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REVIEWS |
From the Departments of Obstetrics & Gynecology and Medical Computer Sciences, University of Vienna School of Medicine, Vienna, Austria.
Address reprint requests to: Clemens B. Tempfer, MD, University of Vienna School of Medicine, Department of Gynecology and Obstetrics, Waehringer Guertel 18–20, Vienna, A-1090, Austria; E-mail: clemens.tempfer{at}akh-wien.ac.at.
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 Terodiline, however, has been withdrawn from the market because of its association with cardiac arrhythmia.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 
-adrenoceptor blocker prazosin, or the 
-aminobutyric acid receptor agonist baclofen showed subjective and/or objective improvement of symptoms without reaching statistical significance, whereas the tricyclic anti-depressant 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.
This article has been cited by other articles:
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  J. S. Brown, C. S. Bradley, L. L. Subak, H. E. Richter, S. R. Kraus, L. Brubaker, F. Lin, E. Vittinghoff, D. Grady, and for the Diagnostic Aspects of Incontinence Study ( The Sensitivity and Specificity of a Simple Test To Distinguish between Urge and Stress Urinary Incontinence Ann Intern Med, May 16, 2006; 144(10): 715 - 723. [Abstract] [Full Text] [PDF]
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 J. M. Holroyd-Leduc and S. E. Straus Management of Urinary Incontinence in Women: Scientific Review JAMA, February 25, 2004; 291(8): 986 - 995. [Abstract] [Full Text] [PDF]
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 F. C Pannill III Review: drugs do not improve symptoms in urinary urge incontinence and may have side effects Evid. Based Med., November 1, 2003; 8(6): 182 - 182. [Full Text] [PDF]
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 OTHER ARTICLES NOTED (25 Oct 02 to 17 Jan 03) Evid. Based Nurs., April 1, 2003; 6(2): e1 - 7. [Full Text]
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