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Treatment for Urge UI—Evidence Review
Level 1a evidence: Systematic reviews, meta-analyses, multiple congruent RCT’s
1) A combination of behavioral therapy—pelvic floor exercise and scheduled
voiding—with pharmacologic therapy is often most effective for urge UI.
2) Pharmacologic therapy clearly yields statistically significant improvement in
urge UI, yet the effect is small (decrease in UI episodes by about 0.5/day).
Unclear if benefit is clinically significant.
3) If pharmacologic therapy is used, no consistent evidence favors any particular
drug, though tolterodine gives less dry mouth than oxybutynin.
4) Pelvic floor exercises are effective in the treatment of urge UI, but the effect is
small. A trial of > 3 months is recommended for mixed UI.
5) Bladder training/scheduled voiding may also be effective, with a small benefit.
A trial of 6 weeks is recommended for urge UI. This method works best in urge
UI patients with cognitive impairment.
Level 1b evidence: Single large RCT’s, weak systematic review conclusions
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Anticholinergic drugs may be more effective than behavioral treatments.
Hormone replacement therapy makes UI worse, with a NNH = 8.
UI returns after a woman discontinues pelvic floor exercises.
Biofeedback, a self-help booklet on pelvic floor exercise, and patient education
on pelvic floor exercise all reduced the number of UI episodes by ~ 60%.
Level 4 evidence: Expert opinion
1) Lifestyle changes such as weight loss, caffeine reduction, and monitoring fluid
intake may have some benefit in urge UI.
2) No herbal supplements are effective in urge UI.
3) Electrical stimulation of pelvic floor muscles may help women who can’t
contract these muscles. Any benefit is quite small.
4) Sacral nerve stimulation may benefit urge UI patients who do not respond to
first-line treatments.
5) A Foley catheter will not prevent leakage in urge UI.
6) Botox and self-catheterization are an option for those who fail all treatments.
7) Surgical procedures include augmentation cystoplasty and urinary diversion.