TY - JOUR
T1 - Can incontinence be cured? A systematic review of cure rates
AU - Riemsma, Rob
AU - Hagen, Suzanne
AU - Kirschner-Hermanns, Ruth
AU - Norton, Christine
AU - Wijk, Helle
AU - Andersson, Karl-Erik
AU - Chapple, Christopher
AU - Spinks, Julian
AU - Wagg, Adrian
AU - Hutt, Edward
AU - Misso, Kate
AU - Deshpande, Sohan
AU - Kleijnen, Jos
AU - Milsom, Ian
PY - 2017/3/24
Y1 - 2017/3/24
N2 - 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 followup >= 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.
AB - 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 followup >= 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.
KW - Incontinence
KW - Systematic review
KW - Cure rates
KW - QUALITY-OF-LIFE
KW - URINARY-INCONTINENCE
KW - FECAL INCONTINENCE
KW - OVERACTIVE BLADDER
KW - STRESS-INCONTINENCE
KW - ANAL INCONTINENCE
KW - WOMEN
KW - PREVALENCE
KW - NEUROMODULATION
KW - COMMUNITY
U2 - 10.1186/s12916-017-0828-2
DO - 10.1186/s12916-017-0828-2
M3 - (Systematic) Review article
C2 - 28335792
SN - 1741-7015
VL - 15
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 63
ER -