Burgio K L, Locher J L, Goode P S
University of Alabama at Birmingham School of Medicine and Center for Aging, USA.
J Am Geriatr Soc. 2000 Apr;48(4):370-4. doi: 10.1111/j.1532-5415.2000.tb04692.x.
The purpose of this study was to examine the effects of combining behavioral treatment and drug treatment for urge incontinence in community-dwelling older women.
Modified crossover design (extension of a randomized clinical trial). Eligible subjects were stratified according to type and severity of incontinence and randomized to behavioral treatment, drug treatment, or a control condition (placebo). Subjects not totally continent or not satisfied after 8 weeks of a single treatment were offered the opportunity to cross over into combined therapy.
A university-based outpatient geriatric medicine clinic.
Subjects in the clinical trial were 197 ambulatory, nondemented, community-dwelling women (age 55 years or older) with persistent urge urinary incontinence. Thirty-five subjects participated in combined treatment.
One group of subjects received four sessions (over 8 weeks) of biofeedback-assisted behavioral training followed by 8 weeks of behavioral training combined with drug therapy (oxybutynin chloride individually titrated from 2.5 mg to 15 mg daily). The second group received drug therapy first, followed by 8 weeks of drug therapy combined with behavioral training.
Bladder diaries completed by subjects before and after each treatment phase were used to calculate change in the frequency of incontinent episodes.
Eight subjects (12.7%) crossed from behavioral treatment alone to combined behavioral and drug therapy. Additional benefit was seen in improvement from a mean 57.5% reduction of incontinence with single therapy to a mean 88.5% reduction of incontinence with combined therapy (P = .034). Twenty-seven subjects (41.5%) crossed from drug therapy alone to combined drug and behavioral treatment. They also showed additional improvement, from a mean 72.7% reduction of incontinence with single therapy to a mean 84.3% reduction of incontinence with combined therapy (P = .001).
This study shows that combining drug and behavioral therapy in a stepped program can produce added benefit for patients with urge incontinence.
本研究旨在探讨行为治疗与药物治疗相结合对社区居住老年女性急迫性尿失禁的影响。
改良交叉设计（随机临床试验的扩展）。符合条件的受试者根据尿失禁的类型和严重程度进行分层，随机分为行为治疗组、药物治疗组或对照组（安慰剂组）。单一治疗8周后未完全控尿或不满意的受试者有机会交叉接受联合治疗。
一所大学的门诊老年医学诊所。
临床试验的受试者为197名能走动、无痴呆、居住在社区的女性（年龄55岁及以上），患有持续性急迫性尿失禁。35名受试者参与了联合治疗。
一组受试者接受为期4节（共8周）的生物反馈辅助行为训练，随后8周的行为训练与药物治疗相结合（氯奥昔布宁每天单独滴定，从2.5毫克至15毫克）。第二组受试者先接受药物治疗，随后8周的药物治疗与行为训练相结合。
受试者在每个治疗阶段前后完成的膀胱日记用于计算尿失禁发作频率的变化。
8名受试者（12.7%）从单纯行为治疗交叉至行为与药物联合治疗。联合治疗显示出额外益处，单一治疗时尿失禁平均减少57.5%，联合治疗时平均减少88.5%（P = 0.034）。27名受试者（41.5%）从单纯药物治疗交叉至药物与行为联合治疗。他们也显示出额外改善，单一治疗时尿失禁平均减少72.7%，联合治疗时平均减少84.3%（P = 0.001）。
本研究表明，在逐步治疗方案中结合药物和行为疗法可为急迫性尿失禁患者带来额外益处。
