Review
Drug therapy of urinary urge incontinence: a systematic review

https://doi.org/10.1016/S0029-7844(02)02238-XGet rights and content

Abstract

OBJECTIVE:

To review the efficacy of drug therapy for urinary urge incontinence by examining the published literature.

METHODS OF STUDY SELECTION:

In October 1999, we searched the medical databases MEDLINE, EMBASE, and Cochrane Controlled Trials Register to identify prospective randomized, double-blind, placebo-controlled clinical trials in the English literature evaluating drug therapy (except hormonal therapy) of urinary urge incontinence. Trials were categorized by type of drug and outcome variables.

TABULATION, INTEGRATION, AND RESULTS:

Forty-seven trials were identified. Twenty-four, 12, and 11 trials evaluated anticholinergic drugs, drugs with anticholinergic and calcium antagonistic properties, and alternative regimens, respectively. Data regarding treatment effects of anticholinergic drugs are consistent with a high therapeutic efficacy and characteristic side effects. Therapeutic efficacy and side effect patterns of terodiline, an agent with anticholinergic and calcium antagonistic properties, were comparable to those of anticholinergic agents. Terodiline, however, has been withdrawn from the market because of its association with cardiac arrhythmia. Of the investigated alternative drug regimens, the papaverine-like smooth muscle relaxant flavoxate was reported to be ineffective. Studies investigating the dopamine agonist bromocryptine, the α-adrenoceptor blocker prazosin, or the γ-aminobutyric acid receptor agonist baclofen showed subjective and/or objective improvement of symptoms without reaching statistical significance, whereas the tricyclic antidepressant doxepin, the neurotoxin capsaicin, and the prostaglandin synthase inhibitor flurbiprofen led to statistically significant subjective and/or objective improvement of symptoms. No data for subjective and/or objective improvement of symptoms could be extracted from the studies using the anticholinergic and calcium antagonistic agent propiverine and the calcium antagonist thiphenamil.

CONCLUSION:

Published trials support anticholinergic drugs as efficacious therapy for urinary urge incontinence, with predictable side effects. At present, these agents represent the pharmacological treatment of choice for this condition. The potential value of selected alternative drugs is underscored by the available data.

Section snippets

Sources

In October 1999, the medical databases MEDLINE (since 1966), EMBASE (since 1989), and Cochrane Controlled Trials Register were searched to identify all literature included under “urge incontinence,” “therapy,” and “prospective study.” The following criteria were used to select studies: article; original published English-language report; study design; placebo-controlled, double-blind, randomized clinical trial; population; patients with urge incontinence, confirmed by urodynamic assessment and

Study selection

We scanned all abstracts from the computer printouts and retrieved full-text reports and the references from each retrieved report to determine whether studies met the inclusion criteria.

All trials included were reviewed systematically to evaluate the quality of the trials and to determine the clinical homogeneity of the study populations. To evaluate the quality of each trial, we compared the following characteristics: randomization process, numbers of patients excluded after randomization,

Results

Forty-seven trials satisfying the selection criteria were identified, among them 24 trials evaluating anticholinergic drugs,9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 12 trials evaluating agents with anticholinergic and calcium antagonistic properties,16, 21, 22, 31, 32, 33, 34, 35, 36, 37, 38, 39 and 11 trials investigating alternative regimens.6, 7, 19, 40, 41, 42, 43, 44, 45, 46, 47 Because terodiline, an agent with anticholinergic and calcium

Conclusion

Urge incontinence is a common and troublesome problem considerably reducing the quality of life of affected individuals. Various drugs are currently available for the alleviation of signs and symptoms of the overactive bladder. Urge incontinence, however, remains a clinical challenge to treating physicians. Treatment of patients with urge incontinence continues to be unsatisfying in light of a lack of bladder-specific medications. Although considerable improvements are seen in patients on drug

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