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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Medicine 1/2017

Can incontinence be cured? A systematic review of cure rates

Zeitschrift:
BMC Medicine > Ausgabe 1/2017
Autoren:
Rob Riemsma, Suzanne Hagen, Ruth Kirschner-Hermanns, Christine Norton, Helle Wijk, Karl-Erik Andersson, Christopher Chapple, Julian Spinks, Adrian Wagg, Edward Hutt, Kate Misso, Sohan Deshpande, Jos Kleijnen, Ian Milsom
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12916-017-0828-2) contains supplementary material, which is available to authorized users.

Abstract

Background

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.

Methods

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.

Results

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%).

Conclusions

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

PROSPERO registration number: CRD42015023763.
Zusatzmaterial
Additional file 1: Embase search strategy. (PDF 61 kb)
12916_2017_828_MOESM1_ESM.pdf
Additional file 2: Online tables. Table S1. Characteristics of included studies. Table S2. Risk of bias of included studies. Table S3. Study characteristics for female and male patients with stress urinary incontinence (SUI). Table S4. Treatment characteristics in studies for female and male patients with SUI. Table S5. Results of interventions for patients with SUI. Table S6. Study characteristics for patients with urgency urinary incontinence (UUI). Table S7. Treatment characteristics in studies for patients with UUI. Table S8. Results of interventions for patients with UUI. Table S9. Study characteristics for patients with mixed urinary incontinence (MUI). Table S10. Treatment characteristics in studies for patients with MUI. Table S11. Results of interventions for patients with MUI. Table S12. Study characteristics for patients with fecal incontinence (FI). Table S13. Treatment characteristics in studies for patients with FI. Table S14. Results of interventions for patients with FI. Table S15. Study characteristics for patients with neurological problems or diseases. Table S16. Treatment characteristics in studies for patients with neurological problems or diseases. Table S17. Results of interventions for patients with neurological problems or diseases. Table S18. Study characteristics for elderly or cognitively impaired patients with incontinence. Table S19. Treatment characteristics in studies for elderly or cognitively impaired patients with incontinence. Table S20. Results of interventions for elderly or cognitively impaired patients with incontinence. (PDF 4723 kb)
12916_2017_828_MOESM2_ESM.pdf
Literatur
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