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Management of Urinary Incontinence
in Women
Scientific Review
Context Urinary incontinence is a common health problem among women that nega-
tively impacts quality of life. Therefore, it is important that primary care physicians have an understanding of how to manage urinary incontinence effectively.
Objective To review the most recent, high-quality evidence regarding the etiology
and management of urinary incontinence in women.
tary leakage of urine,1 is acommon health problem Data Sources and Study Selection Searches of MEDLINE, EMBASE, The Coch-
rane Library, and the ACP Journal Club were performed to identify English-language
articles published between 1998-2003 that focused on the etiology or treatment of uri- nary incontinence in adult women. The references of each retrieved article were re- viewed and an expert in the field was contacted to identify additional relevant articles.
Data Extraction Using a combination of more than 80 search terms, we included
articles of etiology that were cohort studies, case-control studies, cross-sectional stud- ies, or systematic reviews of cohort, case-control, and/or cross-sectional studies. Stud- ies of treatment had to be randomized controlled trials or systematic reviews of ran- domized controlled trials. The quality of each article was assessed independently by each author and inclusion (n=66) was determined by consensus.
Data Synthesis Multiple factors have been found to be associated with urinary in-
continence, some of which are amenable to modification. Factors associated with in- continence include age, white race, higher educational attainment, pregnancy- and overflow incontinence. Stress in- related factors, gynecological factors, urological and gastrointestinal tract factors, continence is involuntary leakage from comorbid diseases, higher body mass index, medications, smoking, caffeine, and func- tional impairment. There are several effective nonpharmacological treatments includ- ing pelvic floor muscle training, electrical stimulation, bladder training, and promptedvoiding. Anticholinergic drugs are effective in the treatment of urge urinary inconti- nence. Several surgical interventions are effective in the management of stress incon- intrinsic sphincter function. Urge in- tinence, including open retropubic colposuspension and suburethral sling procedure.
continence is involuntary leakage ac- Conclusion Urinary incontinence in women is an important public health concern,
and effective treatment options exist.
by urgency,1 and it usually indicates de- trusor overactivity. Mixed incontinenceis the complaint of involuntary leak-age associated with urgency and also flow incontinence, which is associated Author Affiliations: San Francisco Veterans Affairs Medi-
cal Center, San Francisco and Division of Geriatrics, De- partment of Medicine, University of California, San Fran- cisco (Dr Holroyd-Leduc) and Division of General Internal nary incontinence in women is over- Medicine, University Health Network, University of Toronto, Toronto, Ontario (Dr Straus).
Corresponding Authors: Jayna M. Holroyd-Leduc,
See also p 996.
MD, SFVAMC (181G), 4150 Clement St, Bldg 1, SanFrancisco, CA 94121 ( .gov); Sharon E. Straus, MD, Department of Medi- CME available online at
cine, University Health Network, Toronto General Hos-pital, 200 Elizabeth St, ENG 248, Toronto, Ontario,
Canada, M5G 2C4 (
986 JAMA, February 25, 2004—Vol 291, No. 8 (Reprinted)
2004 American Medical Association. All rights reserved.
MANAGEMENT OF URINARY INCONTINENCE IN WOMEN ported by other trials.20,21 The associa- Clinical Issues
What Factors Increase the Risk of De-
Cochrane Library, and the ACP Jour- veloping Urinary Incontinence? Mul-
gardless of the age of the patient at the nal Club were performed by using more fication, so clinicians can focus on iden- delivery (hazard ratio [HR], 3.5; 95% CI, Pregnancy, Mode of Delivery, and Par- ity. After adjusting for the length of the liveries (HR, 3.5; 95% CI, 1.2-9.8) after and duration of labor.22 The risk of stress cross-sectional studies, or systematic re- cross-sectional studies. Studies of treat- CI, 1.5-13.2).9 Increased parity also ap- ery, vaginal laceration or episiotomy, and tion, the reference lists of retrieved ar- factor (OR, 10.43; 95% CI, 1.17-93.42).23 development of urinary incontinence.
tion between fetal weight and urinary in- tempt to retrieve additional articles. For delivery, perineal trauma, duration of la- OR, 2.1; 95% CI, 1.7-2.6, respectively).
2004 American Medical Association. All rights reserved.
(Reprinted) JAMA, February 25, 2004—Vol 291, No. 8 987
MANAGEMENT OF URINARY INCONTINENCE IN WOMEN Hysterectomy and Other Gynecologi- cal Factors. A systematic review found Comorbid Diseases. The presence of p o r t e d b y a l a r g e c o h o r t s t u d y uria in the past 12 months.14 This study, en.2 After adjusting for age, parity, and Parkinsonism,39 arthritis,16,36 back prob- Medications, Smoking, Alcohol, and Age. Advancing age is associated with Caffeine. Several medications have been 2.86; P = .001),31 and poor pelvic floor Urological and Gastrointestinal Fac- tional attainment, financial assets, age, tors. Recurrent urinary tract infection functional status, vision and hearing ca- ated with urinary incontinence.12,16,30,32,33 In one study, recurrent urinary tract in- 988 JAMA, February 25, 2004—Vol 291, No. 8 (Reprinted)
2004 American Medical Association. All rights reserved.
MANAGEMENT OF URINARY INCONTINENCE IN WOMEN Table 1. Comparison of Pelvic Floor Muscle Training vs Other Physical Therapies in the
Self-reported Cure
Reduction in Urinary
PFMT Alone
or Improvement,
Leakage Episodes per
Compared With
RR (95% CI)
24 h, WMD* (95% CI)
Abbreviations: CI, confidence interval; PFMT, pelvic floor muscle training; RR, relative risk; WMD, weighted mean differ- Socioeconomic Status. Higher levels of *Based on data from Hay-Smith et al.42†Based on data from Burgio KL.48 ‡Represents results for cure only.
ticularly mild incontinence and stressincontinence.10,21,37 Although the rea-son for this association is unclear, it re- factors such as age, race, assets, comor- pelvic floor muscles to prevent the cones tors (eg, natural history of the disease), from slipping out of the vagina. Electri- but the placebo effect might have a small tion between a person’s financial assets pelvic floor musculature or to inhibit de- Body Mass Index. Many studies have training, which aims to increase the time nence10-14,16,21,30,31,33,37 (OR per unit Functional Status. Functional impair- Pelvic Floor Muscle Training. Stud- nence.30,32,34,37,39 The presence of trunk ied in terms of the duration of each con- tion in urinary leakage with pelvic floor not significantly different between elite What Nonpharmacological Manage-
ment Strategies Are Effective? There are
or placebo (TABLE 1).42 The placebo
intervention used in the different trials alter the pelvic floor musculature).
vidual isolate the relevant muscles.
2004 American Medical Association. All rights reserved.
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MANAGEMENT OF URINARY INCONTINENCE IN WOMEN training (RR, 1.41; 95% CI, 1.09-1.81).53 suggested that there is no difference be- Vaginal Cones. Use of weighted vagi-
nal cones theoretically requires that the ter than pelvic floor training alone (rela- ing resulted in fewer self-reported cures sion, and the weight is increased as tol- surgery group had a significantly greater reduction (PϽ.01). All reported ad- Electrical Stimulation. Electrical
nificantly better than regular social vis- fectiveness of electrical stimulation may Bladder Training. Bladder training
tinence, there was no difference in self- Ͼ50 mL).54 There was no significant to experience a subjective cure vs those tion was not significantly different from [WMD], −0.41; 95% CI, −0.79 to −0.03).
enced dry mouth and inability to void.
990 JAMA, February 25, 2004—Vol 291, No. 8 (Reprinted)
2004 American Medical Association. All rights reserved.
MANAGEMENT OF URINARY INCONTINENCE IN WOMEN ticipants.61 In particular, the risk of dry Prompted Voiding. There are a num-
intervals. Several of these trials (includ- tynin was associated with a significantly participants in the control groups, there currence of at least 1 adverse event (eg, Adrenergic Drugs. ␣-Adrenoceptor
provement, 0.59; 95% CI, 0.31-1.14)while more in the intervention groupshad significantly fewer incontinent epi- Table 2. Comparison of the Pharmacological Treatments for Urinary Incontinence
Potential Adverse Reactions*
CI, −1.32 to −0.53).57 One trial found For Urge Incontinence
a statistically significant increase in in- Abnormal vision, dry eyesNausea, dyspepsia, abdominal pain least 1 object out of 2 on 3 separate oc- HypotensionHeadacheDiarrhea, GI tract symptoms What Are the Risks and Benefits
of Pharmacological Therapies?
Bone marrow suppressionHypotension, hypertension (TABLE 2).
Anticholinergic Drugs. Anticholin-
Dry mouth, rashConstipation, GI tract symptoms For Stress Incontinence
Confusion, anxietyUrinary symptoms, retention Abbreviations: ECG,electrocardiogram; GI, gastrointestinal.
*Based on information in the included trials and the Physicians’ Desk Reference, 56th ed, 2002.
−0.56; 95% CI, −0.73 to −0.39).58 The †These medications need to be used with caution in elderly patients because of the increased risk of adverse events ‡Phenylpropanolamine and clenbuterol have also been studied but are not approved by the US Food and Drug 2004 American Medical Association. All rights reserved.
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MANAGEMENT OF URINARY INCONTINENCE IN WOMEN ␣-1A adrenoceptors have been found nence. Doxepin as been found to re- incontinence, voiding difficulties, re-to mediate the contractile response of renergic drugs have also been studied.
not available in the United States. Phen- matic activity. A controlled trial of du- Open Retropubic Colposuspen-
sion. Open retropubic colposuspen-
vealed a significant dose response in the P=.6; 40 mg, 59%; P=.02; 80 mg, 58%; P = .04).69 However, there was no sig- in any single adverse-effect category, the What Are the Risks and Benefits
(TABLE 3).70 Open retropubic colpo-
of Surgical Interventions?
Other Drug Treatments. Because of
the individual patient, the choice of pro- their benefit.66 A recently published pla- sion differed in the rates of repeat sur- 2-91).68 The only reported adverse effect 992 JAMA, February 25, 2004—Vol 291, No. 8 (Reprinted)
2004 American Medical Association. All rights reserved.
MANAGEMENT OF URINARY INCONTINENCE IN WOMEN Table 3. Comparative Failure Rates (Not Cured) Within 1 Year for Surgical Procedures for
Relative Risk (95% Confidence Interval)
dence to identify differences in rates ofde novo urge symptoms, urge inconti- Subjective Failure
Objective Failure†
Bladder Neck Needle Suspension.
*Based on data from Lapitan MC.70†Failure to be cured based on objective tests such as stress test, pad test, and/or urodynamic parameters.
the sutures through to the paraure-thral tissue on each side of the bladderneck to support it. There are 3 main 3-11).75,76 There was also a death in the there is a paucity of data, there does not appear to be a difference in failure rates Suburethral Sling Procedure. Sub-
sion and anterior vaginal repair.71 There b i n e d a b d o m i n a l a n d v a g i n a l injection (RR, 1.69; 95% CI, 1.02-2.79).
Anterior Vaginal Repair. During an-
are placed in the periurethral tissue and on their quality of life. Therefore, it is dure and Kelly plication. As already out- Periurethral Injections. The injec-
artificial urethral cushions that can help lowest risk for adverse complications.
Laparoscopic Colposuspension.
fat) with placebo (injection of saline).
ever, there are technical differences in- this field in an attempt to bridge the gap cal practice. Part 2 of this series will fo- 2004 American Medical Association. All rights reserved.
(Reprinted) JAMA, February 25, 2004—Vol 291, No. 8 993
RB, Diokno AC. Prevalence and severity of urinary in- skaar S. Urinary incontinence after vaginal delivery continence in older African American and Caucasian or cesarean section. N Engl J Med. 2003;348:900- women. J Gerontol A Biol Sci Med Sci. 1999;54: Funding/Support: Dr Holroyd-Leduc is funded as a
20. Foldspang A, Mommsen S, Djurhuus J. Preva-
38. Arya LA, Myers DL, Jackson ND. Dietary caf-
Veterans Affairs National Quality Scholar fellow. Dr lent urinary incontinence as a correlate of pregancy, feine intake and the risk for detrusor instability: a case- Straus is supported by a Career Scientist Award from vaginal childbirth, and obstetric techniques. Am J Pub- control study. Obstet Gynecol. 2000;96:85-89.
the Ontario Ministry of Health and Long-term Care.
39. Maggi S, Minicuci N, Langlois J, Pavan M, Enzi
21. Kuh D, Cardozo L, Hardy R. Urinary inconti-
G, Crepaldi G. Prevalence rate of urinary inconti- REFERENCES
nence in middle aged women: childhood enuresis and nence in community-dwelling elderly individuals: the other lifetime risk factors in a British prospective co- Veneto study. J Gerontol A Biol Sci Med Sci. 2001; 1. Abrams P, Cardozo L, Fall M, et al. The standardi-
hort. J Epidemiol Community Health. 1999;53:453- sation of terminology in lower urinary tract function: 40. Garcia A, Smith M, Freedman M. Vitamin B12 de-
report from the standardisation sub-committee of the 22. Arya LA, Jackson ND, Myers DL, Verma A. Risk
ficiency and incontinence in older people. Can J Urol. International Continence Society. Urology. 2003;61: of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women. Am J Ob- 41. Bo K, Borgen JS. Prevalence of stress and urge uri-
2. Thom D. Variation in estimates of urinary incon-
stet Gynecol. 2001;185:1318-1323; discussion, 1323- nary incontinence in elite athletes and controls. Med tinence prevalence in the community: effects of dif- Sci Sports Exerc. 2001;33:1797-1802.
ferences in definition, population characteristics, and 23. Van Kessel K, Reed S, Newton K, Meier A, Lentz
42. Hay-Smith EJ, Bo K, Berghmans LC, et al. Pelvic
study type. J Am Geriatr Soc. 1998;46:473-480.
G. The second stage of labor and stress urinary in- floor muscle training for urinary incontinence in women 3. Herzog AR, Fultz NH. Prevalence and incidence of
continence. Am J Obstet Gynecol. 2001;184:1571- [Cochrane Review]. In: Cochrane Library, Issue 1.
urinary incontinence in community-dwelling popula- Chichester, England: John Wiley & Sons; 2003.
tions. J Am Geriatr Soc. 1990;38:273-281.
24. Samuelsson EC, Victor FT, Svardsudd KF. Five-
43. Hrobjartsson A, Gotzsche PC. Placebo treat-
4. Johnson TM II, Kincade JE, Bernard SL, Busby-
year incidence and remission rates of female urinary ment vs no treatment [Cochrane Review]. In: Coch- Whitehead J, Hertz-Picciotto I, DeFriese GH. The as- incontinence in a Swedish population less than 65 years rane Library, Issue 1. Chichester, England: John Wiley sociation of urinary incontinence with poor self- old. Am J Obstet Gynecol. 2000;183:568-574.
rated health. J Am Geriatr Soc. 1998;46:693-699.
25. Chaliha C, Kalia V, Stanton SL, Monga A, Sultan
44. Goode PS, Burgio KL, Locher JL, et al. Effect of be-
5. Temml C, Haidinger G, Schmidbauer J, Schatzl G,
AH. Antenatal prediction of postpartum urinary and havioral training with or without pelvic floor electrical Madersbacher S. Urinary incontinence in both sexes: fecal incontinence. Obstet Gynecol. 1999;94(5 pt 1): stimulation on stress incontinence in women: a ran- prevalence rates and impact on quality of life and sexual domized controlled trial. JAMA. 2003;290:345-352.
life. Neurourol Urodyn. 2000;19:259-271.
26. Brown JS, Sawaya G, Thom DH, Grady D. Hys-
45. Herbison P, Plevnik S, Mantle J. Weighted vagi-
6. Wyman JF, Harkins SW, Fantl JA. Psychosocial im-
terectomy and urinary incontinence: a systematic re- nal cones for urinary incontinence [Cochrane Re- pact of urinary incontinence in the community- view. Lancet. 2000;356:535-539.
view]. In: Cochrane Library, Issue 1. Chichester, En- dwelling population. J Am Geriatr Soc. 1990;38:282- 27. Kjerulff KH, Langenberg PW, Greenaway L, Uman
J, Harvey LA. Urinary incontinence and hysterec- 46. Aukee P, Immonen P, Penttinen J, Laippala P, Air-
7. Dugan E, Cohen SJ, Bland DR, et al. The associa-
aksinen O. Increase in pelvic floor muscle activity af- tion of depressive symptoms and urinary inconti- tomy in a large prospective cohort study in American nence among older adults. J Am Geriatr Soc. 2000; women. J Urol. 2002;167:2088-2092.
ter 12 weeks’ training: a randomized prospective pi- 28. van der Vaart CH, van der Bom JG, de Leeuw
lot study. Urology. 2002;60:1020-1023; discussion, 8. Rossouw JE, Anderson GL, Prentice RL, et al. Risks
JR, Roovers JP, Heintz AP. The contribution of hys- and benefits of estrogen plus progestin in healthy post- terectomy to the occurrence of urge and stress uri- 47. Morkved S, Bo K, Fjortoft T. Effect of adding bio-
menopausal women: principal results from the Wom- nary incontinence symptoms. Bjog. 2002;109:149- feedback to pelvic floor muscle training to treat uro- en’s Health Initiative randomized controlled trial. JAMA. dynamic stress incontinence. Obstet Gynecol. 2002; 29. Roovers JP, van der Bom JG, Huub van der Vaart
9. Viktrup L, Lose G. The risk of stress incontinence
C, Fousert DM, Heintz AP. Does mode of hysterec- 48. Burgio KL, Goode PS, Locher JL, et al. Behavioral
5 years after first delivery. Am J Obstet Gynecol. 2001; tomy influence micturition and defecation? Acta Ob- training with and without biofeedback in the treat- stet Gynecol Scand. 2001;80:945-951.
ment of urge incontinence in older women: a ran- 10. Sampselle CM, Harlow SD, Skurnick J, Brubaker
30. Van Oyen H, Van Oyen P. Urinary incontinence
domized controlled trial. JAMA. 2002;288:2293- L, Bondarenko I. Urinary incontinence predictors and in Belgium; prevalence, correlates and psychosocial con- life impact in ethnically diverse perimenopausal women.
sequences. Acta Clin Belg. 2002;57:207-218.
49. Wyman JF, Fantl JA, McClish DK, Bump RC, for
Obstet Gynecol. 2002;100:1230-1238.
31. Holtedahl K, Hunskaar S. Prevalence, 1-year
the Continence Program for Women Research Group.
11. Moller LM, Lose G, Jorgensen T. Risk factors for
incidence and factors associated with urinary incon- Comparative efficacy of behavioral interventions in the lower urinary tract symptoms in women 40 to 60 years tinence: a population based study of women 50-74 management of female urinary incontinence. Am J Ob- of age. Obstet Gynecol. 2000;96:446-451.
years of age in primary care. Maturitas. 1998;28:205- stet Gynecol. 1998;179:999-1007.
12. Bortolotti A, Bernardini B, Colli E, et al. Preva-
50. Janssen CC, Lagro-Janssen AL, Felling AJ. The ef-
lence and risk factors for urinary incontinence in Italy.
32. Aggazzotti G, Pesce F, Grassi D, et al. Preva-
fects of physiotherapy for female urinary inconti- lence of urinary incontinence among institutional- nence: individual compared with group treatment. BJU 13. Schmidbauer J, Temml C, Schatzl G, Haidinger G,
ized patients: a cross-sectional epidemiologic study in Madersbacher S. Risk factors for urinary inconti- a midsized city in northern Italy. Urology. 2000;56: 51. McDowell BJ, Engberg S, Sereika S, et al. Effec-
nence in both sexes: analysis of a health screening tiveness of behavioral therapy to treat incontinence project. Eur Urol. 2001;39:565-570.
33. Brown JS, Grady D, Ouslander JG, Herzog AR,
in homebound older adults. J Am Geriatr Soc. 1999; 14. Chiarelli P, Brown W, McElduff P. Leaking urine:
Varner RE, Posner SF, for the Heart & Estrogen/ prevalence and associated factors in Australian women.
Progestin Replacement Study (HERS) Research Group.
52. Burgio KL, Locher JL, Goode PS, et al. Behavioral
Neurourol Urodyn. 1999;18:567-577.
Prevalence of urinary incontinence and associated risk vs drug treatment for urge urinary incontinence in older 15. Samuelsson E, Victor A, Svardsudd K. Determi-
factors in postmenopausal women. Obstet Gynecol. women: a randomized controlled trial. JAMA. 1998; nants of urinary incontinence in a population of young and middle-aged women. Acta Obstet Gynecol Scand. 34. Nelson R, Furner S, Jesudason V. Urinary incon-
53. Alhasso A, Glazener CM, Pickard R, N’Dow J. Ad-
tinence in Wisconsin skilled nursing facilities: preva- renergic drugs for urinary incontinence in adults [Coch- 16. Sherburn M, Guthrie JR, Dudley EC, O’Connell
lence and associations in common with fecal incon- rane Review]. In: Cochrane Library, Issue 1. Chichester, HE, Dennerstein L. Is incontinence associated with tinence. J Aging Health. 2001;13:539-547.
England: John Wiley & Sons; 2003.
menopause? Obstet Gynecol. 2001;98:628-633.
35. Landi F, Cesari M, Russo A, Onder G, Sgadari A,
54. Yamanishi T, Yasuda K, Sakakibara R, Hattori T,
17. Rortveit G, Hannestad YS, Daltveit AK, Hun-
Bernabei R. Benzodiazepines and the risk of urinary Suda S. Randomized, double-blind study of electrical skaar S. Age- and type-dependent effects of parity on incontinence in frail older persons living in the com- stimulation for urinary incontinence due to detrusor urinary incontinence: the Norwegian EPINCONT study.
munity. Clin Pharmacol Ther. 2002;72:729-734.
overactivity. Urology. 2000;55:353-357.
Obstet Gynecol. 2001;98:1004-1010.
36. Finkelstein MM. Medical conditions, medica-
55. Jeyaseelan SM, Haslam EJ, Winstanley J, Roe BH,
18. Persson J, Wolner-Hanssen P, Rydhstroem H. Ob-
tions, and urinary incontinence: analysis of a popula- Oldham JA. An evaluation of a new pattern of elec- stetric risk factors for stress urinary incontinence: a tion-based survey. Can Fam Physician. 2002;48:96- trical stimulation as a treatment for urinary stress in- population-based study. Obstet Gynecol. 2000;96: continence: a randomized, double-blind, controlled trial.
37. Fultz NH, Herzog AR, Raghunathan TE, Wallace
Clin Rehabil. 2000;14:631-640.
994 JAMA, February 25, 2004—Vol 291, No. 8 (Reprinted)
2004 American Medical Association. All rights reserved.
MANAGEMENT OF URINARY INCONTINENCE IN WOMEN 56. Roe B, Williams K, Palmer M. Bladder training for
spective randomized controlled trial of extended- 69. Norton PA, Zinner NR, Yalcin I, Bump RC.
urinary incontinence in adults [Cochrane Review]. In: release oxybutynin chloride and tolterodine tartrate Duloxetine vs placebo in the treatment of stress uri- Cochrane Library, Issue 1. Chichester, England: John in the treatment of overactive bladder: results of nary incontinence. Am J Obstet Gynecol. 2002;187: the OBJECT Study. Mayo Clin Proc. 2001;76:358- 57. Eustice S, Roe B, Paterson J. Prompted voiding for
70. Lapitan MC, Cody DJ, Grant AM. Open retro-
the management of urinary incontinence in adults 64. Davila GW, Daugherty CA, Sanders SW. A
pubic colposuspension for urinary incontinence in [Cochrane Review]. In: Cochrane Library, Issue 1.
short-term, multicenter, randomized double-blind women [Cochrane Review]. In: Cochrane Library, Is- Chichester, England: John Wiley & Sons; 2003.
dose titration study of the efficacy and anticholiner- sue 1. Chichester, England: John Wiley & Sons; 2003.
58. Hay-Smith J, Herbison P, Ellis G, Moore K. Anti-
gic side effects of transdermal compared to imme- 71. Glazener CM, Cooper K. Bladder neck needle sus-
cholinergic drugs versus placebo for overactive blad- diate release oral oxybutynin treatment of patients pension for urinary incontinence in women [Coch- der syndrome in adults [Cochrane Review]. In: Coch- with urge urinary incontinence. J Urol. 2001;166: rane Review]. In: Cochrane Library, Issue 1. Chichester, rane Library, Issue 1. Chichester, England: John Wiley England: John Wiley & Sons; 2003.
65. Phenylpropanolamine information page. US Food
72. Glazener CM, Cooper K. Anterior vaginal repair
59. Zinner NR, Mattiasson A, Stanton SL. Efficacy,
and Drug Administration Web site. Available at: www for urinary incontinence in women [Cochrane Re- safety, and tolerability of extended-release once- Ac- view]. In: Cochrane Library, Issue 1. Chichester, En- daily tolterodine treatment for overactive bladder in cessed January 27, 2004. Accessibility verified Janu- older vs younger patients. J Am Geriatr Soc. 2002; 73. Moehrer B, Ellis G, Carey M, Wilson PD. Lapa-
66. Haeusler G, Leitich H, van Trotsenburg M, Kaider
roscopic colposuspension for urinary incontinence in 60. Leung HY, Yip SK, Cheon C, et al. A randomized
A, Tempfer CB. Drug therapy of urinary urge incon- women [Cochrane Review]. In: Cochrane Library, Is- controlled trial of tolterodine and oxybutynin on tol- tinence: a systematic review. Obstet Gynecol. 2002; sue 1. Chichester, England: John Wiley & Sons; 2003.
erability and clinical efficacy for treating Chinese 74. Bezerra CA, Bruschini H. Suburethral sling opera-
women with an overactive bladder. BJU Int. 2002; 67. Naglie G, Radomski SB, Brymer C, Mathiasen K,
tions for urinary incontinence in women [Cochrane Re- O’Rourke K, Tomlinson G. A randomized, double- view]. In: Cochrane Library, Issue 1. Chichester, En- 61. Lee JG, Hong JY, Choo MS, et al. Tolterodine: as
blind, placebo controlled crossover trial of nimo- effective but better tolerated than oxybutynin in Asian dipine in older persons with detrusor instability and 75. Pickard R, Reaper J, Wyness L, Cody DJ, McClinton
patients with symptoms of overactive bladder. Int J urge incontinence. J Urol. 2002;167(2 pt 1):586- S, N’Dow J. Periurethral injection therapy for urinary incontinence in women [Cochrane Review]. In: Coch- 62. Malone-Lee J, Shaffu B, Anand C, Powell C.
68. Gordon D, Groutz A, Ascher-Landsberg J, Less-
rane Library, Issue 1. Chichester, England: John Wiley Tolterodine: superior tolerability than and compa- ing JB, David MP, Razz O. Double-blind, placebo- rable efficacy to oxybutynin in individuals 50 years old controlled study of magnesium hydroxide for treat- 76. Lee PE, Kung RC, Drutz HP. Periurethral autolo-
or older with overactive bladder: a randomized con- ment of sensory urgency and detrusor instability: gous fat injection as treatment for female stress uri- trolled trial. J Urol. 2001;165:1452-1456.
preliminary results. Br J Obstet Gynaecol. 1998;105: nary incontinence: a randomized double-blind con- 63. Appell RA, Sand P, Dmochowski R, et al. Pro-
trolled trial. J Urol. 2001;165:153-158.
2004 American Medical Association. All rights reserved.
(Reprinted) JAMA, February 25, 2004—Vol 291, No. 8 995


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