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Meta-Analysis
. 2005 Jul 20;2005(3):CD001842.
doi: 10.1002/14651858.CD001842.pub2.

Adrenergic drugs for urinary incontinence in adults

A Alhasso  1 , C M A Glazener, R Pickard, J N'dow
Affiliations
Meta-Analysis

Adrenergic drugs for urinary incontinence in adults

A Alhasso et al. Cochrane Database Syst Rev. .

Abstract

Background: Adrenergic drugs have been used for the treatment of urinary incontinence. However, they have generally been considered to be ineffective or to have side effects which may limit their clinical use.

Objectives: To determine the effectiveness of adrenergic agonists in the treatment of urinary incontinence in adults.

Search strategy: We searched the Cochrane Incontinence Group specialised trials register (searched 9 March 2005) and the reference lists of relevant articles.

Selection criteria: Randomised or quasi-randomised controlled trials in adults with urinary incontinence which included an adrenergic agonist drug in at least one arm of the trial.

Data collection and analysis: Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Reviewers' Handbook.

Main results: Twenty-two eligible randomised trials were identified, of which 11 were crossover trials. The trials included 1099 women with 673 receiving an adrenergic drug (phenylpropanolamine in 11 trials, midodrine in two, norepinephrine in three, clenbuterol in another three, terbutaline in one, eskornade in one and Ro-115-1240 in one). No trials included men. The limited evidence suggested that an adrenergic agonist drug is better than placebo in reducing the number of pad changes and incontinence episodes, as well as improving subjective symptoms. In two small trials, the drugs also appeared to be better than pelvic floor muscle training, possibly reflecting relative acceptability of the treatments to women but perhaps due to differential withdrawal of women from the trial groups. There was not enough evidence to evaluate the use of higher compared to lower doses of adrenergic agonists nor the relative merits of an adrenergic agonist drug compared with oestrogen, whether used alone or in combination. Over a quarter of women reported adverse effects. There were similar numbers of adverse effects with adrenergics, placebo or alternative drug treatment. However, when these were due to recognised adrenergic stimulation (insomnia, restlessness and vasomotor stimulation) they were only severe enough to stop treatment in 4% of women.

Authors' conclusions: There was weak evidence to suggest that use of an adrenergic agonist was better than placebo treatment. There was not enough evidence to assess the effects of adrenergic agonists when compared to or combined with other treatments. Further larger trials are needed to identify when adrenergics may be useful. Patients using adrenergic agonists may suffer from minor side effects, which sometimes cause them to stop treatment. Rare but serious side effects, such as cardiac arrhythmias and hypertension, have been reported.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Adrenergic agonist vs placebo, Outcome 1 Number cured (subjective).
1.2
1.2. Analysis
Comparison 1 Adrenergic agonist vs placebo, Outcome 2 Number cured or improved (subjective).
1.3
1.3. Analysis
Comparison 1 Adrenergic agonist vs placebo, Outcome 3 Number cured (objective).
1.4
1.4. Analysis
Comparison 1 Adrenergic agonist vs placebo, Outcome 4 Number improved (objective).
1.7
1.7. Analysis
Comparison 1 Adrenergic agonist vs placebo, Outcome 7 Pad weight/24 hrs.
1.8
1.8. Analysis
Comparison 1 Adrenergic agonist vs placebo, Outcome 8 Adverse events.
2.1
2.1. Analysis
Comparison 2 Adrenergic agonist vs conservative therapy, Outcome 1 Number cured or improved (subjective).
2.2
2.2. Analysis
Comparison 2 Adrenergic agonist vs conservative therapy, Outcome 2 Number cured (objective).
2.3
2.3. Analysis
Comparison 2 Adrenergic agonist vs conservative therapy, Outcome 3 Number cured or improved (objective).
2.4
2.4. Analysis
Comparison 2 Adrenergic agonist vs conservative therapy, Outcome 4 Incontinence episode/24 hrs.
2.5
2.5. Analysis
Comparison 2 Adrenergic agonist vs conservative therapy, Outcome 5 Adverse events.
2.6
2.6. Analysis
Comparison 2 Adrenergic agonist vs conservative therapy, Outcome 6 Satisfaction with treatment.
4.7
4.7. Analysis
Comparison 4 Lower dose of an adrenergic agonist vs higher dose, Outcome 7 Adverse events.
6.1
6.1. Analysis
Comparison 6 Adrenergic agonist vs other drugs, Outcome 1 Number cured (subjective).
6.2
6.2. Analysis
Comparison 6 Adrenergic agonist vs other drugs, Outcome 2 Number cured or improved (subjective).
6.3
6.3. Analysis
Comparison 6 Adrenergic agonist vs other drugs, Outcome 3 Number with urgency or urge incontinence improved.
6.4
6.4. Analysis
Comparison 6 Adrenergic agonist vs other drugs, Outcome 4 Adverse events.
6.5
6.5. Analysis
Comparison 6 Adrenergic agonist vs other drugs, Outcome 5 Withdrawal due to adverse effects.
7.1
7.1. Analysis
Comparison 7 Adrenergic agonist + other drug vs other drug alone, Outcome 1 Number cured (subjective).
7.2
7.2. Analysis
Comparison 7 Adrenergic agonist + other drug vs other drug alone, Outcome 2 Number cured or improved (subjective).
7.4
7.4. Analysis
Comparison 7 Adrenergic agonist + other drug vs other drug alone, Outcome 4 Adverse events.
8.1
8.1. Analysis
Comparison 8 Adrenergic agonist + other drug vs adrenergic agonist alone, Outcome 1 Number cured or improved (subjective).
8.4
8.4. Analysis
Comparison 8 Adrenergic agonist + other drug vs adrenergic agonist alone, Outcome 4 Adverse events.
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Update of

References

References to studies included in this review

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References to studies excluded from this review

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MeSH terms