Teunissen T A M, de Jonge A, van Weel C, Lagro-Janssen A L M
Department of General Practice and Social Medicine, Nijmegen University, Nijmegen, The Netherlands.
J Fam Pract. 2004 Jan;53(1):25-30, 32.
To evaluate the effectiveness of conservative treatment in the community-based elderly (aged > or = 55 years) with stress, urge, and mixed urinary incontinence.
Systematic review of before-after studies or randomized controlled trials on the effect of exercise and drug therapy in urinary incontinence.
Reduction of urinary accidents, patient's perception, cystometric measurement, perineometry, and side effects.
MEDLINE (1966-2001), EMBASE (1986-2001), Science Citation Index (1988-2001), The Cochrane Library, and PiCarta were searched. RESULTS Four before-after studies and 4 randomized controlled trials were identified. Drug therapy alone: no study of sufficient quality. Drug therapy compared with behavioral therapy, 3 studies: bladder-sphincter biofeedback reduced urinary accidents in cases of urge or mixed incontinence by 80.7%, significantly better than oxybutynin (68.5%) or placebo (39.4%). Adding drug to behavioral treatment or behavioral to drug treatment also resulted in significant reduction in urodynamic urge incontinence (57.5%-88.5% vs 72.7-84.3%). Pelvic floor exercises alone reduced urinary accidents by 48% (compared with 53% for phenylpropanolamine) in patients with mixed or stress incontinence. Behavioral therapy, 5 studies: bladder-sphincter biofeedback in case of urge or mixed incontinence, bladder training in case of urge incontinence and pelvic floor exercises in case of stress incontinence reduced the urinary accidents with 68% to 94%.
There are only a few studies of sufficient methodological quality on the effect of conservative treatment of urinary incontinence in the elderly. Behavioral therapy reduced urinary accidents; the effect of drug therapy is unclear. We recommend behavioral therapy as first choice.
评估以社区为基础的老年（年龄≥55岁）压力性、急迫性和混合性尿失禁患者保守治疗的效果。
对运动和药物治疗尿失禁效果的前后对照研究或随机对照试验进行系统评价。
尿失禁次数减少、患者感受、膀胱测压、会阴测压及副作用。
检索MEDLINE（1966 - 2001年）、EMBASE（1986 - 2001年）、科学引文索引（1988 - 2001年）、考克兰图书馆和PiCarta。结果确定了4项前后对照研究和4项随机对照试验。单纯药物治疗：无质量足够的研究。药物治疗与行为治疗比较，3项研究：膀胱括约肌生物反馈使急迫性或混合性尿失禁患者的尿失禁次数减少80.7%，显著优于奥昔布宁（68.5%）或安慰剂（39.4%）。在行为治疗基础上加用药物或在药物治疗基础上加用行为治疗也使尿动力学急迫性尿失禁显著减少（57.5% - 88.5%对72.7% - 84.3%）。单纯盆底肌锻炼使混合性或压力性尿失禁患者的尿失禁次数减少48%（苯丙醇胺为53%）。行为治疗，5项研究：急迫性或混合性尿失禁采用膀胱括约肌生物反馈，急迫性尿失禁采用膀胱训练，压力性尿失禁采用盆底肌锻炼，使尿失禁次数减少68%至94%。
关于老年尿失禁保守治疗效果的方法学质量足够的研究较少。行为治疗可减少尿失禁次数；药物治疗的效果尚不清楚。我们推荐行为治疗作为首选。
