Major Finding: The combination of behavioral therapy and pessary placement for women with stress urinary incontinence is not significantly better than the single treatments alone.
Data Source: A multicenter study of 445 women with stress urinary incontinence.
Disclosures: None reported.
HOLLYWOOD, FLA. — A combination of clinical therapies is not always superior to a single treatment alone, as in the combined use of behavioral treatment and pessary placement for women with stress urinary incontinence, based on a multicenter study of 445 women.
“Because there was no significant difference versus behavioral therapy, we cannot say that combined therapy was better than single treatments,” Dr. Holly E. Richter said.
“Nonsurgical options should be offered, but there is surprisingly little evidence available for these options,” Dr. Richter said at the annual meeting of the American Urogynecologic Society.
To find out more, Dr. Richter and her associate Dr. Kathryn L. Burgio with the Pelvic Floor Disorder Network studied 445 women with stress urinary incontinence. They randomized 150 participants to combination therapy, 146 to behavioral treatment, and 149 to a pessary to determine if two treatments are, in fact, better than one.
At 3 months, they found no significant differences in the percentage reporting “much better” or “very much better” on the Patient Global Impression of Improvement (PGI-I) scale. This outcome was reported by 53% of the combination group, 49% of the behavioral group, and 40% of the pessary group in an intent-to-treat analysis of the data.
“How has this [study] changed your practice?” a meeting attendee asked. Dr. Richter replied, “It has changed my counseling of patients. This trial is giving us a little more insight into how we may address these treatments with our patients.” For example, even though a greater percentage of women reported improvement, “we know some women are not going to adhere to behavioral therapy.” Treatment of stress urinary incontinence with a pessary may be more appropriate for less-motivated patients, said Dr. Richter, professor of obstetrics and gynecology at the University of Alabama at Birmingham.
Behavioral therapy consisted of four visits at 2-week intervals conducted by centrally trained interventionists. The protocol included pelvic muscle training.
The pessary group had a continence ring or dish fitted by a physician or nurse.
Patients' mean age was 50 years. A total of 46% had stress-only incontinence, and 54% had stress-predominant mixed incontinence at baseline. A total of 21% reported a prior nonsurgical treatment, and 6% reported prior surgery for their stress urinary incontinence.
At 3 months, 44% in the combined group, 49% of the behavioral group, and 33% of the pessary patients reported no bothersome stress urinary incontinence.
A total of 79% of the combination group, 75% of the behavioral group, and 63% of the pessary group said they were satisfied with their treatment. “At 3 months, behavioral therapy resulted in fewer incontinence symptoms and greater satisfaction than a pessary,” Dr. Richter said. However, “the difference in outcome did not persist in any measure in any group up to 12 months.”