Women with urge urinary incontinence are commonly treated with antimuscarinic medications, although many discontinue therapy. A study by Burgio and colleagues attempted to determine whether combining antimuscarinic drug therapy with supervised behavioral training, compared with drug therapy alone, improved the ability of women with urge incontinence to achieve clinically important reductions in incontinence episodes and to sustain these improvements after discontinuing drug therapy. The study featured a two-stage, multicenter, randomized clinical trial conducted from July 2004 to January 2006 at 9 university-affiliated outpatient clinics. Subjects included 307 women with urge-predominant incontinence. The intervention consisted of10 weeks of open-label, extended-release tolterodine alone (n = 153) or combined with behavioral training (n = 154), followed by discontinuation of therapy and follow-up at 8 months. The primary outcome, measured at 8 months, was no receipt of drugs or other therapy for urge incontinence and a 70% or greater reduction in frequency of incontinence episodes. Secondary outcomes were reduction in incontinence, self-reported satisfaction and improvement, and scores on validated questionnaires measuring symptom distress and bother, and health-related quality of life. Study staff who performed outcome evaluations, but not participants and interventionists, were blinded to group assignment. A total of 237 participants completed the trial. According to life-table estimates, the rate of successful discontinuation of therapy at 8 months was the same in the combination therapy and drug therapy alone groups (41% in both groups; difference, 0 percentage points). A higher proportion of participants who received combination therapy than drug therapy alone achieved a 70% or greater reduction in incontinence at 10 weeks (69% vs. 58%). Combination therapy yielded better outcomes over time on the Urogenital Distress Inventory and the Overactive Bladder Questionnaire at both time points for patient satisfaction and perceived improvement but not health-related quality of life. Adverse events were uncommon (12 events in 6 participants [3 in each group]).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER. The authors concluded that behavioral therapy components (daily bladder diary and recommendations for fluid management) in the group receiving drug therapy alone could have attenuated between-group differences.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The addition of behavioral training to drug therapy may reduce incontinence frequency during active treatment but does not improve the ability to discontinue drug therapy and maintain improvement in urinary incontinence. Combination therapy has a beneficial effect on patient satisfaction, perceived improvement, and reduction of other bladder symptoms.

KL Burgio et al. Behavioral therapy to enable women with urge incontinence to discontinue drug treatment: a randomized trial. Annals of Internal Medicine, 2008;149:161-169.