UT Southwestern Medical Center, Department of Urology, Dallas, TX 75390-9110, USA.
BJU Int. 2010 Jun;105(12):1680-5. doi: 10.1111/j.1464-410X.2009.09055.x. Epub 2009 Nov 13.
To explore whether instruction in fluid management resulted in changes in fluid intake and incontinence over a 10-week study period in women with urinary urge incontinence (UUI), as fluid management might be a critical strategy in treating this condition.
In the 'Behaviour Enhances Drug Reduction of Incontinence' trial, women with predominant UUI were randomized to daily treatment with tolterodine or tolterodine combined with behavioural therapies, among which were individualized instructions on fluid management. Patients in both groups received general fluid management instructions, while in the drug + behaviour arm, those with excessive urine output (>2.1 L/day) had additional individualized instruction during each of four study visits to learn behavioural strategies. Variables measured at baseline and at 10 weeks were type of incontinence, using the Medical, Epidemiological, and Social Aspects of Aging questionnaire, severity of incontinence by number of incontinence episodes based on a 7-day diary, number of voids/24 h (F(24)), urgency rating, 24-h fluid intake (I(24)) and 24-h volume voided (V(24)), volume average (V(avg)), pad use, bothersomeness of UUI (Urogenital Distress Inventory and Overactive Bladder questionnaire), and quality of life (Incontinence Impact Questionnaire-7 and Short-Form-12).
Leakage episodes/24 h, V(24), I(24) and average urgency ratings all significantly decreased from baseline to 10 weeks (P < 0.001 for each). V(avg) increased (P < 0.001), as did voids/L intake (P = 0.01). None of the changes in diary variable outcomes differed by treatment group after accounting for these changes between baseline and 10 weeks. In a multivariable model, treatment group was not associated with change in V(24) from baseline to 10 weeks (P = 0.81), but the difference in the number of accidents/diary day, F(24), I(24), and average voids/day each were positively related with the change in V(24) (P < 0.001 for each). Patients had a response to fluid management instructions; the decrease in the percentage of women with a V(24) of >2.1 L between baseline and follow-up was statistically significant (P = 0.01 McNemar's test).
General fluid instructions can contribute to the reduction in UUI symptoms for women taking anticholinergic medications, but additional individualized instructions along with other behavioural therapies did little to further improve the outcome.
探讨在为期 10 周的研究期间，液体管理指导是否会改变患有急迫性尿失禁（UUI）女性的液体摄入和失禁情况，因为液体管理可能是治疗这种疾病的关键策略。
在“行为增强药物减少失禁”试验中，将以 UUI 为主的女性随机分为每日接受托特罗定或托特罗定联合行为治疗，其中包括个性化的液体管理指导。两组患者均接受一般液体管理指导，而在药物+行为组中，对于尿量过多（>2.1L/天）的患者，在四次研究访问中的每一次都接受额外的个性化指导，以学习行为策略。在基线和 10 周时测量的变量包括失禁类型，使用医疗、流行病学和老龄化社会方面问卷，根据 7 天日记计算的失禁发作次数评估失禁严重程度，24 小时排尿次数（F（24））、急迫感评分、24 小时液体摄入量（I（24））和 24 小时尿量（V（24））、平均容量（V（avg））、垫使用量、UUI 困扰程度（尿生殖窘迫量表和膀胱过度活动症问卷）以及生活质量（失禁影响问卷-7 和简明健康状况调查问卷-12）。
从基线到 10 周，漏尿发作/24 小时、V（24）、I（24）和平均急迫感评分均显著降低（P<0.001）。V（avg）增加（P<0.001），摄入的尿量/摄入量也增加（P=0.01）。在考虑到基线和 10 周之间的变化后，日记变量结果的任何变化在治疗组之间均无差异。在多变量模型中，治疗组与从基线到 10 周的 V（24）变化无关（P=0.81），但每个意外/日记日的数量差异、F（24）、I（24）和平均排尿次数/天与 V（24）的变化呈正相关（P<0.001）。患者对液体管理指导有反应；从基线到随访，V（24）>2.1L 的女性百分比下降具有统计学意义（P=0.01 麦克内尔检验）。
一般液体指导可以有助于减少服用抗胆碱能药物的女性的 UUI 症状，但额外的个性化指导和其他行为治疗并没有进一步改善结果。
