Gastroenterology

Gastroenterology

Volume 126, Supplement 1, January 2004, Pages S77-S81
Gastroenterology

Treatment options for urinary incontinence
Medical management of urinary incontinence

https://doi.org/10.1053/j.gastro.2003.10.005Get rights and content

Abstract

Treatment options for urinary incontinence include behavioral techniques, pharmacologic agents, and surgical procedures. Caregivers use pharmacotherapy heavily because of its availability, immediacy of results, and convenience. However, only pharmacotherapy for urge incontinence has advanced to the level at which several drugs that have undergone rigorous scientific testing using randomized controlled trials have received FDA approval; these are the antimuscarinic and anticholinergic/direct smooth muscle relaxant drugs. However, promising new drugs targeting other receptors are under investigation. There is no FDA-approved drug for stress incontinence or overflow incontinence. Pharmacologic clinical trials for urinary incontinence are no different than pharmacologic trials in other areas. A randomized controlled trial is the best approach for documenting effectiveness and safety. A rigorous trial should include identification of primary and secondary outcomes. The measurement tools of outcomes must be reliable and validated. Preferably, the severity level of urinary incontinence should be established, and measurement of effectiveness must include durability. Not only must side effects be identified, but their impact on the quality of life must be quantified. An exciting area in pharmacologic treatment of urinary incontinence is the method of drug delivery. In addition to sustained release oral medication, the transdermal patch and the intravaginal route are starting to be used in clinical practice. The intravesical route is still in the investigational phase. Pharmacologic research for urinary incontinence is now entering an exciting time because technologic advances are creating new agents with more precise targeting and more sophisticated methods of delivery are being developed and tested.

Section snippets

Pharmacotherapy for urinary incontinence

When pharmacotherapy is under consideration, one must identify the indication for the agent or agents being advocated. This step is particularly important in treating urinary incontinence because each of the several types of this disorder requires a different drug category. Identifying the indication is important not only to the caregivers but also to the patient who at times presents to our office with a request for an advertised drug that is inappropriate for the type of urinary incontinence

Randomized controlled trials and their design

Review of the voluminous pharmacologic studies for the treatment of urinary incontinence reveals several issues that need to be attended to when one undertakes an intensive randomized trial to establish the efficacy and safety of an agent (Table 1). First and foremost is the need for randomized controlled trials. Unquestionably, randomized controlled trials are considered to be the best approach in documenting the effectiveness and safety of a new agent or to determine the equivalence of 1

View full text