Stress Urinary Incontinence

Systematic review and economic modelling of the effectiveness and efficiency of non-surgical treatments for women with stress urinary incontinence (SUI)

Various surgical and non-surgical therapies have been developed to alleviate the symptoms of SUI, improve quality of life and patient satisfaction. The wide range of proposed treatments and the rather disappointing reviews of efficacy suggest that none of the options yet provide the ideal combination of clinical efficacy, high safety, patient satisfaction and low cost.

Non-surgical treatments for stress urinary incontinence were found to be effective and could potentially be cost-effective, but judgement is required as to whether the benefits are worth the cost. There is clear evidence that Pelvic Floor Muscle Training (PFMT) plus biofeedback and PFMT with extra sessions were effective and potentially cost-effective. Several other treatments look promising but there is insufficient evidence to recommend their routine use.

Outcome and Translation

Results from this study will be used to inform future use of non-surgical treatments. Currently recommended regimes for PFMT are not likely to be cost-effective.

As a result of this review, the NIHR commissioned a new trial, OPAL, to investigate whether PFMT plus biofeedback is really more effective than PFMT alone.

HERU researchers involved in this research project: Mary Kilonzo and Luke Vale (HERU/HSRU)

External Collaborators: J Wardle (Continence Foundation); P Abrams (British Urological Institute); R Pickard (University of Newcastle); C Glazener, J Cody, J Cook, G Mowatt, S Wallace, Z Shihua, I Mari (HSRU, University of Aberdeen); J N'Dow, G Nabi, A Grant (Division of Applied Health Science); L Cardozo (King's College Hospital, London); B Buckley (Incontact); JH Smith (University of Otago, New Zealand); B Christine (NHS Grampian) and S Eustice (NHS Cornwall)

Publications

Imamura, M., Abrams, P., Bain, C., Buckley, B., Cardozo, L., Cody, J., Cook, J., Eustice, S., Glazener, C., Grant, A., Hay-Smith, J., Hislop, J., Jenkinson, D., Kilonzo, M., Nabi, G., N'Dow, J., Pickard, R., Ternent, L., Wallace, S., Wardle, J., Zhu, S. and Vale, L. (2009) Systematic review and economic modelling of the effectiveness and efficiency of non-surgical treatments for women with stress urinary incontinence, Final report submitted to NIHR HTA Programme.

Ternent, L., Vale, L., Buckley, B. and Glazener, C. (2009) 'Measuring outcomes of importance to women with stress urinary incontinence', British Journal of Obstetrics and Gynaecology, 116 (5), 719-725.

Imamura, M., Abrams, P., Bain, C., Buckley, B., Cardozo, L., Cody, J., Cook, J., Eustice, S., Glazener, C., Grant, A., Hay-Smith, J., Hislop, J., Jenkinson, D., Kilonzo, M., Nabi, G., N'Dow, J., Pickard, R., Ternent, L., Wallace, S., Wardle, J., Zhu, S. and Vale, L. (2010) 'Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence', Health Technology Assessment, 14(40).

Presentations

Jenkinson, D., Imamura, M., Hislop, J. and Vale, L. for the Stress Urinary Incontinence Review Group (2009) 'Non-surgical treatment for stress urinary incontinence in women: a systematic review incorporating a mixed treatment comparison analysis', Health Technology Assessment International (HTAi), Singapore, June 2009. [2nd Prizewinner].

Vale, L. on behalf of the Stress Urinary Incontinence Review Group (2009) 'Non-surgical treatment for stress urinary incontinence in women: a systematic review and economic analysis', Association for Continence Advice, Coventry, June 2009.

Imamura, M., Jenkinson, D., Glazener, C. and Vale, L. (2010) 'The stress urinary incontinence review group. Effectiveness of non-surgical interventions for women with stress urinary incontinence: systematic review and meta-analysis of randomised controlled trials', International Continence Society/International Urogynecological Association Annual meeting, Toronto, August 2010.