Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

SYSTEMATIC REVIEW

August 8, 2018

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Purpose of Review

Compare nonpharmacological and pharmacological interventions in adult women with urinary incontinence.

Key Messages

The nonpharmacological and pharmacological interventions studied, except hormones and periurethral bulking agents, result in better urinary incontinence (UI) outcomes than no treatment.
For stress UI, among treatments commonly used as first- or second-line interventions, behavioral therapy is more effective than either alpha agonists or hormones. Combination behavioral therapy and hormones are more effective than alpha agonists. Alpha agonists, in turn, are more effective than hormones.
There is insufficient evidence comparing periurethral bulking agents and intravesical pressure release, treatments used as third-line interventions for women with stress UI.
For urgency UI, among treatments commonly used as first- or second-line interventions, behavioral therapy is more effective than anticholinergics.
Onabotulinum toxin A may be more effective than neuromodulation as third-line therapy for women with urgency UI.
Dry mouth is the most common side effect of pharmacological interventions, particularly with anticholinergics. Duloxetine is associated with numerous constitutional adverse effects such as nausea, insomnia, and fatigue.
Serious adverse events are rare for all interventions. Onabotulinum toxin A is associated with risk of urinary tract infections and urinary retention. Periurethral bulking agents are associated with erosion in a small percentage of women.