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Combining Behavioural and Drug Therapy for Urge Incontinence Improves Patient Satisfaction But Not Drug Withdrawal: Presented at ICS

By Shazia Qureshi

ROTTERDAM, NETHERLANDS -- August 23, 2007 -- Treatment that combines behavioural training with drug therapy improves patient satisfaction among women with urge incontinence but does not help them to discontinue their drug therapy, according to findings presented here at the 37th Annual Meeting of the International Continence Society (ICS).

Lead investigator Kathryn Burgio, PhD, Professor and Director, Continence Program, University of Alabama at Birmingham, and Associate Director of Research, Veterans Affairs Medical Center, Birmingham, Alabama, United States, noted that behavioural interventions and drug therapy are each individually known to be effective in reducing urge incontinence.

Dr. Burgio and colleagues studied the outcomes when these two approaches were used in combination by women with urge incontinence.

The study randomised 307 women with predominant urge incontinence to receive the antimuscarinic agent tolterodine in a sustained-release formulation at a dose of 4 mg/day alone (n = 153) or in combination with behavioural training (n = 154).

Behavioural training consisted of pelvic floor muscle training and exercise, bladder control techniques, delayed voiding, and fluid management. Both the drug and the behavioural interventions were stopped after 10 weeks.

The primary endpoint was a composite of successful drug withdrawal (defined as not requesting drug or any other treatment for incontinence) and maintenance of at least a 70% reduction in the frequency of incontinence episodes. This endpoint was measured 6 months after discontinuation of treatment.

At the end of the 10-week treatment period, the two groups showed a noticeable but not significant difference in the primary endpoint (70.7% in the combination therapy group and 59.6% in the group on drug therapy alone; P =.09).

At 6 months, similar results were seen in both treatment groups, with 44% of combination-therapy patients and 43% of those on drug therapy alone reaching the primary endpoint (P =.83).

However, the study also showed that combination treatment provided greater patient satisfaction, with 33% of patients reporting that they were completely satisfied with their progress at 6 months compared with 20% of women who received drug therapy alone (P =.02).

Perceived improvement was also higher in patients who received combination therapy (P <.001 at 6 months).

Dr. Burgio said that she and her colleagues had initially expected that patients would continue to use behavioural continence skills after stopping drug therapy at 10 weeks. "However," she continued, it was possible that "drug therapy may have altered the sensory context, and with it the effectiveness, of the behavioural training."

The study was partially funded by Pfizer.


[Presentation title: Combining Behavior and Drug Therapy to Improve Drug Withdrawal in the Treatment of Urge Incontinence: A Randomized Trial. Abstract 21]

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