 onwards. Title and abstract screening, full paper screening, data extraction and risk-of-bias assessment were performed independently by two reviewers. Disagreements were resolved through discussion or referral to a third reviewer where necessary. A narrative summary of included studies is presented.



Most evidence was found for UI: Surgical interventions for stress UI showed a median cure rate of 82.3% (interquartile range (IQR), 72-89.5%); people with urgency UI were mostly treated using medications (median cure rate for antimuscarinics = 49%; IQR, 35.6-58%). Pelvic floor muscle training and bulking agents showed lower cure rates for UI. Sacral neuromodulation for FI had a median cure rate of 38.6% (IQR, 35.6-40.6%).



Many individuals were not cured and hence may continue to rely on containment. No studies were found assessing success of containment strategies. There was a lack of data in the disabled and in those with neurological diseases, in the elderly and those with cognitive impairment. Surgical interventions were effective for stress UI. Other interventions for UI and FI showed lower cure rates. Many individuals are likely to be reliant on containment strategies.



PROSPERO registration number: CRD42015023763 .
Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK. rob@systematic-reviews.com.
Rob
0000-0001-8892-0861
R
Riemsma
NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
Suzanne
S
Hagen
Neuro-Urologie, Clinic of Urology, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Bonn, Germany.
Ruth
R
Kirschner-Hermanns
Florence Nightingale Faculty of Nursing and Midwifery King's College London, London, UK.
Christine
C
Norton
Centre for Person-Centred Care (GPCC), Institution for Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Helle
H
Wijk
Clinical Medicine, Aarhus University, Aarhus, Denmark.
Karl-Erik
KE
Andersson
Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.
Christopher
C
Chapple
Court View Surgery, Strood, UK.
Julian
J
Spinks
Division of Geriatric Medicine, University of Alberta, Edmonton, Canada.
Adrian
A
Wagg
Medica Market Access Ltd, Tonbridge, UK.
Edward
E
Hutt
Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
Kate
K
Misso
Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
Sohan
S
Deshpande
Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.|Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Jos
J
Kleijnen
Department of Obstetrics & Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Ian
I
Milsom
D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D017773:Pelvic Floor; D012074:Remission Induction / Q000379:methods; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000628:therapy*
Cure rates; Incontinence; Systematic review