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      Can incontinence be cured? A systematic review of cure rates

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          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.

          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.

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          Most cited references22

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          Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction.

          Debra Irwin, Zoe Kopp, Barnabie Agatep … (2011)
          • To estimate and predict worldwide and regional prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence (UI) and LUTS suggestive of bladder outlet obstruction (LUTS/BOO) in 2008, 2013 and 2018 based on current International Continence Society symptom definitions in adults aged ≥20 years. • Numbers and prevalence of individuals affected by each condition were calculated with an estimation model using gender- and age-stratified prevalence data from the EPIC study along with gender- and age-stratified worldwide and regional population estimates from the US Census Bureau International Data Base. • An estimated 45.2%, 10.7%, 8.2% and 21.5% of the 2008 worldwide population (4.3 billion) was affected by at least one LUTS, OAB, UI and LUTS/BOO, respectively. By 2018, an estimated 2.3 billion individuals will be affected by at least one LUTS (18.4% increase), 546 million by OAB (20.1%), 423 million by UI (21.6%) and 1.1 billion by LUTS/BOO (18.5%). • The regional burden of these conditions is estimated to be greatest in Asia, with numbers of affected individuals expected to increase most in the developing regions of Africa (30.1-31.1% increase across conditions, 2008-2018), South America (20.5-24.7%) and Asia (19.7-24.4%). • This model suggests that LUTS, OAB, UI and LUTS/BOO are highly prevalent conditions worldwide. Numbers of affected individuals are projected to increase with time, with the greatest increase in burden anticipated in developing regions. • There are important worldwide public-health and clinical management implications to be considered over the next decade to effectively prevent and manage these conditions. © 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.
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            The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study.

            Karin Coyne, Chris C Sexton, Debra Irwin … (2008)
            To examine the effect overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in a population sample, as OAB often occurs in conjunction with many other LUTS. A nested case-control analysis was performed on men and women with (cases) and without (controls) OAB, from the EPIC study. OAB was assessed using 2002 International Continence Society definitions. Based on their responses to questions about LUTS, cases were classified into five groups; continent OAB, OAB with incontinence, OAB + postmicturition, OAB + voiding, and OAB + postmicturition + voiding. Both cases and controls were asked questions about symptom bother (OAB-q), generic QoL (EQ-5D), work productivity (Work Productivity and Activity Impairment, WPAI), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sexual satisfaction, and erectile dysfunction (men only) using the Massachusetts Male Aging Study. Cases answered additional condition-specific questions HRQoL (OAB-q short form), Patient Perception of Bladder Condition and work productivity related to a specific health problem (WPAI-SHP). General linear models were used to evaluate group differences. Of the EPIC participants, 1434 identified OAB cases were matched by age, gender and country, with 1434 participants designated as controls. Cases and controls were primarily Caucasian (96.2% and 96.7%, respectively), and most (65%) were female; the mean age was 53.8 and 53.7 years, respectively. Comorbid conditions differed significantly by case/control status, with cases reporting significantly greater rates of chronic constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. There were significant differences between the cases and controls in all reported LUTS. The OAB + postmicturition + voiding group reported significantly greater symptom bother, worse HRQoL, higher rates of depression and decreased enjoyment of sexual activity, than the other subgroups. OAB has a substantial, multidimensional impact on patients; OAB with additional LUTS has a greater impact. The diagnosis and treatment of OAB should be considered in conjunction with other LUTS, to maximize treatment options and optimize patient outcomes.
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              Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience.

              Adrian S. Wagg, Carolyn Fahey, Emad Siddiqui … (2012)
              Study Type--Therapy (prevalence) Level of Evidence 2b. What's known on the subject? and What does the study add? Persistence with long-term medication in chronic diseases is typically low and that for overactive bladder medication is lower than average. Sub-optimal persistence is a major challenge for the successful management of overactive bladder. Using UK prescription data, persistence was generally low across the range of antimuscarinics. Patients aged 60 years and above were more likely to persist with prescribed oral antimuscarinic drugs than younger patients (40-59 years). Solifenacin was consistently associated with the highest rate of persistence compared with the other antimuscarinics included in the study • To describe the level of persistence for patients receiving antimuscarinics for overactive bladder (OAB) over a 12-month period based on real prescription data from the UK. • To investigate patterns of persistence with oral antimuscarinic drugs prescribed for OAB, across different age groups. • UK prescription data from a longitudinal patient database were analysed retrospectively to assess persistence with darifenacin, flavoxate, oxybutynin (extended release [ER] and immediate release [IR]), propiverine, solifenacin, tolterodine (ER/IR) and trospium. • Data were extracted from the medical records of >1,200,000 registered patients via general practice software, and anonymized prescription data were collated for all eligible patients with documented OAB (n = 4833). • Data were collected on patients who started treatment between January 2007 and December 2007 and were collected up to December 2008, to allow each patient a full 12-month potential treatment period. Failure of persistence was declared after a gap of at least 1.5 times the length of the period of the most recent prescription. • The analysis included only patients who were new to a course of treatment (i.e. who had not been prescribed that particular treatment or dosage for at least 6 months before the study period). • The number of patients prescribed each antimuscarinic drug varied from 23 for darifenacin to 1758 for tolterodine ER. • The longest mean persistence was reported for solifenacin (187 days versus 77-157 days for the other treatments). • At 3 months, the proportions of patients still on their original treatment were: solifenacin 58%, darifenacin 52%, tolterodine ER 47%, propiverine 47%, tolterodine IR 46%, oxybutynin ER 44%, trospium 42%, oxybutynin IR 40%, flavoxate 28%. • At 12 months, the proportions of patients still on their original treatment were: solifenacin 35%, tolterodine ER 28%, propiverine 27%, oxybutynin ER 26%, trospium 26%, tolterodine IR 24%, oxybutynin IR 22%, darifenacin 17%, flavoxate 14%. • In a sub-analysis stratified by age, patients aged ≥ 60 years were more likely to persist with prescribed therapy over the 12-month period than those aged <60 years. • Twelve months after the initial prescription, persistence rates with pharmacotherapy in the context of OAB are generally low. • Solifenacin was associated with higher levels of persistence compared with other prescribed antimuscarinic agents. • Older people are more likely than younger patients to persist with prescribed therapy. Further studies are required to understand this finding and why patients are more likely to persist with one drug rather than another. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.
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                Author and article information

                Contributors
                Rob Riemsma:
                ORCID: http://orcid.org/0000-0001-8892-0861
                rob@systematic-reviews.com
                Journal
                Journal ID (nlm-ta): BMC Med
                Journal ID (iso-abbrev): BMC Med
                Title: BMC Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1741-7015
                Publication date (Electronic): 24 March 2017
                Publication date PMC-release: 24 March 2017
                Publication date Collection: 2017
                Volume: 15
                Electronic Location Identifier: 63
                Affiliations
                [1 ]ISNI 0000 0004 0450 3334, GRID grid.450936.d, , Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, ; Riccall Road, Escrick, York, YO19 6FD UK
                [2 ]ISNI 0000 0001 0669 8188, GRID grid.5214.2, NMAHP Research Unit, , Glasgow Caledonian University, ; Glasgow, UK
                [3 ]ISNI 0000 0000 8786 803X, GRID grid.15090.3d, Neuro-Urologie, Clinic of Urology, , University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, ; Bonn, Germany
                [4 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, , Florence Nightingale Faculty of Nursing and Midwifery King’s College London, ; London, UK
                [5 ]ISNI 0000 0000 9919 9582, GRID grid.8761.8, Centre for Person-Centred Care (GPCC), Institution for Health and Care Science, Sahlgrenska Academy, , University of Gothenburg, ; Gothenburg, Sweden
                [6 ]ISNI 0000 0001 1956 2722, GRID grid.7048.b, Clinical Medicine, , Aarhus University, ; Aarhus, Denmark
                [7 ]ISNI 0000 0004 0641 6031, GRID grid.416126.6, Department of Urology, , Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, ; Sheffield, UK
                [8 ]Court View Surgery, Strood, UK
                [9 ]GRID grid.17089.37, Division of Geriatric Medicine, , University of Alberta, ; Edmonton, Canada
                [10 ]Medica Market Access Ltd, Tonbridge, UK
                [11 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), , Maastricht University, ; Maastricht, The Netherlands
                [12 ]ISNI 0000 0000 9919 9582, GRID grid.8761.8, Department of Obstetrics & Gynecology, Institute of Clinical Sciences, , Sahlgrenska Academy at Gothenburg University, ; Gothenburg, Sweden
                Author information
                http://orcid.org/0000-0001-8892-0861
                Article
                Publisher ID: 828
                DOI: 10.1186/s12916-017-0828-2
                PMC ID: 5364653
                PubMed ID: 28335792
                SO-VID: a91f4cce-00d1-4bcb-86ff-95937c7e413b
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 18 October 2016
                Date accepted : 23 February 2017
                Funding
                Funded by: Svenska Cellulosa Aktiebolaget (SCA), Sweden
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Medicine
                Keywords: incontinence,systematic review,cure rates
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: incontinence, systematic review, cure rates

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