Evidence Report/Technology Assessment 

Number 161 

Prevention of Urinary and Fecal Incontinence in Adults 

Prepared for: 

Agency for Healthcare Research and Quality 

U.S. Department of Health and Human Services 

540 Gaither Road 

Rockville, MD 20850 

www.ahrq.gov 

Contract No. 290-02-0009 

Prepared by: 

Minnesota Evidence-based Practice Center, Minneapolis, Minnesota 

Investigators

Tatyana Shamliyan, M.D., M.S. 

Jean Wyman, Ph.D. 

Donna Z. Bliss, Ph.D., R.N., F.A.A.N. 

Robert L. Kane, M.D. 

Timothy J. Wilt, M.D., M.P.H. 

AHRQ Publication No. 08-E003 

December 2007
This report is based on research conducted by the Minnesota Evidence-based Practice Center 

(EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, 

MD (Contract No. 290-02-0009, Task Order #5). The findings and conclusions in this document 

are those of the authors, who are responsible for its content, and do not necessarily represent the 

views of AHRQ. No statement in this report should be construed as an official position of AHRQ 

or of the U.S. Department of Health and Human Services. 

The information in this report is intended to help clinicians, employers, policymakers, and others 

make informed decisions about the provision of health care services. This report is intended as a 

reference and not as a substitute for clinical judgment. 

This report may be used, in whole or in part, as the basis for the development of clinical practice 

guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage 

policies. AHRQ or U.S. Department of Health and Human Services endorsement of such 

derivative products may not be stated or implied. 
ii 

This document is in the public domain and may be used and reprinted without permission except 

those copyrighted materials noted for which further reproduction is prohibited without the 

specific permission of copyright holders. 

Suggested Citation: 

Shamliyan T, Wyman J, Bliss DZ, Kane RL, Wilt TJ. Prevention of Fecal and Urinary 

Incontinence in Adults. Evidence Report/Technology Assessment No. 161 (Prepared by the 

Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ 

Publication No. 08-E003. Rockville, MD. Agency for Healthcare Research and Quality. 

December 2007. 

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, 

honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) 

that conflict with material presented in this report. 
iii 

Preface 

 The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based 

Practice Centers (EPCs), sponsors the development of evidence reports and technology 

assessments to assist public- and private-sector organizations in their efforts to improve the 

quality of health care in the United States. This report was requested by the NIH Office of 

Medical Applications of Research as a background paper for the State-of-the-Science 

Conference on Prevention of Fecal and Urinary Incontinence in Adults. The reports and 

assessments provide organizations with comprehensive, science-based information on common, 

costly medical conditions, and new health care technologies. The EPCs systematically review the 

relevant scientific literature on topics assigned to them by AHRQ and conduct additional 

analyses when appropriate prior to developing their reports and assessments. 

 To bring the broadest range of experts into the development of evidence reports and health 

technology assessments, AHRQ encourages the EPCs to form partnerships and enter into 

collaborations with other medical and research organizations. The EPCs work with these partner 

organizations to ensure that the evidence reports and technology assessments they produce will 

become building blocks for health care quality improvement projects throughout the Nation. The 

reports undergo peer review prior to their release. 

 AHRQ expects that the EPC evidence reports and technology assessments will inform 

individual health plans, providers, and purchasers as well as the health care system as a whole by 

providing important information to help improve health care quality. 

 We welcome written comments on this evidence report. They may be sent to the Task Order 

Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, 

Rockville, MD 20850, or by email to epc@ahrq.gov.

Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. 

Director Director, Center for Outcomes and Evidence 

Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality 

Lata S. Nerurkar, Ph.D. Beth A. Collins Sharp, R.N., Ph.D. 

Office of the Director Director, EPC Program 

NIH Office of Medical Applications of Research Agency for Healthcare Research and Quality 

Office of Disease Prevention 

 Ernestine Murray, M.A.S., R.N. 

 EPC Program Task Order Officer 

 Agency for Healthcare Research and Quality 
iv 

Acknowledgments 

 We would like to thank the librarians, Jim Beattie, M.L.I.S., Judy Stanke, M.A., and Delbert 

Reed, Ph.D., for their contributions to the literature search; Jing Du, Ryan Ping, Joseph Kaiya 

M.D., Susan Penque, and Mary Dierich for their assistance with the literature search and data 

abstraction; Marilyn Eells for editing and formatting the report; and Charmaine Bird and Kristina 

Mucha for assistance with data entry and formatting tables. 

 We also want to thank Linda Brubaker, M.D., Tomas Griebling, M.D., Robert Madoff, M.D., 

Richard Nelson, M.D., Joseph Ouslander, M.D., Neil Resnick, M.D., Carolyn Sampselle, Ph.D., 

David Thom, M.D., Ph.D., and Joanne Townsend, R.N., for serving on our Technical Expert 

Panel, Chadwick Huckabay, M.D., for advice and counsel on urinary incontinence management, 

and Ingrid Nygaard, M.D., Mary H. Palmer, Ph.D., and Debra Saliba, M.D., for reviewing the 

draft of this report and providing us with helpful recommendations for revisions and 

clarifications. 
v 

Structured Abstract 

Objectives: To assess the prevalence of and risk factors for urinary (UI) and fecal (FI) 

incontinence in adults in long-term care (LTC) settings and in the community, the effectiveness 

of diagnostic methods to identify adults at risk and patients with incontinence, and to review the 

effectiveness of clinical interventions to reduce the risk of incontinence. 

Data Sources: MEDLINE® (PubMed), CINAHL, and Cochrane Databases. 

Review Methods: Observational studies were reviewed to examine the prevalence and incidence 

of UI and FI and the association with risk factors. The effects of treatments on patient outcomes 

were analyzed from randomized controlled and multicenter clinical trials. The diagnostic values 

of the tests were compared from the original epidemiologic studies of different designs. Of the 

6,097 articles identified, 1,077 articles were eligible for analysis. 

Results: The prevalence of UI, FI, and combined incontinence increased with age and functional 

dependency. Cognitive impairment, limitations in daily activities, and prolonged 

institutionalization in nursing homes were associated with a higher risk of incontinence. Stroke, 

diabetes, obesity, poor general health, and comorbidities were associated with UI and FI in 

community dwelling adults. Parity, anal trauma, and vaginal prolapse in women and urological 

surgery and radiation for prostate cancer in men are risk factors for UI and FI. Intensive 

individualized management and rehabilitation programs improved continence status in nursing 

home residents and adults after stroke. Self-administered behavioral interventions including 

pelvic floor muscle training with biofeedback and bladder training resolved UI in incontinent 

women. Electrical stimulation and sacral neuromodulation improved urge UI, but improvement 

for FI was inconsistent. Tension-free vaginal tape procedures and modified surgical techniques 

for prolapse to support the bladder neck resolved stress UI in the majority of treated women. 

Behavioral treatments of FI resulted in small improvements in severity and quality of life related 

to incontinence. The effects on FI of surgical techniques for hemorrhoids, rectal prolapse, rectal 

cancer, and anal fissures are not consistent across studies. Surgical interventions in patients with 

ulcerative colitis resulted in the same rates of fecal continence when compared to each other. The 

few clinical interventions to treat FI that were tested in well-designed trials had no clear evidence 

of better effects of the compared treatments. Instrumental outcomes to evaluate the effectiveness 

of treatments did not correlate with patient outcomes. Epidemiologic surveys to detect persons at 

risk and patients with undiagnosed UI have the same diagnostic value and less cost compared to 

professional examinations and diagnostic tests. Self-reported questionnaires and scales have 

unsatisfactory validity to diagnose FI. 

Conclusions: Epidemiologic surveys are cost-effective ways to estimate the prevalence of UI in 

large nationally representative population groups. Routine clinical evaluation should include an 

assessment of the risk factors, symptoms, and signs of incontinence. Pregnant or menopausal 

women, women with vaginal prolapse, males treated for prostate disease, patients with rectal 

prolapse, and frail elderly and nursing home residents are high risk groups. Individualized 

management programs can improve continence in LTC facilities but are hard to sustain. Regular 

monitoring and documentation of the continence status in relation to implemented continence 
vi 

services should be quality of care indicators for nursing homes. Pelvic floor muscle trainings 

with biofeedback can resolve incontinence and improve quality of life. Surgery is effective in 

curing stress UI in females. Clinical interventions for UI in males and for FI in adults need future 

investigation. A list of research recommendations is offered. 
vii 

Contents 

Executive Summary........................................................................................................................ 1 

Evidence Report.......................................................................................................................... 17 

Chapter 1. Introduction ................................................................................................................. 17 

 Overview ................................................................................................................................ 17 

Chapter 2. Methods....................................................................................................................... 21 

 Literature Search Strategy and Eligibility Criteria ................................................................. 21 

 Search Strategy................................................................................................................. 21 

 Eligibility.......................................................................................................................... 21 

 Quality Assessment and Rating the Body of Evidence.................................................... 22 

 Applicability..................................................................................................................... 23 

 Data Extraction................................................................................................................. 23 

 Data Synthesis .................................................................................................................. 23 

 Definitions of incontinence ........................................................................................ 23 

 Definitions of outcomes ............................................................................................. 24 

Chapter 3. Results ......................................................................................................................... 27 

Question 1. What are the Prevalence and Incidence of UI in the Community and 

LTC Settings? ........................................................................................................................ 27 

 UI in the Adult Population ............................................................................................... 27 

 Overview .................................................................................................................... 27 

 Prevalence, severity, and impact of UI ...................................................................... 28 

 Incidence of UI........................................................................................................... 28

 Progression and Remission of UI in Community Dwelling Adults ................................. 28 

 Prevalence of UI in Community Dwelling Women ......................................................... 29 

 Overview .................................................................................................................... 29 

 Prevalence, severity, and impact of UI ...................................................................... 29 

 Racial/ethnic differences............................................................................................ 30 

 Type of UI .................................................................................................................. 30 

 Incidence of UI in Community Dwelling Women ........................................................... 31 

 Summary .................................................................................................................... 31 

 Progression and Remission of UI in Community Dwelling Women ............................... 32 

 Prevalence of UI in Community Dwelling Men............................................................... 32 

 Type of UI .................................................................................................................. 33 

 Severity of UI............................................................................................................. 33 

 Racial/ethnic differences............................................................................................ 33 

 Incidence of UI in Community Dwelling Men................................................................. 34 

 Progression and remission of UI in community dwelling men.................................. 34 

 Epidemiology of UI in LTC Settings ............................................................................... 34 

 Overview .................................................................................................................... 34 

 Prevalence of UI in the LTC population .................................................................... 34 

 Incidence of UI in LTC settings................................................................................. 35 
viii 

 Progression and remission of UI in LTC settings ...................................................... 35 

Question 1. What are the Prevalence and Incidence of FI in the Community and 

LTC Settings? ......................................................................................................................... 84 

 Prevalence of Combined UI and FI in Adults in LTC Settings........................................ 84 

 Prevalence of FI with or without UI in Adults in LTC Settings ...................................... 84 

 Prevalence of FI in Community Dwelling Elderly Adults ............................................... 85 

 Prevalence of FI in Community Dwelling Men ............................................................... 85 

 Prevalence of FI in Community Dwelling Women.......................................................... 85 

 Prevalence of FI in Community Dwelling Adults............................................................ 86 

 Prevalence of FI in Community Dwelling Adults by Race.............................................. 86 

 Limitations........................................................................................................................ 87 

 Summary .......................................................................................................................... 87 

Question 2. What are the Independent Contributions of Risk Factors for Urinary, 

Fecal, and Combined Urinary and Fecal Incontinence?......................................................... 93 

 Overview of Risk Factors for UI...................................................................................... 93 

 Risk Factors for UI in Community Dwelling Women ..................................................... 93 

 Age ............................................................................................................................. 93 

 Gender ........................................................................................................................ 94 

 Race/ethnicity............................................................................................................. 94 

 Obesity ....................................................................................................................... 95 

 Geriatric influence...................................................................................................... 96 

 Lifestyle Factors ............................................................................................................... 96 

 Physical activity ......................................................................................................... 96

 Education and occupational status ............................................................................. 97 

 Marital status and social support................................................................................ 97 

 Dietary factors............................................................................................................ 97 

 Caffeine................................................................................................................ 97 

 Carbonated beverages .......................................................................................... 97 

 Food consumption................................................................................................ 97 

 Alcohol use .......................................................................................................... 97 

 Smoking ..................................................................................................................... 98 

 Functional status......................................................................................................... 98

 Cognitive function ............................................................................................... 98 

 Depression............................................................................................................ 98 

 Physical function.................................................................................................. 99 

 Gynecological Factors...................................................................................................... 99

 Parity .......................................................................................................................... 99 

 Obstetric and fetal factors ........................................................................................ 100 

 UI during and following pregnancy................................................................... 100 

 Mode of delivery................................................................................................ 100 

 Oxytocin............................................................................................................. 100 

 Epidural analgesia.............................................................................................. 100 

 Duration of labor................................................................................................ 100 

 Episiotomy, lacerations, and perineal suturing.................................................. 101 

 Gestational age................................................................................................... 101 

 Fetal weight and head circumference ................................................................ 101 
ix 

 Lactation ............................................................................................................ 101 

 Menstrual cycle and menopause .............................................................................. 101 

 Gynecological or abdominal surgery ....................................................................... 101 

 Pelvic floor muscle contraction strength.................................................................. 102 

 Other factors............................................................................................................. 102 

 Urological Factors .......................................................................................................... 102 

 Childhood voiding dysfunction................................................................................ 102 

 Lower urinary tract symptoms ................................................................................. 103 

 Urinary tract infections ............................................................................................ 103 

 Postvoid residual bladder volume ............................................................................ 103 

 Bladder or urinary surgery ....................................................................................... 103 

 Medical Conditions ........................................................................................................ 103

 Arthritis and musculoskeletal disorders ................................................................... 103 

 Diabetes.................................................................................................................... 104 

 Stroke ....................................................................................................................... 104 

 Neurological disorders ............................................................................................. 104 

 Pulmonary disorders................................................................................................. 105 

 Comorbidity and poor health ................................................................................... 105 

 Cardiovascular disorders.......................................................................................... 105 

 Gastrointestinal diseases and procedures ................................................................. 105 

 Constipation ..................................................................................................... 105 

 Other surgical procedures ........................................................................................ 106 

 Medications .................................................................................................................... 106 

 Incident UI ............................................................................................................... 106 

 Diuretics ................................................................................................................... 106 

 Estrogen.................................................................................................................... 106 

 Psychotropic medications......................................................................................... 106 

 Other medication...................................................................................................... 107 

 Summary .................................................................................................................. 107

 Risk Factors for UI in Community Dwelling Men............................................................... 107 

 Summary ........................................................................................................................ 109 

 Association between Stroke and UI in Community Dwelling Adults............................ 109 

 Risk Factors for UI in LTC Settings .............................................................................. 109 

 Association between risk factors and UI in LTC settings........................................ 109 

 Overview of Risk Factors for FI..................................................................................... 144 

 Age ........................................................................................................................... 144 

 Gender ...................................................................................................................... 144 

 Race.......................................................................................................................... 145 

 Diet, BMI, and diabetes ........................................................................................... 145 

 Physical activity ....................................................................................................... 145 

 Smoking and pulmonary diseases ............................................................................ 145 

 Muscle-skeletal disorders......................................................................................... 145 

 Neoplasm.................................................................................................................. 145 

 Comorbidities........................................................................................................... 146 

 Stroke and other neurological disorders................................................................... 146 
x 

 Functional impairments and dependency status in association to FI in 

residents of nursing homes....................................................................................... 146 

 Functional status and mental health in association with FI in community 

dwelling adults ......................................................................................................... 146 

 Chronic gastrointestinal conditions.......................................................................... 147 

 Surgical procedures.................................................................................................. 147 

 Drug administration ................................................................................................. 147 

 Prostate diseases....................................................................................................... 147 

 Anal trauma.............................................................................................................. 148

 FI in association with UI .......................................................................................... 148 

 Prolapse .................................................................................................................... 148 

 FI related to pregnancy and birth ............................................................................. 148 

 Summary .................................................................................................................. 150

Question 3. What is the Evidence to Support Specific Clinical Interventions to 

Reduce the Risk of UI and FI? ............................................................................................. 185 

 Effects of Clinical Interventions on UI in Adults in LTC Settings ................................ 185 

 Implementation of evidence-based guidelines ......................................................... 185 

 Conservative management programs ....................................................................... 185 

 Level of evidence ..................................................................................................... 186 

 Summary .................................................................................................................. 186

 Effects of Clinical Interventions on UI in Community Dwelling Adults....................... 186 

 Implementation of evidence-based guidelines ......................................................... 186 

 Conservative management programs ....................................................................... 186 

 Dietary and other lifestyle interventions in females................................................. 187 

 Attributable to conservative management program events...................................... 187 

 Primary prevention of female UI related to pregnancy and birth ............................ 188 

 Pelvic floor muscle training for secondary prevention of UI in community 

dwelling females ...................................................................................................... 188 

 Outcome – Continence........................................................................................ 188 

 Outcome – Improvement in UI in community dwelling females ....................... 189 

 Outcome – Progression of UI in community dwelling females.......................... 189 

 Clinical interventions for primary prevention of UI in community dwelling 

males ......................................................................................................................... 190 

 Outcome – Continence........................................................................................ 190 

 Outcome – UI in community dwelling males..................................................... 190 

 Behavioral clinical interventions for secondary prevention of urinary 

continence in adults................................................................................................... 190 

 Effects of Behavioral Interventions on Severity of UI and Quality of Life.................... 190 

 Surrogate outcomes................................................................................................... 190 

 Subjective measures of severity of UI and quality of life in females 

(continuous surrogate variables)......................................................................... 190 

 Objective measures of severity of UI in females (pad test, urodynamic 

cystometry, and perineometry) ........................................................................... 191 

 Subjective measures of severity of UI in adults.................................................. 191 

 Pooled estimates of behavioral interventions on urinary continence in adults......... 191 

 Attributable benefits of behavioral interventions ..................................................... 192 
xi 

 Level of evidence...................................................................................................... 192 

 Summary .................................................................................................................. 192

 Effects of Physiotherapeutic Interventions on UI in Community Dwelling Adults ....... 192 

 Patient outcomes ...................................................................................................... 192 

 Continence in community dwelling females....................................................... 192 

 Improvement in UI in community dwelling females.......................................... 193 

 UI in community dwelling females..................................................................... 193 

 Continence in community dwelling adults ......................................................... 194 

 Improvement in UI in community dwelling adults............................................. 194 

 Surrogate outcomes................................................................................................... 194 

 Subjective measures of severity and quality of life of UI in community 

dwelling females ................................................................................................. 194 

 Objective measures of severity of UI in community dwelling females.............. 194 

 Subjective measures of severity of UI in community dwelling adults ............... 195 

 Objective measure of severity of UI in community dwelling adults .................. 195 

 Events attributable to stimulation therapy .......................................................... 195 

 Summary................................................................................................................... 195 

 Effects of Medical Devices on UI in Community Dwelling Females ........................... 195 

 Patient outcomes ....................................................................................................... 195 

 Continence and improvement of UI in community dwelling females................ 195 

 Severity of UI and quality of life with UI in community dwelling females....... 196 

 UI in community dwelling males........................................................................ 196 

 Effects of Bulking Agents on UI in Community Dwelling Females.............................. 196 

 Outcomes .................................................................................................................. 196 

 Continence .......................................................................................................... 196 

 Improvement in UI.............................................................................................. 196 

 UI ........................................................................................................................ 197 

 Clinical Effects of Obstetric Interventions on UI........................................................... 197 

 Patient outcome – UI ................................................................................................ 197 

 Effects of Hysterectomy on UI....................................................................................... 198 

 Patient outcome – UI ................................................................................................ 198 

 Surrogate outcome – objective measures of severity of UI ...................................... 198 

 Effects of Vaginal Tapes and Sling Procedures on UI................................................... 198 

 Patient outcomes ....................................................................................................... 198 

 Continence (curative effects) .............................................................................. 198 

 Improvement of UI in females............................................................................ 198 

 UI in females....................................................................................................... 199 

 Surrogate outcomes................................................................................................... 199 

 Subjective measure of severity of UI.................................................................. 199 

 Objective measure of severity of UI ................................................................... 199 

 Effects of Surgical Interventions on UI in Community Dwelling Women.................... 199 

 Patient outcomes ....................................................................................................... 199 

 Continence .......................................................................................................... 199 

 Improvement in UI.............................................................................................. 200 

 Incidence of UI ................................................................................................... 200 

 Surrogate outcomes................................................................................................... 200 
xii 

 Subjective measures of UI .................................................................................. 200 

 Objective measures of UI.................................................................................... 200 

 Possible predictors of better effect............................................................................ 200 

 Summary................................................................................................................... 201 

 Reducing the Adverse Effects of Clinical Interventions Done for Other Purposes ....... 201 

 Effects of clinical interventions on UI in adults with adenocarcinoma of the 

rectum ................................................................................................................. 201 

 Effects of clinical interventions on UI in males with urological diseases ................ 201 

 Patient outcomes – Continence........................................................................... 201 

 Patient outcomes – Incidence of UI.................................................................... 201 

 Surrogate outcomes – Subjective measures of quality of life............................. 202 

 Surrogate outcomes – Objective measures of UI................................................ 202 

 Summary............................................................................................................. 202 

 Effects of Hormone Therapy on UI in Community Dwelling Women .................... 202 

 Patient outcomes – Continence........................................................................... 202 

 Patient outcomes – Improvement of UI.............................................................. 203 

 Patient outcomes – UI......................................................................................... 203 

 Patient outcomes – Subjective progression of UI............................................... 203 

 Surrogate outcomes – Subjective measures of severity of UI ............................ 203 

 Surrogate outcomes – Objective measures of severity ....................................... 204 

 Summary............................................................................................................. 204 

 Effects of Pharmacological Agents on UI ................................................................ 204 

 Summary............................................................................................................. 205 

 Effects of Clinical Interventions on FI ........................................................................... 277 

 Baseline mechanisms of FI ....................................................................................... 277 

 Clinical Interventions to Reduce Progression of FI in Adults in Nursing Homes 

and LTC Settings ............................................................................................................ 277

 Conservative management of FI in nursing homes................................................... 277 

 Pharmacological interventions on FI in LTC settings .............................................. 277 

 Evidence-based conservative management of FI...................................................... 277 

 Summary................................................................................................................... 277 

 Dietary Interventions on FI in Community Dwelling Adults......................................... 278 

 Effects of Conservative Management of Postnatal FI in Females ................................. 278 

 Summary................................................................................................................... 278 

 Behavioral Interventions on FI in Females .................................................................... 278 

 Patient outcomes ....................................................................................................... 278 

 Continence .......................................................................................................... 278 

 FI......................................................................................................................... 278 

 Surrogate outcome – Objectively measured mean maximum resting 

pressure ............................................................................................................... 278 

 Effects of Behavioral Interventions on FI in Community Dwelling Adults .................. 279 

 Patient outcomes ....................................................................................................... 279 

 Continence .......................................................................................................... 279 

 Improvement of FI .............................................................................................. 279 

 FI......................................................................................................................... 279 
xiii 

 Surrogate outcome – Subjectively measure severity of FI and quality of life 

with FI....................................................................................................................... 279 

 Summary................................................................................................................... 279 

 Effects of Electrical Stimulation and Neuromodulation on FI....................................... 280 

 Patient outcomes ....................................................................................................... 280 

 Continence .......................................................................................................... 280 

 Improvement....................................................................................................... 280 

 Surrogate outcomes................................................................................................... 280 

 Subjective measures of quality of life................................................................. 280 

 Objective measures of severity of FI .................................................................. 280 

 Summary................................................................................................................... 280 

 Effects of Massage on FI................................................................................................ 280 

 Effects of Pharmacological Agents on FI in Community Dwelling Adults................... 280 

 Botulinum toxin ........................................................................................................ 280 

 Outcome – FI ...................................................................................................... 280 

 Surrogate outcome – Subjective measures of severity of FI............................... 281 

 Surrogate outcome – Objective measure of severity of FI ................................. 281 

 Loperamide ............................................................................................................... 281

 Surrogate outcome – Subjective measure of severity of UI ............................... 281 

 Surrogate outcome – Objective measure of severity of FI ................................. 281 

 Effects of Chemical Sphincterotomy.............................................................................. 281 

 Patient outcomes – Continence................................................................................. 281 

 Surrogate outcomes – Subjective and objective measures of severity of FI............. 281 

 Effects of Alpha-Adrenergic Agonist on FI ................................................................... 281 

 Patient outcome – Improvement in FI ...................................................................... 281 

 Surrogate outcome – Subjective measures of severity of FI..................................... 281 

 Effects of Nonabsorbable Basic Aluminum Salt on Late Rectal Injury Related 

to Radiotherapy .............................................................................................................. 282 

 Patient outcome – FI ................................................................................................. 282 

 Effects of Medical Bowel Confinement on FI ............................................................... 282 

 Patient outcome – Improvement in FI ...................................................................... 282 

 Summary................................................................................................................... 282 

 Effects of Different Techniques to Repair External Anal Sphincter after Acute 

Obstetric Trauma ............................................................................................................ 282

 Patient outcome – FI ................................................................................................. 282 

 Surrogate outcome – Subjective and objective measures of FI ................................ 282 

 Effects of Clinical Interventions to Prevent FI after Delivery ....................................... 282 

 Patient outcome – FI ................................................................................................. 282 

 Surrogate outcome – Subjective and objective measures of FI ................................ 283 

 Summary................................................................................................................... 283 

 Effects of Early Ultrasound Diagnosis of Anal Obstetric Trauma................................. 283 

 Primary outcomes – FI.............................................................................................. 283 

 Effects of Surgical Interventions on FI in Females with Rectal Prolapse...................... 283 

 Patient outcome – Continence .................................................................................. 283 

 Effects of Surgical Interventions on Females with FI.................................................... 283 

 Patient outcome – Continence .................................................................................. 283 
xiv 

 Surrogate outcome – Subjective and objective measures of severity of FI .............. 284 

 Effects of Clinical Interventions in Men with Prostate Diseases on the Risk of FI ....... 284 

 Patient outcomes ....................................................................................................... 284 

 Continence .......................................................................................................... 284 

 FI......................................................................................................................... 284 

 Surrogate outcome – Subjective measure of severity of FI ...................................... 284 

 Effects of Bowel Management on FI in Patients with Spinal Cord Injury..................... 284 

 Surrogate outcomes – Subjective measures of severity of FI................................... 284 

 Effects of Different Techniques of Hemorrhoidectomy on FI ....................................... 285 

 Patient outcomes ....................................................................................................... 285 

 Continence .......................................................................................................... 285 

 Improvement in FI .............................................................................................. 285 

 Surrogate outcome – Objective measure of severity of FI ....................................... 285 

 Effects of Clinical Interventions in Patients with Colorectal Diseases on FI................. 285 

 Patient outcome – FI ................................................................................................. 285 

 Surrogate outcome – Subjective measures of severity of FI..................................... 286 

 Effects of Clinical Interventions in Patients with Rectal Prolapse on FI ....................... 286 

 Patient outcome – FI ................................................................................................. 286 

 Surrogate outcome – Subjective and objective measures of severity of FI .............. 286 

 Effects of Surgical Treatments of Anal Sphincter on FI ................................................ 286 

 Patient outcomes ....................................................................................................... 286 

 Continence .......................................................................................................... 286 

 FI......................................................................................................................... 286 

 Surrogate outcome – Subjective and objective measures of severity of FI .............. 287 

 Surrogate outcome – Dynamic gracioplasty............................................................. 287 

 Summary................................................................................................................... 287 

 Surgical Interventions (Restorative Proctocolectomy) on FI in Adults (FI as 

Secondary Outcome)...................................................................................................... 287 

 Patient outcome – Continence .................................................................................. 287 

 Surrogate outcome – Subjective and objective measures of severity of FI .............. 288 

 Summary................................................................................................................... 288 

Question 4. What are the Strategies to Improve the Identification of Persons at Risk 

and Patients who have FI and UI? ........................................................................................ 304 

 Strategies to Improve the Identification of Persons at Risk and Patients who 

have UI........................................................................................................................... 304 

 Valid questionnaires to assess UI............................................................................. 304 

 Diagnostic value of the questionnaires and scales for UI ........................................ 305 

 Diagnostic value of clinical history compared to multichannel urodynamic 

for stress UI in community dwelling adults ............................................................. 306 

 Diagnostic value of clinical history compared to multichannel urodynamics 

for urge UI in community dwelling adults............................................................... 307 

 Diagnostic values of different tests to detect persons at risk and patients with 

UI.............................................................................................................................. 308 

 Diagnostic value of ultrasound compared for UI in community dwelling adults .... 308 

 Strategies to Improve the Identification of Persons at Risk and Patients who have 

FI .................................................................................................................................. 321 
xv 

Chapter 4. Discussion ................................................................................................................. 323 

 Detection of UI ..................................................................................................................... 323 

 Detection of FI...................................................................................................................... 323 

 Treatment.............................................................................................................................. 324 

 Sampling......................................................................................................................... 324 

 Definitions of Incontinence and Measures of Success ......................................................... 324 

 Clinical Effectiveness to Reduce the Risk of Incontinence.................................................. 325 

 Primary Prevention......................................................................................................... 325 

 Secondary Prevention..................................................................................................... 326 

 Strength of the Evidence....................................................................................................... 327 

 Policy Implications ............................................................................................................... 328 

Question 5. What are the Research Priorities for Identifying Effective Strategies to 

Reduce the Burden of Illness in these Conditions?........................................................ 328 

References and Included Studies ................................................................................................ 337 

List of Acronyms/Abbreviations................................................................................................. 379 

Tables

Table 1. Prevalence of UI in community dwelling adults by age and race .............................. 36 

Table 2. Pooled prevalence of UI in women by time of occurrence (random effects 

model, statistical test for between studies heterogeneity significant for all 

estimates) .................................................................................................................... 57 

Table 3. Pooled prevalence of UI in women by frequency and severity (random 

effects model, statistical test for between studies heterogeneity significant 

for all estimates).......................................................................................................... 60 

Table 4. Prevalence of UI by incontinence type, age, and race in community 

dwelling women ......................................................................................................... 61 

Table 5. Pooled prevalence of UI in women by type of incontinence (random effects 

model, statistical test for between studies heterogeneity significant for all 

estimates).................................................................................................................... 69 

Table 6. Incidence of UI in community dwelling adults .......................................................... 72 

Table 7. Pooled annual incidence of UI in women (random effects model) 18 studies ........... 76 

Table 8 Pooled prevalence of total, mixed, stress, and urge male UI among age 

categories (random effects model) ............................................................................. 77 

Table 9 Pooled prevalence of UI in American males by definition and age 

categories (random effects model) ............................................................................. 77 

Table 10 Pooled prevalence of UI in American males by severity and age categories 

(random effects model) .............................................................................................. 78 

Table 11. Prevalence of UI and incontinence types in LTC populations by age, gender, 

and race. ..................................................................................................................... 79 

Table 12. Prevalence of FI in LTC settings................................................................................ 88 

Table 13. Prevalence of FI in community dwelling elderly adults............................................. 89 

Table 14. Prevalence of FI in community dwelling men............................................................ 90 
xvi 

Table 15. Pooled prevalence of AI (FI) in males by type and age categories (random 

effects model)............................................................................................................. 91 

Table 16. Prevalence of FI in community dwelling women....................................................... 91 

Table 17. Pooled prevalence of AI (FI) in females by type and age categories (random 

effects model)............................................................................................................. 92 

Table 18 Association between parity and UI in females ......................................................... 115 

Table 19. Odds ratio of UI according to delivery..................................................................... 122 

Table 20. Association between age, race, and behavioral risk factors with male UI ............... 128 

Table 21. Association between risk factors and male UI ......................................................... 131 

Table 22. Prevalence of UI in patients with stroke................................................................... 137 

Table 23. Association between stroke and UI in community dwelling adults ......................... 138 

Table 24. Prevalence of UI among residents in LTC with risk factors .................................... 139 

Table 25. Association between UI and risk factors (adjusted odds ratios) in LTC settings..... 141 

Table 26. Association between dependency, mental, gastrointestinal diseases, and UI 

(adjusted odds ratios) in LTC settings ..................................................................... 142 

Table 27. Association between age and FI ............................................................................... 151 

Table 28. Association between gender and FI (women as a reference gender) ....................... 153 

Table 29. Association between FI and diet, BMI, and diabetes ............................................... 154 

Table 30. Association between FI, smoking, and pulmonary diseases .................................... 156 

Table 31. Association between FI and muscle-skeletal diseases.............................................. 157 

Table 32. Association between FI and comorbidities............................................................... 158 

Table 33. Association between FI and stroke........................................................................... 159 

Table 34. Association between FI and functional status of residents in nursing homes .......... 160 

Table 35. Association between FI with functional status and mental health in adults............. 161 

Table 36. Association between FI and gastrointestinal conditions in adults............................ 162 

Table 37. Association between FI and prostate diseases.......................................................... 163 

Table 38. Association between FI and anal trauma in females ................................................ 165 

Table 39. Association between FI and UI ................................................................................ 166 

Table 40. Association between FI and pregnancy related risk factors ..................................... 168 

Table 41. Association between risk of FI and severity of FI and factors related to 

pregnancy and birth.................................................................................................. 174 

Table 42. Association between baseline FI, number of pregnancies, and FI ........................... 179 

Table 43. Association between FI and birth related anal trauma ............................................. 182 

Table 44. Comparative effectiveness of combined conservative management 

interventions on UI (significant relative benefit of continence shown from 

individual studies) .................................................................................................... 206 

Table 45. Comparative effectiveness of combined conservative management 

interventions on female UI related to pregnancy and birth (primary 

prevention) ............................................................................................................... 208 

Table 46. Relative benefit of urinary continence after behavioral interventions in 

adults compared to regular care (random effects models, secondary 

prevention) ............................................................................................................... 210 

Table 47. Comparative effectiveness of behavioral interventions on urinary 

continence in adults from the community (significant results from 

individual RCTs)...................................................................................................... 213 
xvii 

Table 48. Comparative effectiveness of behavioral interventions to improve UI in adults 

(significant results from individual RCTs) .............................................................. 217 

Table 49. Comparative effectiveness of behavioral interventions to reduce the risk of 

UI in adults............................................................................................................... 222 

Table 50. Comparative effectiveness of behavioral intervention on severity of UI in adults .. 224 

Table 51. Comparative effectiveness of electrical stimulation on neuromodulation on 

UI in adults............................................................................................................... 226 

Table 52. Comparative effectiveness of electrical stimulation on any UI in adults ................. 229 

Table 53. Comparative effectiveness of bulking agents on UI in females ............................... 230 

Table 54. Effects of surgical interventions on urinary continence in females 

(secondary prevention)............................................................................................. 231 

Table 55. Comparative effectiveness of surgical procedures on urinary continence in 

females (results from RCTs) .................................................................................... 244 

Table 56. Comparative effectiveness of surgical interventions on urinary continence 

in females (secondary prevention) ........................................................................... 246 

Table 57. Comparative effectiveness of surgical interventions on improvement of 

urinary continence in adults ..................................................................................... 251 

Table 58. Comparative effectiveness of surgical interventions on urinary continence 

in adults .................................................................................................................... 254 

Table 59. Comparative effectiveness of hormone therapy compared to placebo on risk 

of UI in females........................................................................................................ 256 

Table 60. Clinical interventions that resulted in stress urinary continence in more than 

75% of participating females ................................................................................... 259 

Table 61. Clinical interventions that resulted in urinary continence in more than 75% 

of participating males............................................................................................... 262 

Table 62. Clinical interventions that resulted in urinary continence at 6 or more 

months of followup (results from RCTs sorted by treatments and rates of 

continence after active treatments [from highest to lowest]) ................................... 263 

Table 63. Surgical interventions that resulted in significant difference in urinary 

continence at 6 or more months of followup (results from RCTs) .......................... 266 

Table 64. Clinical interventions that resulted in a larger number of attributable events 

of urinary continence in adults from the community (number of additional 

continence cases >300 per 1,000 treated.................................................................. 269 

Table 65. Effects of adrenergic drugs on self-reported urinary continence in females 

(results from RCTs).................................................................................................. 271 

Table 66. Effects of anticholinergic drugs compared to placebo on self-reported 

urinary continence or improvement in UI in adults with overactive bladder 

(results from RCTs).................................................................................................. 272 

Table 67. Effects of serotonin and noradrenaline reuptake inhibitor duloxetine on 

stress UI (results from RCTs) .................................................................................. 273 

Table 68. Comparative effectiveness of surgical interventions in anal sphincter on FI 

in adults (events) ...................................................................................................... 289 

Table 69. Effects of restorative proctocolectomy on FI in adults (events)............................... 290 

Table 70. Comparative effectiveness of clinical interventions on FI in community 

dwelling adults (significant differences only shown) .............................................. 297 
xviii 

Table 71. Diagnostic value of validated questionnaires and scales to detect persons at 

risk and patients with UI .......................................................................................... 311 

Table 72. Diagnostic value of clinical history compared to multichannel urodynamics – 

“gold standard” to detect persons at risk and patients with UI ................................ 313 

Table 73. Diagnostic value of ultrasound exam compared to multichannel urodynamics – 

“gold standard” to detect persons at risk and patients with UI ................................ 316 

Table 74. Number needed to screen to detect one case of UI, number of tests to detect 

one case of UI, and cost to detect one case of UI (prevalence of 

undiagnosed UI ........................................................................................................ 317 

Table 75. Number needed to screen and number of tests to detect one case of UI in 

women (pooled sensitivity and sensitivity of tests in comparison with 

multichannel urodynamic) ....................................................................................... 320 

Table 76. Ongoing clinical trials of the interventions for incontinence (registered in 

www.clinicaltrials.gov) ............................................................................................ 331 

Table 77. Ongoing studies of diagnosis of incontinence.......................................................... 335 

Figures 

Figure 1. Flow of study selection ............................................................................................... 27 

Figure 2. Annual incidence of UI in women by type of incontinence (random effects 

model) ......................................................................................................................... 76 

Figure 3. Association between incident UI in women of different races compared to 

Caucasian women (results from two studies) ........................................................... 111 

Figure 4. Prevalent UI in African American women compared to Caucasian women ............ 112 

Figure 5. Prevalent UI in Hispanic women compared to Caucasian women........................... 112 

Figure 6. Association between prevalent UI and BMI in women depending on time of 

having UI .................................................................................................................. 113 

Figure 7. Association between prevalent UI and BMI in women who reported 

involuntary urine loss in the past year ...................................................................... 113 

Figure 8. Association between severity of prevalent UI and BMI in women .......................... 114 

Figure 9. Association between severity of prevalent stress UI and BMI in women ................ 114 

Figure 10. Odds ratio of UI in females with different numbers of births................................... 120 

Figure 11. Odds ratios of stress UI in females with different numbers of births ....................... 121 

Figure 12. Odds ratio of UI after vaginal delivery compared to Caesarean section .................. 124 

Figure 13. Odds ratio of UI after forceps delivery compared to vaginal or no forceps ............. 124 

Figure 14. Association between arthritis and UI in women....................................................... 125 

Figure 15. Association between prevalent stress UI and diabetes in females............................ 125 

Figure 16. Association between prevalent UI and diabetes in women ...................................... 126 

Figure 17. Association between prevalent urge UI and diabetes in women .............................. 126 

Figure 18. Association between stroke and prevalent UI in women.......................................... 127 

Figure 19. Association between alcohol intake and male UI ..................................................... 129 

Figure 20. Association between smoking and male UI.............................................................. 129 

Figure 21. Association between BMI and male UI.................................................................... 130 

Figure 22. Association between diabetes and male UI (random effects model)........................ 130 

Figure 23. Association between neurological diseases and male UI ......................................... 133 

Figure 24. Association between stroke and male UI.................................................................. 133 
xix 

Figure 25. Association between ADL and male UI ................................................................... 134 

Figure 26. Association between urinary tract infections and symptoms and male UI............... 134 

Figure 27. Association between urinary tract conditions and male UI ...................................... 135 

Figure 28. Association between prostate diseases, treatments for prostate disease, and 

male UI...................................................................................................................... 136 

Figure 29. Relative benefit of urinary continence after active treatment compared to usual 

care in males with urological diseases (efficacy RCTs, primary prevention) .......... 209 

Figure 30. Relative benefit of urinary continence after active treatment compared to 

usual care in females (efficacy RCT, secondary prevention) ................................... 211 

Figure 31. Relative benefit of improvement in UI after active treatment compared to 

usual care (pooled results from RCTs, random effects model) ................................ 212 

Appendixes 

Appendix A: Analytical Framework 

Appendix B: Exact Search Strings 

Appendix C: List of Excluded Studies 

Appendix D: Technical Expert Panel Members and Affiliation 

Appendix E: Data Abstraction Forms 

Appendix F: Evidence Tables 

Appendixes cited in this report are available at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/fuiad/fuiad.pdf.

1 

Executive Summary 

Introduction 

 The high prevalence of urinary (UI),1,2 fecal (FI),3

 and combined4,5 incontinence in long-term 

care (LTC) settings and in community dwelling adults6-9 and the substantial impact of 

incontinence on quality of life10-12 13,14 underscores the need for more and better research on 

effective strategies to identify patients at risk15-17 and clinical interventions to reduce the risk of 

incontinence.13,18-21 Prevalence and risk factors depend on baseline physiological mechanisms, 

including weakness of pelvic floor muscles important for both UI and FI, hyperactive bladder 

that may result in urge UI, poor urethral sphincter function associated with stress UI,22,23 and 

impaired structural and functional integrity of pudendal nerve activity, rectal compliance and 

rectal sensation, and anal sphincter associated with FI.17,20,23,24

 Updated evidence-based recommendations to detect high-risk subgroups and to diagnose and 

treat symptoms and baseline causes of incontinence could improve effective patient-centered 

health care.25-27

 This systematic review was commissioned as background material for an NIH/OMAR Stateof-the-Science Conference on the Prevention of Fecal and Urinary Incontinence in Adults. The 

aims of this review are to synthesize the published evidence of effective methods to identify 

individuals at risk and patients with undiagnosed UI and FI in the community and in LTC 

settings and to compare the effectiveness of different clinical interventions to prevent the 

occurrence and progression of UI and FI in adults. 

 The following questions were developed for this review: 

1. What are the prevalence and incidence of urinary and fecal incontinence in the 

community and long-term care settings? How does prevalence differ in race, ethnicity, 

and gender groups? 

2. What are the independent contributions of risk factors for urinary and fecal incontinence, 

including age, functional impairment, institutionalization, parity, childbirth, and 

postpartum state, menopause, dietary factors, smoking, obesity, genetic factors, prostate 

disorders, dementia, psychiatric disorders, specifically depression, diabetes, urinary tract 

infection, chronic gastrointestinal conditions, cardiovascular and pulmonary diseases, 

gastrointestinal, gynecologic, and urological procedures, neurological disorders, such as 

stroke and spinal cord problems? 

3. What is the evidence to support specific clinical interventions to reduce the risk of 

urinary and fecal incontinence? 

4. What are the strategies to improve the identification of persons at risk and patients who 

have urinary and fecal incontinence? 

5. What are the research priorities for identifying effective strategies to reduce the burden of 

illness in these conditions? 

 For Question 1 we reviewed population-based surveys of prevalence and incidence of 

incontinence in LTC settings and in the community. We compared the diagnostic accuracy of 

different questionnaires, scales, and instrumental methods to the methods that are believed to be 

the “gold standard” to detect incontinence in adults. For Question 2 we evaluated the absolute 

risk of incontinence in subpopulations with risk factors, including surgical procedures and 

specific diseases, and adjusted relative risk or odds ratios of incontinence in adults with different 

levels of risk factors. For Question 3 we synthesized the results of the randomized controlled 
2 

clinical trials (RCTs) and large multicenter trials to determine which treatments resulted in better 

rates of cure and improvement in symptoms and quality of life. Severity (frequency and amount 

of involuntary leakage of urine and feces) and impact on quality of life of incontinence were 

analyzed from the published articles. 

Methods 

 Original epidemiologic studies from 1990 to 2007 that examined the risk of incontinence in 

adults were identified from the National Library of Medicine, CINAHL, and Cochrane 

Databases. Randomized controlled clinical trials and nonrandomized large multicenter trials (for 

FI) were reviewed to compare the effects of different treatments. 

 We use the terminology of the International Continence Society (ICS) of urinary (stress, 

urge, mixed) (Chapter 3), anal (flatus and fecal: solid, and liquid feces), and combined 

incontinence (Chapter 5).20,21,23 To facilitate the discussion of fecal incontinence, we use the term 

fecal incontinence in the text to encompass both fecal and anal incontinence and in the evidence 

tables we use the exact definitions from the original reports. These two terms are frequently used 

interchangeably in the literature and create a great deal of confusion. 

Results 

 Of 6,097 potentially relevant articles, we found 1,077 articles eligible for analysis. 

Prevalence of Incontinence in LTC Settings 

 The prevalence of UI in nursing homes varied from 30 to 77 percent.2,28-31 More than half of 

the residents were incontinent at admission,32 while the estimated annual incidence rate was 20 

percent for occasional urge and 14.5 percent for occasional stress UI.33 The majority of women 

in LTC (60-78 percent) reported UI.28-30,32 The prevalence of UI in men ranged from 23 to 72 

percent.28-30,32 Prevalence rates increased with advancing age in both men and women of all 

races.2,29,30,32 One of the largest cross-sectional studies of 10,215 older nursing home residents 

found that 40 percent of the residents suffer from combined UI and FI.5

 Involuntary loss of solid 

or liquid feces was experienced by 46 percent of nursing home residents3

 with an annual 

incidence of 14 percent.4

 Eighty-three percent of nursing home residents with severe cognitive 

impairment had FI.34

Prevalence of Incontinence in Community Dwelling Adults 

 Large population-based studies reported that 9-22 percent of adults had UI,8,9,30,35-38 with 

even higher rates (37 percent) in a recent study of 145,765 men and women 65 years and over.39

Pooled analysis of 117 epidemiological studies of UI prevalence in community dwelling 

women7,8,30,35-148suggested that the prevalence of ever having UI increased from 21 percent in 

19-44 year old (17 studies) to 34 percent in 45-64 year old (45 studies), and to 39 percent among 

elderly women (11 studies). Younger females reported UI in the past year less frequently (two 

studies), the prevalence increased to 35-41 percent among women 45-64 years (11 studies) and 

older than 65 years (13 studies). Elderly women reported UI in the past month (four studies) 
3 

more often. Overall prevalence of monthly UI was the highest in elderly females (two 

studies)111,133 and in women 45-64 years old (nine studies).43,45,46,62,116,124,132,133,148 Weekly 

incontinence was experienced more often by women older than 65 years42,94,97,148 and elderly 

women over 80.42 Few studies reported daily UI, 5 percent of younger women (19-44 years 

old)96 and 17 percent of women older than 65 years79 reported having daily leakage. The 

prevalence of total UI increase in age categories from 19 percent in women 19-44 years (18 

studies)57,64,68,69,75,80,85,86,92,96,98-100,119,130,133,145,148 to 29 percent in those older than 45 years. Stress 

incontinence was the most prevalent type in women 19-44 years old (15 studies) 

37,57,64,80,85,91,95,98,104,108,109,130,133,145,124 and in those 45-64 years of age (36 studies). 

37,38,44,51,57,61,70,73-75,77,78,80,84,85,87,89,95,104,108,116,117,122,124,127,129,131,135-137,139,141,145,148,149 However, 

mixed UI was the most prevalent type of incontinence in older women; 16.8 percent of women 

older than 65 (19 studies)30,35,59,66,71,72,74,80,85,90,104,106,108,110,121,128,142,143,145 and 16 percent of 

elderly women reported mixed UI (seven studies).71,74,80,84,106,124,133 The prevalence of urge 

incontinence gradually increased from 5 percent in younger women37,57,64,80,85,91,95,98,101,104, 

108,130,133,145 to 10 percent in women 45-64 (32 studies),37,44,51,57,61,70,73-75,77,78,80,84,85,87,89,95,102,104, 

108,116,117,124,126,127,129,131,137,139,145,148,149 and to 12 percent in women older than 65 years (28 

studies).30,35,37,56,59,61,63,66,71,72,74,80,84,85,90,104,106,108,110,118,121,123,125,128,133,142,143,145

 Pooled annual incidence of UI (18 studies)38,45,47,56,59,62,103,134,139,149-157 was 6.25 percent for all 

ages, with the highest in elderly women; 7 percent in those older than 65 years and 8.52 percent 

in women over 80. Overall, middle aged and elderly women developed stress UI more often 

(four studies). Annual incidence of mixed UI was close to stress UI (two studies). Less than 7 

percent of women 45-79 years old developed urge UI (three studies). 

 Pooled analysis detected a clear pattern of increased prevalence of total UI in aging men 

from 5 percent in those 19-44 years old (11 studies) to 11 percent in those 45-64 years old (27 

studies), to 21 percent in males over 65 years of age (41 studies). The highest prevalence of UI 

was reported in elderly males of 32 percent (17 studies). Urge UI was the most prevalent type of 

UI in males among all age categories, increasing from 3 percent in those 19-44 years old (7 

studies) to 12 percent in those older than 65 years of age (20 studies) The prevalence estimations 

varied substantially depending on the definitions, with the higher prevalence of UI during the last 

year in American males 19-44 years old (18 percent) and 45-64 years old (25 percent) compared 

to UI during the last month. Older American males reported UI during the last month more 

frequently, from 29 percent among those older than 65 years of age to 42 percent in elderly 

males. Stress UI ever was experienced by 2 percent of American men 45-64 years old, 1 percent 

reported stress UI during the last month, and 1 percent during the last year. Urge UI was the 

more prevalent during the last year (7 percent of men 45-64 years old). Men over 65 years of age 

reported having urge UI during the last month (11 percent). Pooled analysis estimated that daily 

UI was experienced by 5 percent of males 45-64 years, 8 percent of men over 65 years old, and 9 

percent of elderly men. Severe UI that required change of underwear was reported by 2 percent 

of those 45-64 years old and 4 percent of elderly men. 

 Combined UI and FI is experienced by 3 percent111 to 6 percent158 of older adults in the 

community. The prevalence of FI increased with age,111,159 3 percent of adults had daily leakage 

of feces;159 weekly FI was reported by 4-5 percent159,160 and monthly FI by 7 percent.159 Pooled 

prevalence of FI in community dwelling men (22 studies) varied across the studies depending on 

definitions of incontinence and population characteristics. The lowest prevalence of anal 

incontinence (AI) of 2 percent was reported in two studies with median age of participants 

between 45 and 64 years. The prevalence of FI was less than 10 percent in all age groups and 
4 

increased from 6 percent in those 45-64 years old to 10 percent in elderly men. The prevalence of 

solid feces incontinence was reported by 1 percent of men 45-64 years of age and by 2 percent of 

elderly males. The most prevalent was combined incontinence in elderly, 16 percent of men over 

80 years experienced UI and FI. Prevalence of AI was the highest in women compared to other 

definitions and increased from 22 to 45 percent with aging (38 studies). An inclusion of flatus 

incontinence in the definition may contribute to an increased prevalence estimates in females. 

Prevalence of FI was higher than in males and increased from 7 percent in those 45-64 to 10 

percent among elderly women. UI and FI were experienced by 10-12 percent of women. Severity 

of FI in females increased with age.161 The prevalence of monthly FI varied from 6 percent162 to 

25 percent;125 1 percent162 to 5 percent163 of women had more than one FI episode per month. 

The prevalence of weekly FI was less than 7 percent in the majority of the studies.125,160,161,163

Less than 2 percent of community dwelling women reported daily FI.125,161

Risk Factors for Incontinence in LTC 

 The residents of LTC with cognitive impairment,1,34 physical dependency,4,29,34,164,165

prolonged institutionalization,28 diabetes,29,34 and FI29 had higher prevalence of UI. The odds of 

UI increased by 24 percent with each 5 years of age among LTC residents,4,165 by 20-40 percent 

after stroke,4,165 by 300-400 percent in adults with impaired activities of daily living (ADL),4,164

and by 700 percent among wheelchair users and bedridden residents.29 Women in LTC 

experienced UI more often than males.29,165 FI was associated with 1029 to 20165 times larger 

odds of UI. Dependence in daily activities was associated with 6-7 times higher odds of FI, and 

dependency in eating with four times higher odds of FI.3 Increased length of stay in nursing 

homes from 2 weeks to 1 year was associated with a seven times higher prevalence of FI.166

Limited evidence suggested that the prevalence of combined UI and FI was twice as high in nonWhite as White residents of nursing homes.4,5

Risk Factors for Incontinence in Community Dwelling Adults

 The prevalence of UI in men with prostate cancer was less than 10 percent in the majority of 

the studies.167-174 UI rates after radical prostatectomy in 12,079 Medicare beneficiaries decreased 

from 20 percent in 1991 to 4 percent in 1995, being the highest in older patients.175 Age was an 

independent risk factor for male UI in two studies.58,97 Non White men had the same rates of UI 

compared to Whites.175 Two studies showed that sedentary life was associated with UI in 

males.83,92 Alcohol intake72,83,84,92 and smoking72,83,92 did not show a significant association with 

male UI. Males with diabetes had significantly higher adjusted rates of UI58,72,86,97,176 with a 

pooled odds ratio of 1.4. Co morbidities and poor general health were associated with UI in 

several studies.81,84,92,97 Males with arthritis had higher adjusted odds of total86 or urge UI.176

Memory problems, epilepsy, and neurological diseases were associated with higher rates of 

UI.4,58,72,86,97,114,176-178 Stroke was shown as a strong and independent risk factor for UI in nursing 

home residents4

 and in community dwelling males58,86,97,176,177 with pooled odds ratio of 2. 

Restrictions in activities of daily living were associated with higher crude and adjusted odds of 

UI in males in all studies that examined the relationship.4,81,92,97,106,114 Males with urologic 

symptoms72,170,174,179 or urinary tract infections had higher adjusted rates of UI with a pooled 

odds ratio of 3.5.72,74,92,97,106 Men with prostate diseases had higher rates of UI after adjustment 

for confounding factors in the majority of the studies.72,83,92,170,176,180-183
5 

 Age tends to be linearly associated with female UI prevalence and incidence 

rates.

7,41,53,55,56,62,65,80,81,83,85,99,105,133,138,143,184 Prevalent UI significantly increased with age in 20 

7,55,66,67,73,74,81,84,92,96,97,105,118,124,133,138,149,185-187 of 28 studies that reported the association.7,55,62,66,67, 

73,74,81,84,92,93,95-97,105,118,124,132,133,138,140,144,149,185-189 

 The evidence of the association between race and incident UI is limited to two studies123,149

being higher in Whites. African American women had higher odds of incident urge but lower 

odds of incident stress UI. Hispanic women developed weekly UI more often compared to 

Caucasians. Prevalence of mild, moderate, and severe UI was lower among African American 

women than White women in all six studies that examined the association.93,105,137,138,149,189

Prevalence of moderate UI was lower among Hispanic women compared to Caucasian women in 

four of five studies.93,105,138,149,189 

 Obesity was associated with higher incidence of UI in women in two studies.103,149 Prevalent 

urge UI showed a positive dose response association in individual studies.51,133 The strength of 

the association varied depending on definitions of UI. Adjusted odds of UI in the past month 

were higher in overweight and obese females.83,92,133,143 Weekly UI was more prevalent in obese 

but not overweight women with a dose response increase per one unit of BMI.66,90,92,96,138,189

With the definition of UI in the past year, the majority of the studies showed a significant 

increase in UI 7,51,59,68,72,144 and daily UI corresponding to an increase in BMI per one 

unit.55,67,70,149,189 Obese women had greater odds of at least monthly UI compared to women with 

normal weight.67,104,121,124,138,149,190 Daily and weekly stress UI were significantly associated with 

an increase in BMI in all studies that examined this association.51,66,70,118,132,133,135,149,187 

One large prospective cohort, the Nurses' Health Study, reported that intensive physical 

activity in women 50-79 years of age was associated with a significant reduction in incident total 

UI and stress UI.156 Higher education was associated with increased odds of prevalent UI in 

several studies.67,70,72,83,93,149,189,191 Six studies92,93,138,186,189,192 of 1267,72,83,92,93,138,143,186,189,191,192

found a significant positive association between smoking and UI but the effect was not consistent 

in dose response models. 

The studies of impaired cognitive function reported conflicting results about the association 

with incident147,186 or prevalent UI.97,114,132,186 Prevalence of UI was significantly higher in 

depressed women in five studies90,124,149,189,191 of eight90,97,106,118,124,149,189,191 that examined the 

association in multivariate analysis. Decreased physical function measured by self report and 

physical performance was significantly associated with UI in six studies67,81,92,97,144,189 of 

eight67,81,92,97,106,132,144,189 that examined this association. 

The association between parity and UI in females was examined in 24 observational 

studies.55,59,64,68,70,72,83,92,93,95,96,105,119,124,133,135,138,149,185,191,193-196 Incident UI was not associated 

with parity.149,193 A positive significant association between prevalent UI and parity was reported 

in 13 studies,68,72,83,93,96,105,119,124,138,185,191,193,195 while six studies did not find a significant 

increase in prevalent UI in relation to parity.59,64,92,133,149,194 The number of births did not show a 

dose response association with prevalent UI but did with moderate severe UI and severe UI. All 

six studies that measured prevalent stress UI reported a significant positive association with 

parity.72,95,133,149,195,196 Prevalent stress UI and severe stress UI did not show a significant dose 

response association with the number of births. Only one study195 of four72,133,195,196 found an 

increase in urge UI corresponding to parity. The role of parity is complex and decreases as a 

woman ages.68,118,128,195 Evidence suggests that UI developing during pregnancy is a risk factor 

for UI in the immediate postpartum period197 and in subsequent years64,96 raising the odds of UI 

by two to 11 times.96,198 
6 

 The association between UI and modes of delivery was conflicting. Cesarean section was 

associated with lower odds of UI in seven studies,119,197,199-203 by 80 percent201 to 41 percent200

and did not show a significant association in five studies.135,141,196,204,205 Two studies reported 

higher odds of UI when women after Cesarean section were compared with nulliparous 

females.7,206 Few prospective studies reported protective effects of Cesarean section on UI 

compared to vaginal delivery.119,197,202,205

Individual studies suggested that menopausal status can be associated with UI, increasing the 

odds by 127 percent93 to 144 percent.191 Five55,83,108,124,138 studies of eight55,62,72,83,108,124,138,144,191

that examined the association between UI and hysterectomy reported significantly higher 

adjusted rates of total UI among women after hysterectomy. The increase was 160 percent for UI 

in the past month,108 130 percent for at least monthly UI,124 140 percent for daily UI (OR 1.4, 95 

percent CI 1.1, 1.6),55 and 160 percent for severe UI.138 Several epidemiological studies have 

examined estrogen therapy as a risk factor for UI.55,59,96,105,118,138,144,191

Women with urinary tract infections had higher rates of UI in 11 studies66,72,74,90,92,97,108, 

116,121,127,144 of 1566,70,72,74,90,92,96,97,106,108,116,121,127,144,187 that examined the association. 

 Evidence from three studies,7,86,118 suggested that women with arthritis had higher rates of UI 

by 80-88 percent.7,86 Two studies134,149 of three134,149,186 reported that women with diabetes 

develop UI more often. Incidence of weekly UI was higher by 147 percent in women with 

duration of diabetes more than 10 years.134 The same Nurses' Health Study cohort showed that 

incidence of severe UI was increased by 175 percent and very severe by 262 percent.134 The 

Study of Women's Health Across the Nation found a 302 percent increase in developing monthly 

UI in women with diabetes independent of other risk factors.149 Prevalence of stress UI was 

greater in women with diabetes in three studies95,133,149 of six66,95,108,133,135,149 that examined the 

association with pooled odds ratios that were not significant. However, the majority of the 

studies reported a significant increase in adjusted odds of total UI among women with 

diabetes55,66,72,86,93,97,108,116,124,127,128,133,134,138,149,186 (16 studies). Four of five studies found a 

significant increase in adjusted odds of urge UI among women with diabetes66,108,118,133,149 (five 

studies). 

 One prospective cohort, the Canadian Study of Health and Aging, found that elderly 

community dwelling women had a higher risk of developing UI after stroke.207 Prevalence of UI 

was significantly higher among women after stroke in five55,86,97,133,186 of six55,67,86,97,133,186

studies that examined this association (pooled OR 1.7). Women with two or more comorbid 

diseases had higher adjusted rates of UI.55,84,92,121,124,149,189 Three studies68,121,144 reported a 

significant increase in adjusted odds of UI in women with constipation among six studies that 

examined this association.68,74,97,121,144 

 Consistent evidence showed that FI increased with age in women.208-213 AI increased by 87 

percent for every additional 10 years of age in Asians and by 36 percent in White females.187

Maternal age older than 25 years was associated with greater odds of FI214 and persistent FI.215

The odds of FI increased by 271 percent after age 75.58 Diabetes,58,216,217 obesity,218 and 

sedentary lifestyle were among risk factors for FI in community dwelling adults.125 Adults with 

poor general health and comorbidities,163,219 including kidney diseases,186 transient ischemic 

attack,219 and arterial hypertension213 had higher odds of FI. Post stroke patients suffered from 

combined UI and FI five times more often58 and from FI three216 to five58 times more often 

compared to adults without a stroke, with an increased risk in older adults,220 diabetics,220 and 

survivors with functional dependency after severe stroke.220,221 Adults with functional 

limitations,222,223 women with major depression,163 older men with depression,219 and adults with 
7 

impaired cognitive status186,223,224 had higher prevalence of FI. Constipation,187,212 irritable bowel 

syndrome,187,211,212 and hemorrhoid surgery in women were associated with increased odds of 

FI.211 The adjusted rates of FI were higher by 240 percent225 to 450 percent219 in women with 

diarrhea, by 190 percent in irritable bowel syndrome patients, by 250 percent in females with 

anal fistula, by 140 percent after cholecystectomy,225 and by 400 percent in adults with 

incomplete bowel evacuation.217 224 Women after previous gynecological surgery complained 

about AI 1.8 times more often.213 Adjusted odds of FI increase by 4.6 times in females after 

perianal surgery.217 The adjusted odds of FI in women with UI were two to six times higher 

compared to continent females.162,163,219,226 

 Delivery of heavy babies,202 FI during pregnancy,209 increased number of births,215,226 and 

high degree of perineal injury187,209,218,227-231 were significant risk factors for FI. A dose response 

association was found between FI and number of births209,213,215,226 and with degree of birth 

related perineal damage.228-230 The adjusted odds of persistent FI were 3.2 times greater among 

women after four or more deliveries.215 Women with birth related sphincter tears after perianal 

trauma had 230 percent209 to 280 percent231,232 higher rates of FI. 

Effects of Clinical Interventions on UI 

Clinical interventions to reduce the progression of UI in adults in LTC settings.

Conservative management programs improved UI in nursing home residents.233-237 Individualized 

prompted voiding and intensive endurance and strength training exercises significantly improved the 

continence status of the residents.234 A computerized quality management pathway would avoid 

progression of UI in 140 per 1,000 treated residents of nursing homes.238 Limited evidence suggested 

that the number of patients continent at discharge after stroke was four times larger after active 

compared to conventional rehabilitation programs, which would result in 722 additional cases of 

continence per 1,000 treated adults with stroke.239 

Community-based conservative management programs. Urinary continence service in the 

community that included lifestyle advice, bladder, and pelvic floor muscle training for 6 months240

increased the proportion of continent patients by 50 percent and patients with improved UI by 20 

percent. With this community-based continence service, UI was improved in an additional 100 

subjects per 1,000 subjects treated; quality of life improved in 90 subjects and satisfaction with 

present urinary symptoms in 110.240 Complex community-based intervention implemened by 

registered nurses, occupational therapist, and public health educators241 and a continence 

management program implemented by nurse continence advisers with physician expertise242 were 

effective to reduce the severity of UI in females. 

Behavioral intervention for primary prevention of UI in women. Continence rates after 

behavioral modification programs, including pelvic floor muscle training, bladder training, and 

individualized test of knowledge and adherence implemented in 359 postmenopausal, continent 

women 55 years and older to prevent UI, were the same compared to usual care at 12 months of 

followup (continence rate 37 percent vs. 28 percent) but resulted in an improvement rate 136 percent 

higher than standard care in one RCT.243,244 Intensive lifestyle therapy to lose and maintain at least 7 

percent of initial body weight and to engage in moderate-intensity physical activity reduced stress UI 

by 15 percent after 2.9 years of followup in the Diabetes Prevention Program RCT among 2,191 

overweight pre-diabetic women with BMI ±24 kg/m2

 (RR 0.85).245

Clinical interventions for primary prevention of UI in pregnant women were examined 

in eight large RCTs with more than 100 women246-253 and one smaller trial;254 three RCTs 
8 

reported continence rates with 3-10 months of followup.249,250,253 Conservative advice about selfadministered pelvic floor muscle training at 5, 7, and 9 months after delivery supplemented with 

bladder training did not change the risk of stress UI and tended to decrease the risk of severe UI 

at 12 months postpartum.251,252 Continence rates after intensive exercise care253 and selfadministered perineal massage250 were comparable to usual care. Pelvic floor muscle training 

with biofeedback and electrostimulation started at 9 weeks after vaginal delivery resulted in 

continence ten times more often compared to usual care at 10 months of followup.249

 Clinical interventions for primary prevention of UI in males with urological diseases. 

The behavioral interventions on UI in males with prostate diseases were examined in 12 

RCTs255-266 but only two257 ,261 of eight trials with continence outcomes255,256,257 ,259,261,262,264,265

reported significant benefit after pelvic floor muscle training with biofeedback compared to usual 

care. The highest continence rate (99percent) was reported in a large, well designed RCT of early 

pelvic floor muscle training and biofeedback in participants who had radical retropubic 

prostatectomy for localized prostate cancer at 1 year of followup with a small significant relative 

benefit compared to usual care (RR 1.1).257 The relative effect in the same RCT was larger when 

continence status was measured with the International Continence Society male questionnaire 

specific for UI (RR 1.3).257 Continence rates in the control groups were more than 60 percent 

across other RCTs with no statistically significant differences compared to active treatments. The 

comparative effectiveness of pelvic floor muscle training compared to usual care in males after 

different treatment options for prostate cancer requires future confirmation in well-designed 

RCTs. 

Pelvic floor muscle training for secondary prevention of UI. A large body of evidence 

suggested beneficial effects of behavioral interventions on UI in females.267-287 Pelvic floor 

muscle training resulted in continence in females more often than usual care in four275,280,288,289 of 

ten trials that compared usual care with active treatments.275,280,281,288-292 Pooled results of relative 

benefits of pelvic floor muscle training (RR 7.1)275,280,288,289 and pelvic floor muscle training 

combined with biofeedback (RR 11.2)288,289 were sensitive to one small RCT288 with a 2 month 

followup. Pelvic floor muscle training combined with bladder training increased continence rates 

by 175 percent compared to usual care (pooled RR 1.8).243,280,290,291

Electrical stimulation for secondary prevention of UI. Urinary continence 1-6 months 

after electrical stimulation in females was reported in seven RCTs.293-298 Two RCTs that assessed 

continence at 6 months or more of followup failed to show significant benefit from electrical 

stimulation compared to continent services or medications.293,299 Other RCTs also did not 

demonstrate significant relative benefit of electrical simulation compared biofeedback assisted 

training297 or placebo.295,296,300,301 Electrical stimulation would result in improvement in UI in 

180 women per 1,000 treated.302 Electrical stimulation would improve UI in more than 400 

women per 1,000 treated compared to placebo.303 Home-managed electrical stimulation with 

vaginal or anal stimulators would avoid 50 cases of UI per 1,000 treated women.304 The rates of 

continence from urge UI were more than 70 percent in one RCT after functional magnetic 

stimulation298 with significant relative benefit compared to sham stimulation in only one trial at 2 

months of followup (RR 3.5).298 

Neuromodulation for secondary prevention of UI. In community dwelling adults the

implantation of a multiprogrammable neurostimulator cured 47 percent of participants with urge 

UI305 with significant relative benefit compared to standard medical therapy.305 Sacral root 

neuromodulation resulted in urge continence more than nine times more often than conservative 
9 

management with medications or pelvic floor muscle training (RR 9.86).306 Sacral nerve 

stimulation would avoid 385306 to 430305 cases of urge UI per 1,000 treated adults. 

Injectable bulking agents for secondary prevention of UI. The effects of different bulking 

agents for secondary prevention of female UI were examined in four RCTs with one study of 

more than 100 females307 and several smaller trials308-310 with 6309 to 12 months307 ,308,310 of 

followup. However, only one RCT reported significant relative benefit in 63 women with stress 

UI at 12 months of followup after transurethral ultrasonography-guided injections of autologous 

myoblasts and fibroblasts compared to conventional endoscopic injections of collagen (RR 

9.5).308

Medical devices for secondary prevention of UI included Hodge pessary,311 disposable 

intravaginal devices,312,313 urethral plug,314 and vaginal cones299,315,316 in females and UroLume 

sphincteric stent317or penile compression devices in males.318 Blocking urinary leakage using a 

urethral insert device with disposable applicator resulted in continence in 67 percent of women 

with mixed or stress UI but showed no relative benefit compared to a urethral insert with a sterile 

balloon device.313 One RCT of 122 women with stress UI did not show differences in continence 

rates after vaginal cones compared to continence guard services at 6 months of followup.299

Limited evidence suggested that medical devices resulted in modest improvement in UI, not 

better than other interventions in females299,311-313,315 and in males.317,318

Surgical interventions for primary prevention of UI in women. Among examined 

gynecological surgeries, intrafascial total abdominal hysterectomy significantly reduced the risk 

of urge UI compared to the extrafascial approach.319 Total or subtotal abdominal hysterectomy 

resulted in comparable continence rates 1 year after the surgery.320 Prolapse surgeries in 

continent women (negative stress test at baseline) were examined in two RCTs.321,322 Cystopexy 

alone compared to cystopexy with posterior pubourethral ligaments plication resulted in the same 

rates of UI at 1 year of follow up.322 Incidence of stress UI was several times higher after Burch 

colposuspension. Compared to colposacropexy without prophylactic colposuspension at 3 years 

of followup.321 

Surgical interventions for secondary prevention of UI in women. Tension-free vaginal 

tape and sling procedures resolved stress UI in more than 75 percent of treated women323-342 with 

some evidence of greater relative benefit compared to Burch colposuspension.343 Surgery with 

Burch colposuspension for stress UI resulted in continence in more than 75 percent of women in 

the majority of the studies344-361 with inconsistent relative benefit when compared to other 

treatments. Few RCTs reported significant relative increase in objective cure at 1 year of 

followup after tension-free vaginal tape procedure compared to active treatment.330,331 Burch 

retropubic urethropexy resulted in continence in more than 90 percent of women and provided 

the largest relative benefit compared to modified anterior colporrhaphy (RR 5.1)353 and anterior 

colporrhaphy with Kelly plication (RR 1.4).345 Burch colposuspension with abdominal 

hysterectomy compared to anterior colporrhaphy with vaginal hysterectomy resulted in higher 

continence rates (RR 1.6) in women undergoing surgery for primary stress incontinence and a 

concurrent grade 2 or 3 cystocele.362

 The largest relative benefits with more than 300 excessive cases of stress UI per 1,000 treated 

females were reported after pelvic floor muscle training compared to regular care, and Burch 

colposuspensions, and tension-free vaginal tape compared to other surgical procedures. Hormone 

replacement therapy increased the risk and progression of UI in postmenopausal females. A few 

studies demonstrated relative benefits of local estrogen administration on stress UI by 64 

percent363 and urge by 55 percent.364 
10 

Hormone therapy for primary prevention of UI increased incident mixed UI by 50 

percent (RR1.5) and incident stress UI in postmenopausal women by 80 percent (RR 1.8).365

Incident urge UI increased by 30 percent and total UI by 40 percent (RR 1.4) after estrogen 

combined with progestin (RR 1.3).366 Oral estrogen alone without progestin increased incident 

stress UI by 210 percent (RR 2.1)365 and worsened UI by 530 percent (RR 5.3).367

Hormone therapy for secondary prevention of UI. Urinary continence was reported in 

four RCTs that examined the curative effects of local hormone therapy on secondary prevention 

among incontinent women.364,368-370 The highest rates of continence were reported after 

transdermal administration of an estrogen patch (100 percent) and estrogen gel (90 percent) 

among postmenopausal women with self-reported urinary symptoms.368 Topical estrogen in 

suppositories or creams combined with physiotherapy and electrostimulation cured 22 percent of 

women 50-74 years of age with regular mild incontinence (>2 leakage episodes per month) 

compared to 0 percent after no hormone treatment.364

Pharmacological agents for secondary prevention of UI. Clenbuterol was more effective 

to achieve continence in females with stress UI compared to placebo but not to pelvic floor 

muscle training. Extended release tolteradine for 2-12 weeks resulted in greater rates of cure or 

improvement compared to placebo in adults with overactive bladder syndrome. Duloxetin 

administered for 3-12 weeks in patients with predominantly stress UI improved UI, but the rates 

of continence did not differ from placebo. Long-term effects of medications combined with 

pelvic floor training on continence are unknown. Comparative effectiveness of combined 

treatments, including medication, requires future research. 

Clinical Interventions to Reduce the Risk of FI 

Conservative management programs for secondary prevention of FI in LTC settings. 

Consistent benefits of conservative management programs,233-235 integrated FI care,235 and 

functional individualized endurance and strength-training exercises234 on FI in nursing homes 

were reported in several studies. 

Pelvic floor muscle training for primary prevention of FI was examined in one RCT of 

747 women with postnatal UI.251,252 Assessment by nurses of incontinence with conservative 

advice on pelvic floor muscle training at five, seven, and nine months after delivery reduced the 

risk of any FI by 51 percent at 1 but not 6 years after index delivery. 

Dietary intervention for secondary prevention of FI was reported in one RCT of 42 adult 

volunteers with incontinent loose or liquid stools at least weekly.371 Usual diet supplemented 

with 25g of Metamucil did not reduce the proportion of incontinent stools at 1 month of 

followup. 

Pelvic floor muscle training with biofeedback for secondary prevention of FI. Sensory 

biofeedback training with pelvic floor muscle training resulted in control of feces (fecal 

continence) twice as frequently in women with FI after obstetric and sphincter trauma as pelvic 

floor muscle training alone,372 which would prevent 382 cases of FI per 1,000 treated. Studies of 

behavioral treatments of FI reported less than 40 percent improvement in severity and quality of 

life related to FI.372-375 Limited evidence suggested a significant reduction in FI after complex 

behavioral interventions, including lifestyle changes and exercises augmented with 

biofeedback.376

Neuromodulation for secondary prevention of FI. Individualized sacral nerve continuous 

stimulation improved FI in 89 percent of patients with severe baseline FI compared to 17 percent 
11 

after sham stimulation in one study,377 resulting in an improvement in symptoms in 720 

additional patients among 1,000 treated. 

Pharmacological agents for FI. Few pharmacological interventions378-380 resulted in fecal 

continence in more than 50 percent of patients but were not statistically better than placebo378,379

or surgery.380 

Surgical interventions to repair external anal sphincter after acute obstetric trauma 

(primary prevention). Four RCTs compared end-to-end technique to overlapping repair of 

obstetric anal sphincter lacerations;381-384 six reported patient outcomes with inconsistent benefit 

from end-to-end technique. 

 Early detection of anal sphincter tears immediately after vaginal delivery followed by 

surgical repair significantly reduced the risk of FI 3 months and 1 year postpartum in RCTs of 

752 pregnant women.385

Delivery interventions for primary prevention of FI. The effects of episiotomy were 

examined in two RCTs;386,387 the effects of Cesarean or vaginal delivery were compared in two 

RCTs;388,389 the effects of delayed or immediate pushing in the second stage of labor with 

epidural analgesia in one RCT;390 and the effects of delivery by forceps or vacuum extractor in 

three RCTs391-393 without significant relative benefit of instrumental compared to vaginal 

delivery. 

Surgical interventions for primary prevention of FI. Of nine RCTs that compared 

different surgical techniques for hemorrhoidectomy, none reported significant relative FI 

benefits.394-402 The effects of “chemical sphincterotomy” in patients with chronic anal fissure 

were analyzed in three RCTs,403-405 with no significant result on FI. 

 The effects of surgical procedures on FI in adults with full-thickness rectal prolapse were 

evaluated in nine RCTs,406-414 with no significant difference between treatments. 

 Different surgical techniques resulted in similar rates of FI in patients with anorectal 

abscesses,415 fistula-in-ano,416-418 and anal fissure.419-423 Adjuvant radiotherapy for 

adenocarcinoma of the rectum424-426 consistently increased the risk of FI in three RCTs, by 60 

percent during the day (RR 1.6), by 90 percent during the night (RR 1.9), by 70 percent in 

utilization of pads (RR 1.7) compared to mesorectal excision,424 and by 220 percent (RR 2.2) 

compared to the low anterior resection.424 

Surgical interventions for secondary prevention of FI. The implantation of artificial bowel 

sphincter reduced FI severity427 in a multicenter, prospective, nonrandomized clinical trial of 115 

patients. However, 25 percent experienced post surgical infection that required surgical revision 

and 37 percent needed reimplantations. 

 Gluteus maximus transposition did not show significant benefit compared to total pelvic floor 

postanal repair with anterior levatoroplasty on women with post obstetric FI.428 

One multicenter noncontrolled nonrandomized clinical trial (Dynamic Graciloplasty Therapy 

Study Group) reported significant improvements in quality of life (Medical Outcomes Study 

Short Form 36 physical function and social functioning) after dynamic gracioplasty. The 

proportion of continent stools among total number of stools of more than 50 percent was 62-56 

percent in nonstoma patients at 12-24 months and 37.5-43 percent in stoma patients at 24 months 

of followup.429,430

 Surgical interventions used to treat ulcerative colitis431-434 resulted in comparable fecal 

continence during the first 10 years after surgery, with an increased risk of FI during the longer 

period of followup. Clinical interventions resulted in comparable incidence and progression of FI 

in the majority of the RCTs with no clear evidence of better prevention of FI. 
12 

Strategies to Improve Identification of Persons at Risk and Patients 

who have UI and FI 

 Few well-designed studies examined the strategies to detect incontinence in adults. Positive 

clinical history of UI was associated with a small likelihood of urodynamic UI in females.435-455

Inconsistent evidence implied that diagnostic values of x-ray,456-461 single channel 

urodynamic,462-465 and Q-tip test measuring straining angle466-469 are similar to multichannel 

urodynamics. Translabial Doppler ultrasound470,471 and transrectal ultrasound for the evaluation 

of the bladder neck anatomy and urethrovesical junction472-477 (stress UI was defined as 

rethrovesical junction drop during stress of ≥1cm) were comparable to fluoroscopy for the 

detection of urinary leakage during urodynamic investigation in community adults and residents 

of nursing homes. Despite differences in positive predictive likelihood ratios compared to “gold 

standard” of urodynamic testing, the number needed to screen to detect one case of UI was 

similar and consistent among the studies. Effectiveness of self-reported scales, professional 

assessment of clinical history, and ultrasound to detect UI in women was comparable to 

urodynamic and consistent across race, age, and socioeconomic groups. However, clinical 

history and diaries were used by less than half the incontinent patients who actively sought 

health care for UI.112,155,478 Population-based surveys using validated scales447,479,480 yielded 

predictive likelihood ratios and the number needed to screen to detect one case of UI comparable 

to clinical history435,436 but also had lower cost ($36-$67 vs. $175-$255 respectively). 

 The diagnostic value of tests among different age, race, and socioeconomic status subgroups 

has not been well established; however, the prevalence of undiagnosed UI differed by 10-20 

percent in such groups.146 Therefore, screening programs should target patients at high risk of 

UI. Limited evidence suggests that the Resident Assessment Protocol included in the Minimum 

Data Set (MDS) had a definitive predictive likelihood ratio to diagnose UI in nursing home 

residents.481 Self-reported questionnaires and scales have unsatisfactory validity to diagnose FI in 

adults. Anal ultrasonography has the largest diagnostic value to detect anal trauma in patients 

with FI.482

Discussion 

 Public awareness of incontinence, its risk factors, and possible treatment options may reduce 

the burden of incontinence. Consistent definitions of incontinence and measures of success are 

important to compare the results from different studies. Despite extensive efforts to standardize 

the definitions of incontinence,483 the original studies produced a plethora of measures. They 

measured self-reported symptoms and signs of incontinence, severity, and quality of life related 

to incontinence, and objective instrumental evidence of leakage inconsistently within and across 

the studies. Ratings of success by doctors and patients about quality of life in FI were also 

different.484 Objective measures of UI showed random changes in most RCTs and could not be 

recommended as a measure of success for primary and secondary prevention of UI. The 

objective improvements in selected physiological measures were not consistent after the same 

interventions and did not correlate with self-reported continence and reduction in severity of 

UI.322,330,485-491 The effects of treatments on quantitative measures of incontinence, including 

frequency and amount of leakage, were less compared to qualitative improvements in symptoms. 
13 

 Other systematic reviews analyzed predominantly self-reported cure and improvement in UI, 

practically omitting objective measures of incontinence still commonly used in individual 

studies.492-494 One review of two clinical trials with urodynamic tests concluded that the data is 

not sufficient to propose this invasive and costly testing as a measure of success.495 The 

association between physiological testing and patient perception of severity of incontinence and 

quality of life is weak. The relationships between objective physiological measures of 

incontinence that are related to quality of life and primary diseases resulting in incontinence need 

future investigation. Long-term continence should be the primary outcome for future RCTs to 

consider the most effective clinical interventions. 

 Previous reviews did not find anal manometry a good measure of success in reducing FI.496-

500 Anal manometry was not a good measure of success in clinical trials of FI showing random 

changes between active and control interventions.372,375,376,403,501-503 Improvement in self-reported 

FI was inconsistent with changes in anal manometry.373,376,378,503 Few trials demonstrated the 

same direction and effect of treatment on improvement in FI and objective measures of FI.372

Composite outcomes, including both self-reported changes in severity of incontinence and 

physiologic parameters in a common scale may offer a better choice to measure success of 

clinical interventions.504,505

 The strength of evidence varied for the research questions in the present review. Studies of 

diagnostic methods had the lowest quality with few RCTs conducted.437,462,506,507 Large 

population-based surveys reported prevalence of incontinence in age, gender, and race 

subgroups.8,9,50,67,508 The independent contribution of risk factors on UI and FI were analyzed 

with adjusted odds ratios in cross-sectional and retrospective cohort studies. However, 

multivariate models included different sets of risk factors. Since causality between risk factors 

and incontinence could not be determined from such studies and the majority of risk factors are 

not modifiable, we hesitated to estimate events attributable to risk factors. Efficacy and 

comparative effectiveness of clinical interventions to reduce the risk and progression of 

incontinence were analyzed from RCTs. The majority of the RCTs had good quality, did not 

exclude subjects from the analysis of the outcomes, and provided adequate randomization. 

However, allocation concealment was not adequate in a large proportion of 

RCTs.258,261,266,277,286,372,375,376,502,509-512 The RCTs of interventions that are regulated by the FDA, 

including hormone replacement therapy, had the best quality.240,245,253,304,365,366,389,513,514 Large 

RCTs, including weight reduction and increased physical activity,245 complex conservative 

management of UI,240 delivery management,388,389 and early prevention of UI in postnatal care253

also had high quality. Variations in populations, interventions, and measures of outcomes, rather 

than quality of RCT resulted in heterogeneity between studies. 

Conclusions 

Epidemiologic surveys with behavioral risk factor surveillance systems are cost-effective to 

estimate the prevalence of urinary incontinence in large nationally representative population 

groups. Routinely collected clinical history should include an evaluation of the risk factors, 

symptoms, and signs of incontinence. Pregnant, obese, and aging women, women with vaginal 

prolapse, males treated for prostate disease, patients with rectal prolapse, and frail elderly and 

nursing home residents are high risk groups. Individualized management programs can improve 

continence in LTC facilities but are hard to sustain. Regular monitoring and documentation of 

the continence status in relation to implemented continence services should be quality of care 
14 

indicators for nursing homes. Pelvic floor muscle and bladder training are effective to reduce the 

risk of incontinence. Preventive strategies might include assessment and reduction of modifiable 

risk factors in early stages of incontinence. Surgery is effective in curing stress UI in females. 

Clinical interventions for UI in males and for FI in adults need future investigation. 

Future Research 

 An important unresolved problem is clear definitions of the type of incontinence and pathophysiology of baseline conditions to have better estimations of prevalence and risk factors of 

incontinence. Inconsistencies between patient reports and physiological measures continue to 

pose a serious problem.484,515 For efficacy studies, some combined measure might be applied, but 

for prevalence assessments, such an approach would pose serious logistical problems. Long-term 

effects of drugs, stimulators, and medical devices need future investigation in well-designed 

randomized trials. Given the social problems caused by incontinence, enthusiasm for surgical 

treatment remains high for treating both stress UI and FI, although future research is needed to 

examine the balance between benefits and harms related to surgery and the cost-effectiveness of 

surgical treatments compared to conservative interventions. 

 Managing both types of incontinence in LTC settings remains problematic. Programs that 

work under experimental conditions have not been sustained because they are labor intensive and 

essentially unreimbursed. Indeed, case mix based payments for nursing homes create a 

disincentive to manage incontinence. 

 Several other specific areas have been identified as needing more research. They include: 

• Interaction between age, race, and other risk factors for UI and FI in women and men 

• Effective strategies to prevent UI and FI in women and men in community and LTC 

settings 

• Association between race and severity of UI and FI and quality of life related to UI and FI 

in men and women from the community and in LTC settings 

• Strategies to reduce the risk of UI and FI related to pregnancy and childbirth 

• Effectiveness of clinical interventions for incontinence by cognitive and physical 

functioning, gender, and ethnicity 

• Long-term effectiveness of individual conservative therapies, conservative management 

programs, including community-based nonmedical interventions, and mechanical devices 

for UI and FI 

• Comparative long-term effectiveness of conservative interventions, pharmacological 

interventions, combined conservative and pharmacological interventions, mechanical 

devices, and surgery for UI 

• Individual patient factors that may modify the effects of different procedures 

• Effects on FI of surgeries for hemorrhoids, rectal prolapse, rectal cancer, and anal fissures 

• Effective strategies to identify patients at risk of UI and FI, including residents of LTC 

settings 
Evidence Report

17 

Chapter 1. Introduction 

Overview 

 Urinary (UI) and fecal (FI) incontinence affect substantial proportions of adults in different 

population groups.20 Baseline mechanisms of UI include hyperactive bladder that may result in 

urge UI and poor urethral sphincter function that can result in primary urethral incompetence and 

stress UI.22,23 Loss of structural and functional integrity of pudendal nerve activity, pelvic floor 

muscles, rectal compliance and rectal sensation, and the anal sphincter may result in FI.17,20,23,24

The differences in baseline mechanisms of incontinence lead to variable definitions of UI and FI, 

some specific for each type of incontinence risk factors, and effective interventions to prevent 

and treat UI and FI.17,23,24 The estimated prevalence of UI in adults was 9 to 22 percent8,9,30,35-38

but varies widely as a result of differences in definitions and sampled populations subgroups.18

For example, recent studies reported that 25 percent of young women,516 44 percent148 to 57 

percent of middle-age and post-menopausal women,93 and 75 percent of elderly females in 

nursing homes32 experienced some degree of involuntary urine loss. UI is prevalent among 

women of all races, though the magnitude, severity, and bother may vary; 41 percent of White 

women, 20 percent of African-American women, and 36 percent of Hispanic women reported 

difficulties controlling their bladders.18 The severity of incontinence influences quality of life 

and treatment decisions. In the 1999-2000 National Health and Nutrition Examination Survey, 32 

to 51 percent of women experienced daily episodes of UI and 20 to 32 percent experienced 

weekly episodes.9 The prevalence of UI in men varied from 11 percent among those 60-64 years 

old to 31 percent in older males, and from 16 percent among White men to 21 percent among 

African American men.8 Daily incontinence was reported by 30 to 47 percent and weekly 

incontinence by 15 to 37 percent of community dwelling men8 and by 72 percent of male nursing 

home residents.32 The fraction of nursing home admissions attributable to UI in the elderly 

population was 10 percent for men and 6 percent for women.517 

 The prevalence of FI ranges from 0.8 to 5 percent in men and 2 to 6 percent in women living 

in the community518 and to more than 50 percent in nursing home residents. Indeed, FI is among 

the most common reasons for nursing home admission.21 The prevalence of combined UI and FI 

in adults in LTC facilities varied from 4 percent519 to 44 percent.34 

 Population-based studies underestimate the incidence of incontinence due to sampling and 

self selection of the survey participants.20 Clinic-based studies included patients actively seeking 

treatment for incontinence, who represent only a small proportion of incontinent adults.13,19,146,520

Only 45 percent of women and 22 percent of men with weekly incontinence episodes ever 

sought medical care for UI. Primary care providers diagnosed UI in 21 percent of older 

incontinent women and in 10 percent of older incontinent men.521 Despite the tremendous impact 

on quality of life, less than 50 percent of older adults with FI ever asked for professional 

help.17,522-524 

 Strategies to detect persons at risk and individuals with incontinence have been 

systematically reviewed for UI15,16 but not for FI, with no special attention to high-risk 

populations in either group. Comparative predictive likelihood ratios of diagnostic tests for 

community dwelling adults and residents in long-term care (LTC) facilities are not well 

established.20,21 No systematic reviews addressed the positive likelihood of diagnostic procedures 

for FI.13
18 

 Clinical interventions to reduce UI have been extensively reviewed during the last years by 

the Cochrane Group,492-495,525-548 and FI497-500,549-557 the International Continence Society,20,21 the 

American College of Gastroenterology Practice Parameters Committee,17 and the Agency for 

Healthcare Research and Quality.25,26 The basis for measuring successful treatment varied across 

the studies that examined different interventions; the criteria for deeming a treatment successful 

are not well established. Pooled analyses of the selected outcomes included small samples of the 

studies and showed substantial heterogeneity across interventions. Patients and clinicians need 

synthesized analysis of clinical efficacy and comparative effectiveness of diagnostic and 

treatment options to make informed decisions of effective care. Policymakers require evidencebased estimations attributable to effective treatment events in different clinical settings and for 

subgroups of patients. 

 The cost of incontinence care in the United States increased over the past decades;558 in 2004 

it averaged $19.5 billion annually.559 One estimate places the 2000 annualized cost of nursing 

home admissions due to incontinence at $6.0 billion ($3.0 billion each for elderly men and 

women).517 Evidence-based recommendations to reduce the risk of incontinence in LTC facilities 

and in the community could improve health care and the quality of life for incontinent patients. 

 This review was commissioned as background material for an NIH/OMAR State of the 

Science Conference on Incontinence. The aims of the present project are: 1) to systematically 

review published evidence to identify individuals at risk and patients with undiagnosed UI and FI 

in the community and in LTC settings and 2) to synthesize evidence of the effectiveness of 

different clinical interventions to prevent the occurrence and progression of UI and FI in adults. 

 The following questions were developed for this review: 

1. What are the prevalence and incidence of urinary and fecal incontinence in the community 

and long-term care settings? 

• Race 

• Ethnicity 

• Gender 

2. What are the independent contributions of risk factors for urinary and fecal incontinence, 

including: 

• Age 

• Functional impairment 

• Institutionalization 

• Parity, childbirth, and postpartum state 

• Menopause 

• Dietary factors 

• Smoking 

• Obesity 

• Genetic factors 

• Prostate disorders 

• Dementia 

• Psychiatric disorders, specifically depression 

• Diabetes 

• Urinary tract infection 

• Chronic gastrointestinal (GI) conditions such as irritable bowel syndrome (IBS), diarrhea, 

constipation, and inflammatory bowel diseases (IBD) 

• Cardiovascular and pulmonary conditions
Appendixes cited in this report are available at http://www.ahrq.gov/clinic/epcindex.htm 

19 

• Gastrointestinal, gynecologic, and urological procedures 

• Neurological disorders, such as stroke and spinal cord problems 

3. What is the evidence to support specific clinical interventions to reduce the risk of urinary 

and fecal incontinence? 

4. What are the strategies to improve the identification of persons at risk and patients who have 

urinary and fecal incontinence? 

5. What are the research priorities for identifying effective strategies to reduce the burden of 

illness in these conditions? 

 The analytical framework for Question 2 focuses on risk factors of incontinence in adults 

(definitions are included in Appendix A). These risk factors can be combined in one person. 

Independent contributions of isolated risk can be addressed in studies with adequate multivariate 

analysis. Such population-based studies are available for some risk factors, including age and 

age-related conditions and behavioral risk factors, but not for surgical procedures and rare 

diseases. Given this reality, the present systematic review addressed the adjusted relative risk of 

incontinence in adults with different levels of risk factors when possible and the absolute risk of 

incontinence in populations after surgical procedures and with specific diseases. 

 The analytical framework for the strategies to identify patients who have UI and FI included 

examination of diagnostic values of different tests compared to multichannel urodynamics as a 

“gold standard” for UI and physician diagnosis for FI. Sensitivity, specificity, positive predictive 

values, predictive likelihood ratio, and cost effectiveness of the index tests were compared to 

standard tests. The validity and reliability of incontinence-specific scales were analyzed from 

published literature. Conceptual and operational definitions of incontinence and risk factors of 

incontinence are presented in the analytical framework. 

 To facilitate the discussion of fecal incontinence, we have adopted the practice of using that 

term to encompass both fecal and anal incontinence. These two terms are frequently used 

interchangeably in the literature and create a great deal of confusion. 

Appendixes cited in this report are available at http://www.ahrq.gov/clinic/tp/fuiadtp.htm

21 

Chapter 2. Methods 

Literature Search Strategy and Eligibility Criteria 

Search Strategy 

 Studies were sought from a wide variety of sources, including MEDLINE® via PubMed®, 

CINAHL, Cochrane databases, and manual searches of reference lists from systematic reviews 

and the proceeding of the International Continence Society (ICS). The search strategies for the 

four research questions are described in Appendix B. Excluded references are shown in 

Appendix C. All work was conducted under the guidance of a Technical Expert Panel (TEP), 

whose members are identified in Appendix D. 

Eligibility 

 Three investigators independently decided on the eligibility of the studies according to 

recommendations from the Cochrane manual for systematic reviews.560 The algorithm to define 

eligibility of the studies was developed for each research question (Appendix A). We reviewed 

abstracts to exclude secondary data analysis, reviews, letters, comments, and case reports. Then 

we confirmed eligible target populations of adults in community and LTC settings. The full texts 

of the original epidemiologic studies published in English after 1989 were examined to include 

studies with eligible outcomes defined as prevalence and incidence of incontinence, absolute and 

adjusted relative risk of incidence, and progression of urinary, fecal, and combined incontinence 

(operational definitions in Appendix A). We also developed a list of risk factors for UI and FI for 

Question 2 (operational definitions of known risk factors of UI and FI in Appendix A). For 

Question 3, we included studies that examined the effects of clinical interventions (operational 

definitions of clinical interventions for the primary and secondary prevention of incontinence in 

Appendix A). For Question 4, we included studies that evaluated different strategies to detect 

patients with incontinence and persons at risk. Then we excluded studies that did not test the 

associative hypotheses and did not provide adequate information on tested hypotheses (e.g., least 

square means, relative risk). 

 Finally, we confirmed eligible levels of evidence for each research question. The following 

inclusion criteria were applied to select articles for full review: For questions of prevalence and 

risk factors of incontinence in large population-based cross-sectional analyses and cohort studies, 

large cross-sectional analyses and cohorts in LTC settings, case-control studies with randomly 

selected controls and case series with more than 100 subjects were selected. For the question on 

clinical interventions to reduce the risk of UI and FI, we selected randomized controlled clinical 

trials and multicenter nonrandomized clinical trials (fecal and combined incontinence). For the 

question on strategies to detect incontinence, we selected randomized controlled clinical trials, 

multicenter controlled clinical trials, large (>100 subjects) observational studies, and case-control 

studies with >10 cases that reported sensitivity, specificity, and reliability of different diagnostic 

methods. 
22 

 The exclusion criteria included the following: 

• Studies with target population as children and adolescents 

• Studies with no information relevant to incidence and progression of incontinence 

• Studies that examined the distribution of different types of incontinence among incontinent 

patients (all incontinent in denominator) 

• Studies that evaluated the association between incontinence as independent variables in 

association with other patient outcomes 

• Case series with small numbers of cases and no control comparison 

• Studies that reported absolute values of the diagnostic tests in incontinent patients 

• Studies that did not report true and false positive and negative cases of diagnostic tests 

• Observational studies and nonrandomized clinical trials that examined treatments in 

incontinent patients and short term (less than 1 year of followup) drug trials that did not 

report continence rates 

Quality Assessment and Rating the Body of Evidence 

 Study quality was analyzed using the following criteria: subject selection, length and loss of 

followup, adjustment for confounding factors in observational studies and intention to treat 

principle in clinical trials, masking the treatment status, randomization scheme and adequacy, 

allocation concealment, and justification of sample sizes in RCTs.561

 The level of evidence for all studies was estimated using a subset of the U.S. Preventive 

Services Task Force criteria noted below.562 

I: Properly designed randomized controlled trial 

II-2A: Well-designed cohort (prospective) study with concurrent controls and multivariate 

analysis of the associations 

II-2B: Well-designed cohort (prospective) study with historical controls and multivariate 

analysis of the associations 

II-2C: Well-designed cohort (retrospective) study with concurrent controls and multivariate 

analysis of the associations 

II-3: Well-designed case controlled (retrospective) study and multivariate analysis of the 

associations 

III: Large differences from comparisons between times and/or places with or without 

interventions (cross-sectional comparisons). 

 For all questions, evidence tables were developed identifying the purpose of the study, 

sample, design, independent and dependent variables, and findings. For Questions 1, 2, and 3, 

incidence and prevalence cases of incontinence, relative risk of incontinence in categories of risk 

factors and clinical interventions, and outcomes level to assess severity and progression of 

incontinence for treatment differences were abstracted.563,564 Baseline data were compared in 

different studies to test differences in the target population and unusual patterns in the data.565,566

Standard deviations, regression coefficients, and 95 percent CI were calculated from reported 

means, standard errors, and sample size.563,564 The protocol for the meta-analyses was created 

according to recommendations for meta-analysis of randomized controlled trials: the QUOROM 

statement.567
Appendixes cited in this report are available at http://www.ahrq.gov/clinic/tp/fuiadtp.htm 

23 

Applicability 

 Applicability of the population was estimated by evaluating the selection of the subjects in 

observational studies and clinical trials.568 Large observational cohorts based on national registries, 

population-based surveys, and nationally representative administrative and clinical databases had 

high applicability. We compared the differences in prevalence of incontinence in studies that 

selected subjects from administrative and clinical databases and that reported random and 

convenience sampling of participants.569 Applicability of the intervention duration was high for 

studies with followup 1 year or more and acceptable for studies with followup of 6-12 months. 

 We assumed the presence of publication bias and did not use statistical tests for bias defined 

as the tendency to publish positive results and to predict association when all conducted 

(published and unpublished) studies are analyzed.560,570-572 We used several strategies to reduce 

bias, including comprehensive literature search of published and unpublished evidence in several 

databases the reference lists of systematic reviews and proceedings of the ICS, contacts with 

experts for additional references they might provide, and agreement on the eligibility status by 

several investigators. 

Data Extraction 

 Evaluations of the studies and data extraction were performed manually and independently 

by three researchers. The data abstraction forms are shown in Appendix E. Errors in data 

extractions were assessed by a comparison with the established ranges for each variable and the 

data charts with the original articles. Any discrepancies were detected and discussed. Patient 

populations were classified as community and LTC settings. Adjustments for patient age, race, 

gender, comorbidities, socioeconomic status, provider characteristics, and clustering of patients 

and providers were extracted from the studies. The details on extracted variables are presented in 

the analytic framework in Appendix A. 

Data Synthesis 

 For Questions 1 and 2, results of individual studies (expressed as crude and adjusted for 

confounding factors) were summarized in evidence tables to analyze differences in incontinence 

in categories by subject age, race, ethnicity, residency, and risk factors. 

Definitions of incontinence. We analyzed separately urinary, fecal, and combined 

incontinence. We used the definitions of signs and symptoms of UI promoted by the ICS 

(Appendix A) including mixed, stress, and urge incontinence. We defined anal incontinence (AI) 

as involuntary loss of flatus, liquid, or solid stool. In the text we used the term FI and in the 

tables clarified the operational definitions of anal (flatus and fecal), FI, solid, or liquid 

incontinence, or its combinations. Continence was defined as self-reported absence of 

involuntary urine or feces loss. We defined combined incontinence as a combination of urine and 

fecal incontinence. When the authors reported prevalence of UI or FI but not combined 

incontinence in the same populations, we define the outcomes as UI only or FI only without 

additional assumption about possible misclassification. We also analyzed urinary continence 

defined as negative stress and pad tests. We used the term “urodynamic UI” to replace the older 
24 

term “genuine stress incontinence.” Frequency of UI or FI was abstracted as daily, weekly, or 

monthly episodes of urine leakage or feces loss. Severity of UI was defined using the objectively 

measured urine loss in pad weight tests or self-reported pad use. Severity of FI was defined as 

self-reported amount of feces loss and pad use. Wet status in nursing home residents was 

analyzed to define severity of incontinence and effects of the treatments. We classified residents 

who needed indwelling urinary catheters and an external urinary drainage device as having 

severe or always UI. Restriction of daily activities, and perceived quality of life with UI or FI 

were defined using scales and composite scores. 

Definitions of outcomes. We defined prevalence of incontinence as the probability of 

experiencing incontinence within a defined population and at a defined time point.20,21 We 

defined true population incidence as newly diagnosed cases of incontinence that developed 

annually in the target population. True population incidence estimates were derived from large 

population-based surveys. However, for Question 3 we defined incidence as the probability of 

developing incontinence under study after active and control interventions during time of 

followup.20,21 We defined reported incontinence as the prevalence of total incontinence or 

episodes of different types of incontinence when the authors did not access continence status as 

baseline or did not exclude prevalence cases from overall estimation 

 The absolute risk of incontinence among patients with rare risk factors was compared to the 

general population when no other evidence was available to estimate the adjusted relative risk. 

 For Question 3, relative risk (RR) and 95 percent confidence intervals (CIs) and differences 

in outcomes were calculated. 

Patient outcomes (clinical events). We report both incidence and progression of incontinence 

as they were used by the authors of the original studies and with calculated rates of cure, 

improvement, and progression for purposes of comparison: 

1. the number of patients that developed newly diagnosed incontinence (incidence cases) or 

the number of incontinent patients after active and control interventions (prevalence 

cases) 

2. the number of patients cured by the clinical interventions 

3. the number of patients with improved continence 

4. the number of patients with progression defined as failure to cure or improve and increase 

in frequency and severity of incontinence. 

 Relative risk/odds ratio of developing incontinence was analyzed in the studies that reported 

incident cases. Relative risk/odds ratio of incontinence was analyzed in the studies that reported 

prevalence cases. Relative benefit of continence was defined as the likelihood of continence in 

patients after active treatment relative to those after control interventions. We defined relative 

benefit of improvement as a likelihood of improved incontinence in patients after active 

treatment relative to those after control interventions. We defined relative risk of progression of 

incontinence as the likelihood of increasing frequency and severity of incontinence and failure to 

cure/improve incontinence in patients after active treatment relative to those after control 

interventions 

 We analyzed continence separately from improvement in incontinence because continence is 

the most clinically desirable patient outcome and is well defined, whereas improvement can 

include substantial differences in definitions and changing perceptions of qualitative and 

quantitative parameters of improvement. We used such conservative approaches to generate 

precise estimates of the effectiveness. Clinicians and patients can make informed decisions based 
Appendixes cited in this report are available at http://www.ahrq.gov/clinic/tp/fuiadtp.htm

25 

on the treatments that resulted in greater rates of long-term continence in well designed 

randomized controlled trials (RCTs). 

 We compared the effectiveness of different clinical interventions in relation to baseline rates 

of incontinence, assuming undiagnosed incontinence when the authors did not report objective 

assessment of continence status at baseline. We defined the clinical intervention to reduce the 

risk of incontinence (primary prevention) when the investigators selected the subjects in clinical 

trials by underlying condition, not by continence status. We defined clinical intervention to 

reduce the progression of incontinence when incontinent patients were invited to participate in 

clinical trials (secondary prevention). 

 For surgical interventions that aimed to treat the baseline conditions, including prolapse, 

cancer, ulcerative colitis, hemorrhoids, and anal fissures, incontinence was analyzed as the 

secondary outcome. The goal of the present review was to compare rates of incontinence after 

such procedures rather than review other therapeutic effects on baseline diseases or all 

complications of surgery. 

 Continuous outcomes (surrogates). We defined subjective continuous outcomes as the 

number of incontinent episodes, use of supplies, and scores from validated scales to analyze the 

quality of life with incontinence. We defined objective continuous outcomes as the results of 

objective tests to measure the severity of incontinence. 

 Pooling criteria included the same operational definitions of incontinence outcomes and the 

same risk factors or clinical interventions.573 Homogeneity in clinical interventions was analyzed 

comparing published information on behavioral, instrumental (devices), pharmacological, and 

surgical treatments. Meta-analysis was used to assess the consistency of the association between 

treatments and incontinence outcomes with random effects models.574 The analyses were 

conducted separately for symptoms and signs of incontinence. Assumptions underlying metaanalysis included valid measurements of continence status and similarity in study and target 

populations. 

 Consistency in the results was tested comparing the direction and strength of the association. 

Chi squared tests were used to assess heterogeneity in study results.575,576 Significant 

heterogeneity means the effects of interventions on UI were not consistent in the studies (not 

replicable results). We explored heterogeneity with meta-regression and sensitivity analysis and 

reported the results from random effects models only. The analytic framework and algorithms for 

the meta-analysis are shown in Appendix A. Calculations were performed using STATA 

software at the 95 percent confidence level.577

 For Question 4 we calculated positive predictive value, predictive likelihood ratio, number 

needed to screen to diagnose one case of incontinence, and number of diagnostic tests needed to 

detect one case of incontinence (Appendix A). Cost-effectiveness of diagnostic methods was 

estimated by comparing the cost and number needed to screen and the number of diagnostic tests 

using different tests.

Appendixes cited in this report are available at http://www.ahrq.gov/clinic/tp/fuiadtp.htm

27 

Chapter 3. Results 

 Figure 1 traces the flow of our literature search for Questions 1-4. We retrieved 6,038 

potentially relevant references (5,938 from MEDLINE®, 16 from CINAHL, 22 from the 

Cochrane database and a manual search of the Cochrane reviews, and 63 from a manual search 

of other published reviews and articles). We excluded 71 percent of the retrieved studies; 40 

percent were case series; 13 percent case reports; 5 percent studies with ineligible independent 

variables, 19 percent with no eligible outcomes, and 12 percent with ineligible target 

populations. 

Figure 1. Flow of study selection 

Question 1. What are the Prevalence and Incidence of UI in 

the Community and LTC Settings? 

UI in the Adult Population (Appendix Table F1) 

 Overview. Fourteen epidemiological studies of UI prevalence in community settings have 

reported prevalence rates in a combined sample of adult women and men (Table 1). Five studies 

were conducted in the United States,8,30,39,54,120 two studies in Sweden,37,114 three studies in the 

United Kingdom,36,38,43 and one study each in China,33 the Netherlands,111 Spain,35 Japan,58 and 

Australia.33 The majority of these population-based surveys sampled middle-aged and older adult 

populations. Three studies included younger adults ages 18 years and over.36,37,54 There are 

Databases:

The National Library of Medicine via PubMed®

: 5,954 

CINAHL – Cumulative Index to Nursing & Allied Health Literature: 13 

The Cochrane Library and 

manual search of reference lists in relevant reviews and articles: 127 

Contact with experts: 3 

Total citations: 6,097 

Eligible for review: 1.077 

Excluded 5,020 for the following reasons: 

Comment: 183 

Review: 62 

Not eligible target population: 531 

Not eligible outcomes: 1,171 

Not eligible exposure: 322 

Guidelines: 14 

Congresses publication: 1 

Case reports: 567 

Patient education handout: 5 

News: 13 

Case series: 1,764 

No associative hypothesis tested, not eligible level of evidence: 358 

Secondary data analysis: 16 

Interview and letter: 5 

No full texts available: 66 
28 

methodological and reporting differences among the studies. Some studies used mailed 

questionnaires, whereas others involved in-home interviews. Most studies reported on the actual 

prevalence of UI in the sample; however, one study extrapolated the prevalence estimate using 

census statistics for the entire United States population.8,9 There is limited information available 

on the incidence, progression, and remission of UI in the adult population combining men and 

women. 

 Prevalence, severity, and impact of UI. Prevalence estimates for the adult population are 

fairly consistent, with most estimating between 16 to 22 percent.8,9,30,35,37,38,120 However, 

estimates varied according to age and gender. Adults ages 60 years and over have the highest 

rates of UI. Prevalence rates differ substantially by gender, with women having higher rates 

across all age groups. One large study of adults ages 40 and over reported a female to male ratio 

at 2:6.38 

 Incidence of UI. The incident rate for the adult population varies by age, gender, and race. In 

a sample of 17,421 men and women ages 40 years and over, the 1-year incidence was 6 

percent,38 whereas in a study of 2,087 adults over age 70, the 2-year incidence was 20 percent, 

with 21 percent for urge UI and 20 percent for stress UI.33 The largest survey involving 58,658 

American men and women 65 years and over estimated a 2-year incidence rate of UI at 37 

percent,39 with rates being significantly higher in women than men, 44 and 28 percent, 

respectively. In this study, the incidence of UI measured as any urine loss experienced in the past 

6 months increased with age beginning at 32 percent in adults 65-69 years and increasing to 54 

percent in those over age 95. The impact of UI was greatest in the oldest age groups, with those 

rating a big impact varying from 14 percent of those 65-69 years to 27 percent for those 90-94, 

and 38 percent in those over 95 years. This study also found that non-Hispanics (38 percent) are 

more likely to be incontinent than Hispanics (31 percent), and American Indians and Whites had 

higher rates of UI than Blacks and Asians.39 In contrast, Hispanics rated a slightly greater UI 

impact, e.g., a big problem (25 percent) compared to non-Hispanics (17 percent). A higher 

proportion of American Indians (30 percent) rated UI as having a big impact compared to Blacks 

(20 percent), Whites (17 percent), and Asians (15 percent).39

Progression and Remission of UI in Community Dwelling Adults 

 There is limited data on UI progression and remission rates comparing men and women. 

Evidence in adults ages 60 and over suggests that changes in severity over a 2-year period 

progress from continence to mild UI, and from mild to moderate UI.47 Few people advanced to 

severe incontinence (e.g., 300 or more days of urine leakage and/or greater than a quarter cup of 

urine loss per day on 50 or more days during past 12 months)47 One study found change patterns 

varied between women and men ages 60 years and over.47 Women first developed stress UI and 

mixed UI as a primary condition, with urge UI as a secondary condition, whereas men developed 

urge UI, with stress UI as a potential secondary condition. Significantly more men than women 

developed urge UI over the 2-year followup period. Conflicting findings were noted in 

examining progression rates over a longer followup period. In a study of adults ages 70 and over 

involving a 10-year followup, women developed urge UI more frequently than men (23 versus 

11 percent).578

 UI remission rates vary by gender, with women having more stable incontinence (e.g., lower 

remission rates).47 At 1 year, the remission rates for women and men were 11 and 27 percent, 

respectively, and at 2 years, they were 13 and 32 percent, respectively.47 
29 

Prevalence of UI in Community Dwelling Women 

 Overview. We identified 117 epidemiological studies of UI prevalence in community 

dwelling women7,8,30,35-148 that have been published over the past 17 years, with both broad and 

narrow age spans of women within specific countries or regions of countries. The majority of the 

studies have been conducted in the United States (40 studies),8,30,39,44,45,47,50,54-56,59,66,67,88-

90,93,102,105,110,113,118,120,123,124,126,128,130,134,136-141,144,146-149 UK (10 studies),36,38,43,52,70,77,82,103,112,132 or 

Northern Europe, including 13 studies from Sweden,37,48,53,57,61,69,71,99,114,115,119,129,131 four studies 

from Norway,49,62,80,98 six studies from Denmark,51,64,73,78,96,133 and one study from Finland.106

 Prevalence rates regarding these variations can be attributed to differences in study 

populations, survey methodology (including sampling, definition, and measurement of UI), and 

reporting methods (Table 1). Although most studies of women are concentrated in middle-age 

and older women, other studies incorporate a broader age span with samples beginning at ages 

15, 18, to 20 years and over. Study designs vary from probability-based methods of sampling of 

either large populations or random samples drawn from general practices, insurance plan 

enrollees; cross-sectional analyses of prospective cohorts of women who are participants in 

longitudinal studies or clinical trials in which UI is not a primary aim, cross-sectional studies of 

clinical populations or national panels, to case-control studies examining the effect of surgical 

interventions such as hysterectomy. Survey methodology involves mailed questionnaires, inhome interviews by trained interviewers, computer-assisted telephone interviews, or clinical 

evaluations. The definition and measurement of UI vary widely; over 20 definitions have been 

used (Table 1). Pooled prevalence of ever having UI was increased from 21 percent in 19-44 

years old (17 studies) to 34 percent in 45-64 years old (45 studies), and to 39 percent among 

elderly women (11 studies) (Table 2). The differences across studies can create artifacts, as seen 

in Table 2, where the mean pooled prevalence for “ever” is less than the monthly rate. Younger 

females reported UI in the past year less frequently (9.61 percent, two studies), the prevalence 

increased to 35 percent among women 45-64 (11 studies) and to 41 percent among those older 

than 65 years old (13 studies). Elderly women reported UI in the past month (four studies) more 

often (56.7 percent). 

 Prevalence, severity, and impact of UI were reported using standardized scales or 

instruments. Following the method used by the 3rd International Consultation on Incontinence in 

summarizing prevalence estimates in women,579 the authors used the most inclusive definition of 

UI (“monthly UI,” “weekly UI,” and “daily UI”). Severity was measured by volume of urine 

lost, by categorical rating scale of the individual’s perception, or by seeking professional help. 

The amount of urine lost was typically categorized as “drops” to “wets outer clothing” or “runs 

down the legs/floor.” In some studies, a higher percentage of women tended to lose drops45,121,122

in comparison to larger volumes, whereas in other studies, women were more likely to have 

damp underwear and/or wet underwear or clothing than losing drops.128 The severity of the 

leakage has been shown to vary by the frequency of leakage, with infrequent leakage more likely 

to be associated with drops, whereas daily leakage with a greater number having to change 

undergarments or outergarments.45 There are conflicting findings about whether younger or older 

populations rate their UI as more severe.38,130 In one study, older women tended to rate their UI 

as more severe than much younger women.38 In a few studies, severity was measured by the 

perception of how severe a problem UI is to how much daily life is restricted.37,55,190,580
30 

 Differences in reporting prevalence rates in UI types make comparisons challenging across 

studies, as some studies report frequencies within the incontinent group and others report the 

rates within the overall population (Table 3). Overall prevalence of monthly UI was the highest 

in elderly females (25.3 percent, 95 percent CI 14.1; 36.5) (two studies)111,133 and in women 45-

64 years old (20.5 percent, 95 percent CI 18.3; 22.8) (9 studies).43,45,46,62,116,124,132,133,148 Weekly 

incontinence was experienced more often by women older than 65 years (16.9 percent, 95 

percent CI 15.1; 18.8)42,94,97,148 and elderly women over 80 (29.9 percent, 95 percent CI 25.4; 

34.4).42 Few studies reported daily UI, 5 percent of younger women (19-44 years old)96 and 17 

percent of women older than 65 years79 reported having daily leakage. Severe UI, defined as wet 

clothes or severe enough to seek treatment, was experienced by 9 percent of women over 65 

(8.96 percent, 95 percent CI 7.51; 6),59,76,77,86,128,144 and 10 percent of middle-aged women (95 

percent CI 9.37;11) (seven studies).40,51,60,77,86,89,131 Less than 2 percent of women younger than 

45 years old experienced severe UI.86

Racial/ethnic differences. The majority of epidemiological studies have been conducted in 

White women in North America, Europe, Australia, and New Zealand. Although several studies 

have been conducted in Asian countries, including Turkey,58,60,79,95,116,121 because of 

methodological differences, it is difficult to directly compare those to studies in which varying 

racial/ethnic groups have been sampled. There have been a limited number of studies from 

Middle Eastern countries, with only one study from an African country. 

 Eight population-based studies in the United States have reported on racial/ethnic differences 

in the prevalence of UI in women (Table 1). The majority of these studies document a higher 

prevalence of UI (including all types) in White women as compared to Black, Hispanic, and 

Asian women. 

 Type of UI. In general, stress and mixed UI were the most common types in studies that 

have compared stress, urge, and mixed UI (16 out of 28 studies) (Table 4). Although surveys 

have found differences in the frequencies of the different types of UI by age and race, these 

differences are inconsistent across studies. Some surveys found higher rates of stress UI in young 

and middle-aged women,57,74,80,104,108 whereas others have found higher rates in older 

women.37,85,133,145,581 Similar inconsistencies are noted with urge UI, with some studies reporting 

higher rates in older women37,106,145 and others reporting it is more prevalent in middle-aged 

women108,133 (Table 5). The prevalence of total UI increase in age categories from 19 percent in 

women 19-44 years (18 studies)57,64,68,69,75,80,85,86,92,96,98-100,119,130,133,145,148 to 29 percent in those 

older than 45 years. Stress incontinence was the most prevalent type in women 19-44 years old 

(12.8 percent, 95 percent CI 8.3; 17.4) (15 studies),37,57,64,80,85,91,95,98,104,108,109,130,133,145,124 and in 

those 45-64 years of age (21.5 percent, 95 percent CI 18.9; 24.1) (36 studies).37,38,44,51,57,61,70, 73-

75,77,78,80,84,85,87,89,95,104,108,116,117,122,124,127,129,131,135-137,139,141,145,148,149 However, mixed UI was the 

most prevalent type of incontinence in older women, 16.8 percent of women older than 65 (95 

percent CI 13.7; 19.9) (19 studies)30,35,59,66,71,72,74,80,85,90,104,106,108,110,121,128,142,143,145 and 16 percent 

of elderly women (95percent CI 7.3; 24.4) reported mixed UI (seven studies).71,74,80,84,106,124,133

Prevalence of urge incontinence gradually increased from 5 percent in younger women (4.9 

percent, 95 percent CI 3.7; 6.1)37,57,64,80,85,91,95,98,101,104,108,130,133,145 to 10 percent in women 45-64 

(10.2 percent, 95 percent CI 8.9; 11.5) (32 studies),37,44,51,57,61,70,73-75,77,78,80,84,85,87,89,95, 

102,104,108,116,117,124,126,127,129,131,137,139,145,148,149 and to 12 percent in women older than 65 years (12.2 

percent, 95 percent CI 9.9; 14.5) (28 studies).30,35,37,56,59,61,63,66,71,72,74,80,84,85,90,104, 

106,108,110,118,121,123,125,128,133,142,143,145
31 

 A small number of population-based surveys conducted in the United States have compared 

racial/ethnic differences in UI types.89,118,137,149 In general, White women have higher rates of 

stress UI than Black, Hispanic, or Asian women,89,149 although one study did find Hispanic 

women had a higher rate of stress UI than White, Black, and Asian women.137 Black women are 

more likely to have higher rates of urge UI and mixed UI as compared to Whites and 

Hispanics.137,149 

Incidence of UI in Community Dwelling Women 

 There are limited data from 18 studies on the incidence of UI in community dwelling women 

(Table 6).38,45,47,56,59,62,103,134,139,149-157 Variations in incidence rates can be attributed to differences 

in study populations, UI definition, followup periods, and reporting methods. One-year incidence 

rates varied from <1 percent in Norwegian women ages 50-74 years62 to 26 percent in American 

women ages 20-84 years.139 Annual cumulative incidence rates averaged between 1-4 

percent,139,153,155 with rates increasing with advancing age.33,38,139 In one study that examined 

incidence rates with respect to age, the incidence increased from 8 percent in women ages 40-49 

years to 15 percent in those 80 years and over,38 whereas in another study, rates increased from 

15 percent in women ages 20-36 years to 47 percent in women 70 years and over.139 There is a 

paucity of studies examining racial/ethnic differences in UI incidence rates. In one study, Whites 

had a slightly higher annual cumulative incidence (13 percent) than Black women (12 

percent).149

 Pooled annual incidence (Table 7) was 6.25 percent (95 percent CI 5.57; 6.93) for all ages 

with the highest in elderly women, 7 percent (95 percent CI 6.12; 9.37) in those older than 65 

years, and 8.52 percent in women over 80 (95 percent CI 3.07; 13.98). Few surveys on the 

incidence of UI in women have included questions on incontinence types (Figure 2). One study 

involving 2,283 women ages 40-60 reported a 1-year incident rate for stress UI of 4 percent.73 In 

a survey of 2,025 women ≥65 years, the 3-year incidence rate for stress and urge UI was 29 

percent each.56 In a recent survey in the United States involving 3,302 women ages 40-55 years, 

the 5-year cumulative incidence rates were highest for stress UI (25 percent), followed by urge 

UI (16 percent) and mixed UI (12 percent); other or unclassified UI had the lowest incidence rate 

(3 percent).149 In this same survey, Whites and Japanese-American women had the highest 

incidence of stress UI compared to Chinese, Hispanic, and Black women. White women also had 

the highest incidence of urge UI; however, Black women had a higher incidence than Chinese, 

Japanese, and Hispanic women, respectively. Black women had the highest incidence of mixed 

UI, followed by White, Chinese, Hispanic, and Japanese women. 

 Overall, middle aged and elderly women developed stress UI more often (pooled annual 

incidence from 4 studies 9.7 percent, 95 percent CI 5.4; 13.9). Annual incidence of mixed UI 

was close to stress UI (pooled annual incidence from two studies 7.6 percent, 95 percent CI 4.1; 

11.0). Less than 7 percent of women 45-79 years old developed urge UI (pooled annual 

incidence from three studies 6.44 percent, 95 percent CI 2.3; 10.6). 

 Summary. Evidence from large observational studies from different countries (level of 

evidence IIB) suggested that UI is a prevalent condition among women of all ages with overall 

prevalence close to the estimations of the National Health and Nutrition Examination Survey (38 

percent).9

 Prevalence increased in women older than 45 years of age with further small increases 

in elderly women. Stress UI is the most prevalent type if UI in women 45-64 years old, while 

elderly women experienced mixed UI more frequently. Incidence of UI (level of evidence IIA-B) 
32 

gradually increases with age. Differences in definitions of UI contributed substantially to 

variability in the results from individual studies. 

Progression and Remission of UI in Community Dwelling Women 

 There is limited data on the natural history of UI in women. Of the several studies of UI 

during and following childbirth, most report prevalence rates making it difficult to determine the 

progression and remission rates of UI in this subpopulation of women. Available data suggest 

that UI is a dynamic process in women, although the rates for full remission tend to be low. In 

nonchildbearing populations, annual remission rates range from 3 to 11 percent.33,47,139,150,151,155

Remission rates tend to decrease with advancing age,150,155 with one study reporting women ages 

22-30 had remission rates more than twice that of women ages 41-50, 33 and 13 percent, 

respectively.155 Duration of incontinence did not affect the chance of remission in a study 

involving women ages 20-59 years; 20 percent in the remission group and 24 percent in the 

incontinent group had been incontinent for at least 10 years.151 Evidence indicates that the 

severity of UI tends to worsen over time.33,47

 Data on the progression and remission of the different types of UI is scarce, with variable 

followup periods making it challenging to summarize remission rates. Data in women ages 60 

years and over suggest that when women become incontinent they tend to first develop stress UI, 

either alone or in combination with urge UI. Those with stress UI alone either continue with 

stress UI alone or develop mixed UI over a 2-year followup period.47 Some evidence indicates 

that the type of UI is relatively stable over 3 to 6.5 years,56,139,155 particularly for stress UI. One 

study involving women ages 20-84 years found that the majority of women (52 percent) had the 

same form of UI after 6.5 years.139 In this study, urge UI had the highest remission rate (38 

percent) followed by stress and mixed UI (21 and 15 percent, respectively). In another study of 

women ages 40-60 years, the 1-year remission rates were 41 percent for stress UI, 42 percent for 

urge UI, and 38 percent for mixed UI.150 In a study of women ages 65 years and over, the 3-year 

remission rates were 25 percent for stress UI and 22 percent for urge UI.56 A study examining 

10-year incidence and progression rates reported that women ages 70 and over with or without 

urgency had incontinence rates for urge UI of 11 percent and 15 percent respectively.582 There 

was also a higher percent of women with urge UI at followup (6 percent at baseline and 26 

percent at 10-years). 

Prevalence of UI in Community Dwelling Men 

 In comparison to women, there have been fewer epidemiological studies in men (Appendix 

Table F2) with highly variable samples, including age categories and definitions of UI. Although 

there is a broad age range in the prevalence studies, the majority concentrate on middle age and 

older male populations (e.g., beginning at age 40, 60, or 65 years and over)8,30,35,37,39,47,61,72,74,81, 

88,97,107,111,113-115,181,583-586 with fewer studies of men younger than 40 years,37,52,54,86,145,181,587-589

including a recent national survey of men ages 18 years and over in the United States.589 The 

majority of these studies have been conducted in North America or European countries using 

predominantly White populations. Two studies have incorporated Asian populations.107,585

Pooled analysis (Table 8) detected a clear pattern of increased prevalence of total UI in aging 

men from 4.8 percent (95 percent CI 3.7; 5.9) in 19-44 years old (11 studies) to 11.2 percent (95 

percent CI 10.1; 12.3) in those 45-64 years old (27 studies), to 21.1 percent (95 percent CI 19.9; 
33 

22.4) in males over 65 years of age (41 studies). The highest prevalence of UI was reported in 

elderly males of 32.2 percent (95 percent CI 29.6; 32.7) (17 studies). Urge UI was the most 

prevalent type of UI in males among all age categories increasing from 3.1 percent (95 percent 

CI 2.0; 4.2) in 19-44 years old (7 studies) to 11.7 percent (95 percent CI 9.3; 14.1) in those older 

than 65 years of age (20 studies). 

Type of UI. The prevalence of UI, defined in various ways (ever, current, any, greater than 

two times/week, or leakage within past 4 weeks, 2, 6, or 12 months), is estimated between 3 

percent in men 30 years and over in a study conducted in the United Kingdom52 to 37 percent in 

men 39-91 years in a Norwegian study.586 In a large population-based study conducted in five 

countries (Canada, Germany, Italy, Sweden, and the United Kingdom), the prevalence rate for 

men ages 18 and over was 5 percent.145 

 Studies in American men reported UI as involuntary leakage of urine during the last year, last 

month, or ever (Appendix Table F3). The prevalence estimations varied substantially depending 

on the definitions, with the higher prevalence of UI during the last year in males 19-44 years old 

(18.4 percent , 95 percent CI 4.5; 32.2) and 45-64 years old (24.6 percent 95 percent CI 19.92; 

29.35) compared to UI during the last month (Table 9). Older males reported UI during the last 

month more frequently, from 29.2 percent (95 percent CI 24.4; 34.0) among those older than 65 

years of age to 42.4 percent (95 percent CI 32.8; 52.0) in elderly males. Two percent of American 

men 45-64 years old ever experienced stress UI (95 percent CI 2.0; 2.0) and one percent reported 

stress UI during the last month. Urge UI was the more prevalent during the last year (6.7 percent, 

95 percent CI 6.7; 6.7) of men 45-64 years old. Men over 65 years of age reported having urge UI 

during the last month (10.6 percent, 95 percent CI 10.6; 10.6). 

Severity of UI. Fewer studies provided estimates for severity of UI in American men

(Appendix Table F4).54,164,181,590,591 A survey of 922 males older than 20 years who were 

recruited in the primary care clinic54 reported that wet underwear less than once per month was 

experienced by 9 percent, monthly by 5 percent, weekly by 7 percent, and daily by 14 percent of 

the responders. A community-based cross-sectional survey of 778 men older than 40 years590

reported that 10.8 percent of the responders had wet underclothing during the last year. Among 

males 41-60 years old from primary care clinics in a Veterans Affairs facility, 4.4 to 4.8 percent 

experienced daily UI. 181 The prevalence of daily UI increased to 8.4 to 8.9 percent among those 

older than 60 years of age. Pooled analysis (Table 10) estimated that daily UI was experienced 

by 4.8 percent of males 45-64 years (95 percent CI 4.8; 4.8), 8.3 percent men over 65 years old 

(95 percent CI 7.0; 9.6), and 9.3 percent elderly men (95 percent CI 4.5; 14.1). Severe UI that 

required a change of underwear was reported by 2 percent of those 45-64 years old and 4 percent 

of elderly men (95 percent CI 3.9; 4.1). 

Racial/ethnic differences. The majority of studies have been conducted in White male 

populations (Table 1). Three studies from the United States provided data on prevalence rates in 

racial/ethnic groups using different survey methodology, including methods for estimating 

prevalence.8,39,181 In one large population-based survey using a weighted prevalence estimate, 

non-Hispanic Black men were found to have a higher rate of UI (21 percent) compared to nonHispanic White men (16 percent) and Mexican-American men (14 percent).8

 In the other study, 

non-Hispanics (38 percent) were more likely than Hispanics (31 percent) to have UI.39 This latter 

study also found that American Indians and Whites had higher rates of UI than Asians and 

Blacks, respectively. A sample of male veterans receiving care in primary care clinics found 

similar rates of incontinence between Whites (32 percent) and Blacks (33 percent).181 In a crossnational comparison of UI prevalence rates, South Korean men had the lowest rates (4 percent) 
34 

followed by men in France (7 percent), the United Kingdom (14 percent), and the Netherlands 

(16 percent).585

Incidence of UI in Community Dwelling Men 

 There is scarce data on the incidence of UI in community dwelling men, excluding studies of 

men following prostatectomy (Table 6). One-year incidence rates vary depending on the age of 

the study population. In one study of men 40 years and over residing in the United Kingdom, the 

1-year incident rate was 4 percent, with incidence of involuntary leakage increasing from 2 

percent in those 40-49 years to 11 percent in those 80 years and over.38 In a study of American 

men 60 years and over, the 1-year incidence rate of involuntary leakage was 20 percent 

(weighted for nonresponders).47 There are no data available on the incidence of the different 

types of UI or comparisons by racial/ethnic groups. 

 Progression and remission of UI in community dwelling men. There is limited evidence 

on the progression and remission of UI in men. Evidence indicates that when men became 

incontinent, they developed urge or other types of UI; those with urge UI alone either stayed as 

urge UI or developed mixed UI.47 In one study over a 10-year period, 3 percent of men without 

either urgency or urgency with incontinence at baseline developed urge UI. There was a slight 

nonsignificant decline in men with urge UI at baseline to have it at the 10-year followup (5 

percent vs. 4 percent, respectively).582

Epidemiology of UI in Long-Term Care Settings 

 Overview. In contrast to community settings, there have been fewer epidemiological studies 

on the prevalence, incidence, progression, and remission of UI in LTC settings. Differences in 

study populations, survey methodology, and definitions and measurement of UI affect the 

variability in prevalence estimates. Also, the timing of the survey, e.g., at admission or at a later 

date, also adds to the variability in estimates. More recent studies have relied on the bladder 

continence item on the Minimum Data Set (MDS) to operationalize UI. Two studies report data 

from the same cohort but derive slightly different estimates.28,166 There are scarce data on the 

severity and impact of UI. 

 Prevalence of UI in the LTC population. The majority of studies sample both men and 

women ages 65 years and over residing in LTC facilities (Table 11). Although most studies 

provide prevalence estimates by gender, some provided only a prevalence estimate that included 

both men and women. For the combined group, prevalence estimates using varying definitions 

(e.g., any daytime urinary incontinence, at least two episodes of urine loss in the past 2 weeks, 

urine loss at least twice a month, or medical record or staff report of UI) ranges from 30-77 

percent.2,28-31 Measuring UI with the MDS, prevalence estimates varied from 30 percent in a 

large sample of 29,645 adults ages 20-109 years31 to 77 percent in a smaller sample of 380 adults 

65 years and over.30 In a recent population-based study involving 95,911 older nursing home 

residents from eight southeastern states, the prevalence rate at admission was 65 percent.32

 The prevalence of UI in female residents in LTC settings is estimated at between 60 and 78 

percent.28-30,32,164 In one study using data from the National Nursing Home Survey, the 

prevalence in women was estimated to be 74-85 percent.2

 However, in this same study when UI 

was identified from the medical record, the prevalence rate was <1 percent (1,366 per 100,000). 

The prevalence of UI in men ranges from 23-72 percent.28-30,32,164
35 

 Prevalence rates increase with advancing age in both men and women.2,29,30 There is limited 

data available on racial/ethnic differences in UI prevalence. Those studies available indicate 

conflicting findings. In one large study involving nursing home residents from eight states, there 

was a higher prevalence in Blacks (71 percent) compared to Whites (64 percent) at admission, 

but after admission the prevalence rate was more similar (78 percent vs. 74 percent, 

respectively.32

 Incidence of UI in LTC settings. Minimal data are available on the incidence of UI in LTC 

settings An early study involving 430 nursing home residents reported an incidence of 27 percent 

2 months after admission and 19 percent at 1 year.166 This is consistent with a later study that 

reported an incidence rate of 20 percent at 1 year.33 The incidence of daytime UI between 2 

months and 1 year after admission was higher in males (46 percent) than in females (16 

percent).166

 Progression and remission of UI in LTC settings. Few studies have examined the 

progression and remission of UI in LTC settings in a way that can be easily interpreted. 

Although there are no large changes documented, the evidence available suggests that UI is a 

dynamic condition that does change over time, including improvement. One large study 

involving nursing home residents from eight states that examined UI at admission and within a 

4-year post-admission period reported a 0 percent progression rate.32 In another study, the 

remission rate at 1 year was reported to be 10 percent.33
36 

Table 1. Prevalence of UI in community dwelling adults by age and race 

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Prevalence of UI in Adults (Women and Men Combined)Miles, 2001592 USA 65 years & 

over 

Population-based mailed survey 

Difficulty holding urine -- 2,660 

O’Brien, 199143 UK 35 years & 

over 

Population-based mailed survey 

Urine leakage twice or more a month 

79 5,661 

Lagace, 199354 USA 20 years & 

over 

Cross-sectional survey using self-administered questionnaire 

Urine leakage over past 12 months 

86 2,830 

Nakanishi, 199758 Japan 65 years & 

over 

Population-based survey with in-home interview 

Urine leakage 95.4 1,473 

Damian, 199835 Spain 65 years & 

over 

Population-based survey with in-home interviews 

Current involuntary urine leakage 

71.2 589 

Roe, 200036 UK 18 years & 

over 

Population-based mailed survey 

Urine leakage ever Regular UI: Twice or more a month 

53 6,319 

Liu, 200233 China 70 years & 

over 

Population-based survey with interview 

Difficulty holding urine until getting to the toilet (urge UI) or accidentally passing urine (stress UI) 

53.4 2,087 

Adelmann, 200430 USA 65 years & 

over 

Population-based survey with in-home interview 

Ever of current urine leakage or trouble holding urine in past 18 months 

59% with 

cooperation 

rate of 90% 

910 

Andersson, 200437 Sweden 18-79 years Population-based mailed 

survey 

Urine leakage at least once a week or at any time 

64.5% 9,836 

Bogner, 2004120 USA 50 years & 

over 

Population-based survey with in-home interview 

Urine loss or having trouble getting to the bathroom on time within past 12 months 

42.8% of 

original sample 

822 

McGrother, 200438 UK 40 years & 

over 

Population-based mailed survey 

Urine leakage either day or night 

60.2% 92,491 

Stenzelius, 2004114 Sweden 75 years & 

over 

Population-based mailed survey 

Difficulty controlling urine during last 3 months 

50.3 4,227 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

37

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Teunissen, 2004111 Netherlands 60 years & 

over 

Population-based mailed survey 

Urine leakage twice or more a month 

88 5,748 

Anger, 20068 USA 60 years & 

over 

Population-based survey using in-home interview 

Difficulty controlling bladder including leaking small amounts of urine with coughing or sneezing over past 12 months 

NA 9,965 

Mardon, 200639 USA 65 years & 

over 

Population-based mailed survey 

Urine leakage in past 6 months 

76% 145,765 

Prevalence of UI in Women Herzog, 199047 USA 60 years & 

over 

Population-based mailed survey 

# days of urine lost in past 12 months 

66-72 1,154 

Lagro-Janssen, 199046

Netherlands 50-65 years Population-based survey 

with in-home interview 

Urine leakage more than twice a month 

60 1,442 

Molander, 199048 Sweden 65-84 years Population-based mailed 

survey 

Based on ICS definition 70.1 4,206 

Roe, 200036 UK 18 years and 

over 

Population-based mailed survey 

Ever experienced urine leakage 

53 (male 

and female 

combined) 

2,699 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

38

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Burgio, 199145 USA 42-51 years Cross-sectional survey 

with clinic and in home interviews 

Urine leakage at least monthly 

60 541 

Kok, 199242 Netherlands 60 years & 

over 

Population-based mailed survey 

Urine leakage twice or more a week 

69 719 

O’Brien, 199343 UK 35 years & 

over 

Population-based mailed survey 

Urine leakage twice or more a month 

79 (women 

and men 

combined) 

3,165 

Rekers, 199241 Netherlands 35-79 years Population-based mailed 

survey 

Urine leakage occurring at least weekly 

68% 1,299 

Brockelhurst, 199352

UK 30 years & 

over 

Cross sectional survey with in-home interviews 

Ever have a bladder problems, e.g., leaking, wet pants, damp pants 

Not reported 2,224 

Lagace, 199354 USA 20 years & 

over 

Cross sectional survey with self-administered questionnaire 

Urine leakage in past 12 months 

86 826 

Milsom, 199353 Sweden 7 birth cohorts 

1900-1940 

Population-based mailed survey 

Not provided but based ICS definition 

74.6 7,459 

Mommsen, 199451 Denmark 30-59 years Population-based mailed 

survey 

Urine leakage over past year 

85 2,589 

Seim, 199549 Norway 20 years & 

over 

Population-based mailed survey 

Any frequency or amount of urine leakage 

77 1,820 

Wetle, 199550 USA 65 years & 

over 

Population-based survey with in-home interview 

Difficulty holding urine 85 2,360 

Brown, 199655 USA 70 years & 

over 

Cross-sectional survey with self-administered questionnaire 

Urine loss during past 12 months 

-- 7,949 

Bogren, 199761 Sweden 65 years & 

older 

Population-based mailed survey 

Involuntary urine loss 92 225 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

39

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Brieger, 199760 Hong Kong Mean age 45 

(SD 15) 

Population-based telephone survey 

Involuntary urine loss which is either socially or hygienically unacceptable 

43 1,054 

Nakanishi, 199758 Japan 65 years & 

over 

Population-based with inhome interviews Urine leakage 95.4 1,405 (women 

not 

specified) 

Samuelsson, 199757

Sweden 20-59 years Cross-sectional mailed 

survey 

Involuntary urine loss 77 491 

Thom, 199759 USA 60 years & 

over 

Population-based mailed survey 

At least one episode of urinary incontinence in past year or having sought treatment 

74.7 939 

Thom, 199759 USA 65 years & 

over 

Population-based using medical record and hospital records 

UI diagnosis in medical record 

-- 3,004 

Damián, 199835 Spain 65 years & 

over 

Population-based survey with in-home interviews 

Difficulty controlling urine or urine escaping 

71.2 (men and women combined) 

589 (men 

and 

women 

combined

Holtedahl, 199862 Norway 50-74 years Population-based survey 

with clinic interview 

Any urine leakage, regular leakage with or without objective demonstration (≥2 

episodes/month); and regular incontinence, ICS definition fulfilled 

72.6 507 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

40

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Chiarelli, 199968 Australia 18-23 years 

45-50 years 70-75 years 

Population-based mailed survey 

Urine leakage in past year 

48% 18-23 years 54% 45-50 years 41% 70-75 years 

14,761 14,070 12,893 

Dolan, 199965 Ireland 35-74 years Population-based mailed 

survey 

Urine loss 66 689 

Foldspang, 199964 Denmark 20-59 years Population-based mailed 

survey 

Urine leakage in past year 

75.5 4,710 

Fultz, 199967 USA 70 years & 

over 

Prospective cohort with in-person and telephone interviews 

Urine loss in past 12 months 

-- 3,385 

White 

606 Black 

Hagglund, 199969 Sweden 18-70 years Population-based mailed 

survey 

Involuntary urine loss at present time 

88 14,761 

Kuh, 199970 UK 48 years Prospective cohort 

mailed survey 

Urine leakage over past year 

93 1,378 

Palmer, 1999593 USA 18 years & 

over 

Cross-sectional mailed survey 

Monthly urine leakage 57% 1,113 

Roe, 1999594 UK 18 years & 

over 

Population-based mailed survey 

Urine leakage at least twice a month 

52.4% 3,356 

Stenberg, 199971 Sweden 71 and 81 

years 

Population-based mailed survey 

SUI, UUI, or MUI 87 (71 

years) 

62 (81 

years) 

2,245 

1,084 (71 

years) 

611 (81 

years) 

Swinthinbank, 199977

UK 19 years & 

over 

Cross-sectional mailed survey 

Any urine leakage in past month; also ICS definition of UI interfering with social life or causing a hygienic problem 

80 2,075 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

41

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Bortolotti, 200072 Italy 40 years & 

over 

Population-based telephone survey 

Urine leakage during past year 

>99 2,767 

Hannestad, 200080 Norway 20 years & 

over 

Population-based mailed survey 

Any urine leakage 80 27,936 

Iglesias, 200076 Spain 65 years & 

over 

Population-based survey with in-home-interview 

Involuntary urine loss or wet underwear, clothes or bedclothes 

95 486 

MacLennan, 20007 New 

Zealand 

15 years & 

over 

Population-based survey with in-home interview 

Urine leakage within past year 

51.3 1.546 

Temml, 200075 Austria 20 years & 

over 

Cross-sectional survey with self-administered questionnaire 

Involuntary urine loss within past 4 weeks 

Not reported 1,262 

Tseng, 200079 Taiwan 65 years & 

over 

Population-based with inhome interview Involuntary urine loss in daily life 80 256 

Ueda, 200074 Japan 40 years & 

over 

Population-based mailed survey 

Any urine leakage 52.5 (women 

and men 

combined) 

968 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

42

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Maggi, 200181 Italy 65 years & 

over 

Population-based survey with in-home interview 

Involuntary urine leakage ever 

89 1,531 

Muscatello, 200184 Australia 41 years & 

over 

Population-based computer-assisted telephone survey 

SUI or UUI during past month 

68 262 

Schmidbauer, 200183

Austria 20 years & 

over 

Cross-sectional with selfadministered questionnaire and clinical assessment 

Urine leakage during past 4 weeks 

-- 1,262 

Stoddart, 200182 UK 65 years & 

over 

Population-based mailed survey 

Urine leakage in past month 

79 740 

Bogner, 200288 USA 50-96 years Population-based mailed 

survey 

Losing urine or having trouble getting to bathroom in past 12 months (ever) 

95 502 

Buchsbaum, 200290

USA 39-91 years Cross-sectional survey 

with self-administered questionnaire 

Current report of urine leakage 

78.4 149 

Finkelstein, 200286 Canada 30 years & 

older 

Population-based mailed survey 

Self-report or urinary incontinence diagnosed by a health professional 

93.6 29,520 

Fitzgerald, 2002188 USA 16-69 years Cross-sectional mailed 

survey 

Urine loss when not able to get to toilet in time, when asleep, or when laughed, coughed, or sneezed 

54% 269 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

43

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Landi, 200294 Italy 65 years & 

older 

Population-based survey using Minimum Data Set for Home Care (MDSHC) 

Any involuntary urine loss regardless of amount ≥2 times/week 

97.2 2,658 

Langa, 2002595 USA 70 years & 

over 

Population-based survey with in-person interviews 

Urine loss during past 12 months 

-- 5,188 

Peyrat, 200285 France 20-62 years Cross-sectional survey 

with self-administered questionnaire 

Current report of urine leakage 

60.7 1,700 

Sampselle, 200293 USA (7 

cities) 

42-52 years Population-based mailed 

survey 

Urine leakage during past year 

-- 3,302 

Sze, 200289 USA 15-91 years Cross-sectional survey 

with self-administered questionnaire 

Urine loss with exertion or urgency or use of pad or protected undergarment because of urine loss with exertion 

Not reported 2,370 

Van Oyen, 200292 Belgium 15 years & 

over 

Population-based survey with in-home interview 

Loss of occurring bladder control sometimes 

60 3,804 

Araki, 2003107 Japan 40-92 years Cross-sectional 

outpatient survey 

Amount of urine leakage 

46% 

(men and 

women 

combined) 

245 

Espino, 2003110 USA 65 years & 

over 

Population-based survey with in-home interview 

Urine loss during past 12 months 

90.5 1,589 

Eva, 200399 Sweden 40-60 years Population-based mailed 

survey 

Urine leakage weekly or more 

67 1,336 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

44

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Grodstein, 2003105 USA 50-75 years Prospective cohort with 

mailed survey 

Urine loss during past 12 months 

-- 83,168 

Hunskaar, 2004112 France, 

Germany, 

Spain, UK 

18 years & 

over 

Cross-sectional mailed survey 

Any urine leakage 58.1 5,976 

Hvidman, 200396 Denmark 20-59 years Population-based mailed 

survey 

Urine leakage the preceding day 

60.3 2,158 

Landi, 200397 Italy 65 years & 

over 

Population-based survey using Minimum Data Set for Home Care 

Any involuntary urine loss regardless of amount ≥2 times/week 

-- 3,194 

Miller, 2003100 Australia 21-26 years 

48-53 years 73-79 years 

Population-based mailed survey 

Urine leakage in past month 

50% 23-26 

years 

83% 48-53 

years 

80% 73-79 

years 

934 

Nuotio, 2003106 Finland 70 years & 

over 

Population-based survey using interviews 

SUI or UUI 93 227 

Rortveit, 200398 Norway 20-64 years Population-based mailed 

survey 

Any involuntary urine loss 

80 27,936 

Adelmann, 200430 USA 65 years & 

over 

Population-based with inhome interviews Positive response to one of 6 questions: 

trouble holding urine or leaking urine; losing urine when one coughs, sneezes, laughs, or with physical activity; losing urine on the way to the bathroom; frequently losing small amounts of urine; other kinds of urinary accidents; and ever having urinary accidents; or involuntary urine loss 

59 (women and men combined) 

308 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

45

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Andersson, 200437 Sweden 18-79 years Population-based mailed 

survey 

Urine leakage at any time or at least weekly 

64.5 (men and women combined) 

7,680 

surveyed; 

response 

not 

provided 

Bogner, 2004120 USA 50 years and 

older 

Population-based mailed survey 

Difficulty losing urine or having trouble getting to bathroom in time (ever) 

95 502 

Holroyd-Leduc, 2004113

USA 70 years & 

over years 

Population-based survey using telephone and inhome interviews 

Any amount of urine loss during past 12 months 

87.4 5,913 

Hunskaar, 2004112 France, 

Germany, 

UK, Spain 

18 years and 

over 

Cross-sectional mailed survey 

Based on ICS definition using symptoms in past 30 days 

60 France 

59 Germany 

64 Spain 

45 UK 

3,881 3,824 6,444 2,931 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

46

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Jackson, 2004123 USA 70-79 years Prospective cohort with 

mailed self-administered questionnaire 

Urine leakage during past 12 months 

98.4% of 

those who 

answered 

incontinence 

questions at 

baseline 

interview 

1,584 

Lagergren, 2004115 Sweden 65 years & 

over 

Population-based survey with self-administered questionnaires and clinic examinations 

Urine loss during the past 12 months with at least one episode in past month 

50-74 

depending 

on region 

4,465 

MacLennan, 20007 Australia 15-97 years Population-based with inhome interviews Stress or urge UI 73.3% 1,546 McGrother, 200438 UK 40 years & 

over 

Population-based mailed survey 

Urine loss with categorical scale determined for frequency and volume of loss 

60.2 50,002 

Østbye, 2004186 Canada 65 years & 

over 

Population-based mailed survey 

Ever lose bladder control or pass water 

-- 5,322 

Özerdogan, 2004116 Turkey 20 years & over Cross-sectional mailed survey Urine loss at least twice a month or more -- 3,259 Stenzelius, 2004114 Sweden 75 & over Population-based mailed 

survey 

Difficulty controlling urine during last 3 months 

61.6 2,636 

Teunissen, 2004111 Netherlands 60 years & 

over 

Population-based mailed survey 

Involuntary urine loss twice or more a month 

88 3,159 

Vandoninck, 2004122

Netherlands 29-79 years Population-based mailed 

survey 

Ever have involuntary urine loss 

73 1,071 

Bradley, 2005125 USA 57-84 years Prospective cohort using 

self-administered questionnaire 

Urine leakage in past 3 months 

88 297 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

47

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Jackson, 2005128 USA 55-75 years Population-based with 

clinic interviews 

Any urine leakage during past month 

-- 1,017 

Kocak, 2005127 Turkey 18 years & 

over 

Population-based survey with in-home interview 

SUI, UUI, or MUI 98.8 1,012 

Lewis, 2005596 ISA 50-69 years Population-based 

telephone or in-person interviews 

Urine lost during past 12 months 

-- 10,678 

Lifford, 2005134 USA 50-75 years Prospective cohort with 

mailed questionnaire 

Urine loss at least weekly 

Not reported 81,845 

Melville, 2005124 USA 30-90 years Cross-sectional mailed 

survey 

Urine leakage at least monthly 

64 3,536 

Nygaard, 2005130 USA 18-60 years Cross-sectional mailed 

survey 

Any leakage in previous 30 days 

68 2,210 

Oskay, 2005121 Turkey 50 years & 

over 

Cross-sectional mailed survey 

Involuntary urine loss either stress, urge, or mixed incontinence 

Not reported 500 

Rohr, 2005133 Denmark 45-68 years Population-based survey 

with in-home interview 

Leaking urine >1 time/month with either physical exertion strong urgency, or both 

91 5,795 

Ruff, 2005126 USA 19-82 years Cross-sectional survey 

with self-administered questionnaire 

Urine leakage or losing control of urination 

47 233 

Swanson, 2005143 Canada 45 years & 

over 

Cross-sectional mailed survey 

Urine loss when coughing, laughing, or with activity or before reaching toilet 

61.1 606 

Teleman, 2005131 Sweden 55-64 years Population-based survey 

with self-administered questionnaire 

Urinary leakage which causes a social and/or hygienic problem 

89% 6,917 

Anger, 20068 USA 60 years & 

over 

Population-based mailed survey 

Difficulty controlling bladder including leaking small amounts of urine with coughing and sneezing 

Not reported 9,965 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

48

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Brown, 2006140 USA 60 years & 

over 

Population-based survey with in-home interview and physical examination 

Weekly or more frequent urine leakage over past 12 months 

NA 1.461 

1,051 

normal 

glucose 

164 

impaired 

fasting 

glucose 

246 

diabetes 

Danforth, 2006138 USA (14 

states) 

Mean age 

44.8 

Prospective cohort with mailed survey 

Urine loss at least once a month or more during past 12 months 

82.3 83,355 

Irwin, 2006145 Canada, 

Germany, 

Italy, 

Sweden, 

and UK 

18 years & 

over 

Population-based survey using computer-assisted telephone interview 

Frequency of urine leakage 

33% 

(women and 

men 

combined) 

1,675 

Jackson, 2006144 USA 55-75 years Population-based survey 

with clinic interview 

Accidental urine leakage during past year 

26% 1,107 

Mardon, 200639 USA 65 years and 

over 

Population-based mailed survey 

Urine leakage in past 6 months 

67% 86,708 

Tannebaum, 2006142

Canada 55 years & 

over 

Population-based mailed survey 

ICI questionnaire 47% 2,361 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

49

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Thom, 2006137 USA 40-69 years Population-based survey 

with self-administered questionnaire and inperson interview 

At least 1 self-reported episode of urine loss 

65.1% 2,109 

Wehrberger, 2006139

Austria 20-84 years Prospective cohort 

mailed survey 

Urine loss during past 4 weeks 

47.7% 441 

Harris, 2007146 USA 30-79 years Population-based survey 

with in-home interview 

Weekly urine leakage 63 331 

Huang, 2007147 USA 65 years & 

over 

Prospective cohort with mailed survey 

Urine leakage in past 12 months 

NA 6,361 

Huang, 2007187 USA 40-69 years Population-based mailed 

survey 

Weekly or daily urine leakage 

-- 1,349 

Kinchen, 2007148 USA 21-75 years Population-based mailed 

survey or telephone interview 

Urine leakage in the past 7 days 

49.7 3,344 

Waetjen, 2007149 USA 40-55 years Prospective cohort with 

mailed survey 

Urine loss during past year 

-- 3,302 

Prevalence of UI in MenHerzog, 199047 USA 60 years & 

over 

Population-based mailed survey 

Urine loss in past 12 months 

66-72% 

check 

802 

O’Brien, 199143 UK 35 years & 

over 

Population-based mailed survey 

Urine leakage at least twice a month 

79 (men and 

women 

combined) 

2,496 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

50

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Brocklehurst, 199352

UK 30 years & 

over 

Population-based survey with in-home interview 

Ever have a bladder problem, e.g., leaking, wet pants, damp pants 

Not reported 1,883 

Lagace, 199354 USA 20 years & 

over 

Cross-sectional survey with self-administered questionnaire 

Urine leakage in past 12 months 

86 (men and 

women 

combined) 

104 

Malmsten, 1997583 Belgium 45 years & 

over (7 birth 

cohorts) 

Population-based with self-administered questionnaire 

Urine leakage when arriving too late to the toilet, when laughing or coughing too much, continuously losing some urine, or losing some urine after micturition 

74.2 overall 

72.2 age 45 74.2 age 50 74.3 age 55 78.5 age 60 79.6 age 65 80.0 age 70 77.9 age 75 

70.5 age 85-89 69.0 age 90+ 

10,458 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

51

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Bogren, 199761 Sweden 65 years & 

over 

Population-based mailed survey 

Involuntary urine loss 92% 233 

Schulman, 1997587 Belgium 30 years & 

over 

Population-based mailed survey 

Urine leakage when arriving too late to the toilet, when laughing or coughing too much, continuously losing some urine, or losing some urine after micturition 

89% 

Men and 

women 

combined 

2,499 

Thom, 199759 USA 65 years & 

over 

Population-based using medical record and hospital records 

UI diagnosis in medical record 

-- 2,982 

Damián, 199835 Spain 65 years & 

over 

Population-based survey with in-home interview 

Current involuntary urine leakage 

71.2 (men 

and women 

combined 

582 (men 

and 

women) 

Koyama, 199863 Japan 66 years & 

over 

Population-based survey with self-administered questionnaire 

Involuntary urine leakage—ever 

-- 856 

Roe, 1999594 UK 18 years & 

over 

Population-based mailed survey 

Urine leakage at least twice a month 

52.4% 2,681 

Bortolotti, 200072 Italy 50 years & 

over 

Population-based survey with telephone interviews and nested case-control with in-home interviews 

Urine leakage in past year 

 2,721 

telephone 

interviews 

64 home 

interviews 

MacLennan, 20007 Australia 15-97 years Population-based with inhome interviews Stress or urge UI 73.3% 1,464 Smoger, 2000181 USA 25-93 years Cross-sectional survey 

with in-home interview 

Urine loss in past 12 months 

85% 840 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

52

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Temml, 200075 Austria 20 years & 

over 

Cross-sectional survey with self-administered questionnaire 

Involuntary urine loss within past 4 weeks 

Not reported 332 

Ueda, 200074 Japan 40 years & 

over 

Population-based mailed survey 

Urine leakage 52.5% (men 

and women 

combined) 

818 

Maggi, 200181 Italy 65 years & 

over 

Population-based survey with in-home interview 

Involuntary urine leakage ever 

89 867 

Stoddart, 200182 UK 65 years & 

over 

Population-based mailed survey 

Urine leakage in past month 

79% 781 

Bogner, 200288 USA 50-96 years Population-based mailed 

survey 

Losing urine or having trouble getting to bathroom in past 12 months 

95% 279 

Finkelstein 200286 Canada 30 years & 

over 

Population-based mailed survey 

Self-report of urinary incontinence diagnosed by a health professional 

93.6% 25,400 

Langa, 2002595 USA 70 years & 

over 

Population-based survey with in-person interviews 

Urine loss during past 12 months 

-- 2,255 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

53

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Van Oyen, 200292 Belgium 15 years & 

over 

Population-based survey with in-home interview 

Loss of occurring bladder control sometimes 

60 3,462 

Araki, 2003107 Japan 40-92 years Cross-sectional 

outpatient survey 

Amount of urine leakage 

46% 

Men and 

women 

combined 

305 

Boyle, 2003585 France, 

Netherlands, 

South Korea, 

and UK 

40-79 years Population-based with inperson interview Current urine leakage Not reported 4,979 

Landi, 200397 Italy 65 years & 

over 

Population-based survey using Minimum Data Set for Home Care 

Any involuntary urine loss regardless of amount ≥2 times/week 

-- 2,178 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

54

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Adelmann, 200430 USA 65 years & 

over 

Population-based survey with in-home interview 

Positive response to one of 6 questions: trouble holding urine or leaking urine; losing urine when one coughs, sneezes, laughs, or with physical activity; losing urine on the way to the bathroom; frequently losing small amounts of urine; other kinds of urinary accidents; and ever having urinary accidents; or involuntary urine loss 

59% (men 

and women 

combined) 

163 

Andersson, 200437 Sweden 18-79 years Population-based mailed 

survey 

Any urine leakage or urine leakage at least once a week 

64.5% (men 

and women 

combined) 

7,680 

surveyed; 

response 

not 

provided 

Haltbakk, 2004586 Norway 39-91 years Cross-sectional mailed 

survey of men with BPH diagnosis 

Any involuntary urine leakage 

78% 612 

Holroyd-Leduc, 2004113

USA 69-103 years Population-based survey 

with in-home interview 

Any amount of urine loss during past 12 months 

87.4% (men 

and women 

combined) 

1,041 

Lagergren, 2004115 Sweden 65 years & 

over 

Population-based survey with self-administered questionnaires and clinic examinations 

Urine loss during the past 12 months with at least one episode in past month 

50-74 

depending 

on region 

3,053 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

55

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Østbye, 2004186 Canada 65 years & 

over 

Population-based mailed survey 

Ever lose bladder control or pass water 

-- 3,574 

Teunissen, 2004111` 

Netherlands 60 years & 

over 

Population-based mailed survey 

Involuntary urine loss twice a month or more 

88 2,589 

Anger, 20068 USA 60 years & 

over 

Population-based survey with in-home interview 

Difficulty controlling bladder, including small amounts of urine loss with coughing or sneezing over past 12 months 

NA Not 

reported 

Irwin, 2006145 Canada, 

Germany, 

Italy, 

Sweden, 

UK 

18 years & 

over 

Population-based computer-assisted telephone interview 

Frequency of urine leakage 

33% 

men and 

women 

combined 

Not 

reported 

Lewinshtein, 2006588

Canada 33-80 years Cross-sectional survey 

using self-administered questionnaire 

Frequency of urine leakage over past 4 weeks 

Not reported 366 

Mardon, 200639 USA 65 years & 

over 

Random sample of Medicare enrollees 

Urine leakage in past 6 months 

67% 

(men and 

women 

combined) 

88,708 
Table 1. Prevalence of UI in community dwelling adults by age and race (continued)

56

Author 

Sample Country Ages (years) Design UI Definition Response Rate (%) Number 

Diokno, 2007589 USA 18 years & 

over 

Population-based mailed survey 

Urine leakage in past 30 days 

-- 21,590 
57 

Table 2. Pooled prevalence of UI in women by time of occurrence (random effects model, statistical test for between studies hefor all estimates) 

Ever In the Past Month In the Past Year 

Age Prevalence 

(95% CI) 

 Prevalence 

(95% CI) 

 Prevalence 

(95% CI) 

19-44 17 studies 

Samuelsson, 199757

Foldspang, 199964

Hannestad, 200080

Peyrat, 200285

Van der Vaart, 200291

Van Oyen, 200292

Chen, 200395

Rortveit, 200398

Chen, 2003101

Miller, 2003104

Parazzini, 2003108

Mawajdeh, 2003109

Andersson, 200437

Schytt, 2004119

Nygaard, 2005130

Rohr, 2005133

Irwin, 2006145

Melville, 2005124* 

21.3 

(16.3; 26.2) 

US* 

28 (27.8; 28.) 

5 studies Hagglund, 199969

Temml, 200075

Peyrat, 200285

Miller, 2003100

Nygaard, 2005130

25.2 

(21.7; 28.7) 

US* 

30 (0; 59) 

2 studies Foldspant, 199964

Chiarelli, 199968

13.37 

(9.61; 17.13) 

45-64 45 studies 

Rekers, 199241

Burgio. 100144* 

Seim, 199549

Mommsen, 199451

Brocklehurst, 199352

Samuelsson, 199757

Bogren, 199761

Dolan, 199965

Kuh, 199970

Moller, 200073

Ueda, 200074

Temml, 200075

Swithinbank, 199977

Alling Moller, 200078

Hannestad, 200080

Muscatello, 200184

Peyrat, 200285

Van der Vaart, 200287

34.1 

(29.6; 38.5) 

US* 

43.2 

(37.1; 49.3) 

7 studies Hagglund, 199969

Temml, 200075

Swithinbank, 199977

Schmidbauer, 200183Peyrat, 200285Miller, 2003100

Hunskaar, 2004112

40.1 

(36.7; 43.5) 

US* 

44.3 

(31.7; 56.7) 

11 studies Mommsen, 199451

Lagace, 199354* 

Foldspang, 199964

Chiarelli, 199968

Kuh, 199970

Bortolotti, 200072

MacLennan, 20007

Sampselle, 200293* 

Grodstein, 2003105* 

Danforth, 2006138* Waetjen, 2007149* 

35.4 

(31.6; 39.2) 

US* 

37.6 

(33.3; 41.9) 
Table 2. Pooled prevalence of UI in women by time of occurrence (random effects model, statistical test for between studies he

for all estimates) (continued) 

58

Ever In the Past Month In the Past Year 

Age Prevalence 

(95% CI) 

 Prevalence 

(95% CI) 

 Prevalence 

(95% CI) 

Sze, 200289* 

Van Oyen, 200292

Chen. 200395

Stewart, 2003102* 

Miller, 2003104

Parazzini, 2003108

Hunskaar, 2004112

McGrother, 200438

Andersson, 200437

Ozerdogan, 2004116

Corcos, 2004117

Vandoninck, 2004122

Melville, 2005124* 

Ruff, 2005126* 

Kocak, 2005127

Tegerstedt, 2005129

Teleman, 2005131Fritel, 2005135Goldberg, 2005136* 

Thom, 2006137* 

Wehrberger, 2006139* 

Lukacz, 2006141* 

Swanson, 2005143

Irwin, 2006145

Waetjen, 2007149* Kinchen, 2007148* 

65+ 40 studies 

Molander, 199048Wetle, 199550* Milsom, 199353

Nygaard, 199656Nakanishi, 199758

Thom, 199759* 

Bogren, 199761

Koyama, 199863

Damian, 199835

Brown, 199966* 

Stenberg, 199971

Bortolotti, 200072

Ueda, 200074

Gavira Iglesias, 200076

35.1 

(33.9; 36.2) 

US* 

35.8 

(30.7; 40.9) 

9 studies Hagglund, 199969

Temml, 200075

Swithinbank, 199977

Stoddart, 200182

Muscatello, 200184

Peyrat. 200285

Miller, 2003100

Bradley. 2005125* 

Jackson, 2005128* 

44.2 

(38.9; 49.4) 

US* 

47.7 

(38.9; 56.3) 

13 studies Herzog, 199047* 

Thom, 199759* 

Chiarelli, 199968

Bortolotti, 200072Bogner, 200288* 

Espino, 2003110* 

Lagergren, 2004115Jackson, 2004118* 

Jackson, 2004123* Mardon, 200639* 

Brown, 2006140* 

Jackson, 2006144* Huang, 2007147* 

40.8 

(32.7; 48.9) 

US* 

47 

(38.9; 55.1) 
Table 2. Pooled prevalence of UI in women by time of occurrence (random effects model, statistical test for between studies he

for all estimates) (continued) 

59

Ever In the Past Month In the Past Year 

Age Prevalence 

(95% CI) 

 Prevalence 

(95% CI) 

 Prevalence 

(95% CI) 

Hannestad, 200080

Maggi, 200181

Muscatello, 200184

Peyrat, 200285

Buchsbaum, 200290* 

Van Oyen, 200292

Dallosso, 2003103

Miller, 2003104

Nuotio, 2003106Araki, 2003107

Parazzini, 2003108

Espino, 2003110* 

McGrother, 200438

Andersson, 200437

Adelmann, 200430* 

Bogner, 2004120* 

Oskay, 2005121

Jackson, 2004123* Bradley, 2005125* 

Jackson, 2005128* 

McGrother, 2006132

Rohr, 2005133

Tannenbaum, 2006142

Swanson, 2005143

Irwin, 2006145

Anger, 20062* 

80+ 11 studies 

Stenberg, 199971

Ueda, 200074

Hannestad, 200080

Maggi, 200181

Muscatello, 200184

Van Oyen, 200292

Nuotio, 2003106

McGrother, 200438

Adelmann, 200430* 

Rohr, 2005133

Swanson, 2005143

38.5 

(36.1; 40.9) 

US* 

50.8 

(35.7; 65.9) 

4 studies Nuotio, 2003106

Stoddart, 200182

Stenzelius, 2004114

Temml, 200075

56.7 

(50.3; 63.1) 

4 studies Brown, 199655* 

Fultz, 199967* 

Bortolotti, 200072

Holroyd-Leduc, 2004113*

22.9 

(12.5; 33.3) 

US* 

24.6 

(12.4; 36.7) 

* Studies conducted in the U.S.
60 

Table 3. Pooled prevalence of UI in women by frequency and severity (random effects model, statistical test for between studie

significant for all estimates) 

Monthly Weekly Daily 

Age Prevalence 

(95% CI)

Prevalence 

(95% CI)

Prevalence 

(95% CI)

19-44 3 studies 

Kinchen, 2007148* 

Rohr, 2005133

Eva, 200399

7.4 

(0.9; 13.9) 

US* 10.3 

(0; 25.2) 

1 study Hvidman, 200396

5.1 

(1.4; 8.9) 

US* 

3.7 

(0.1; 7.41) 

1 study Finkelstein

45-64 9 studies 

O’Brien, 199143

Burgio, 199145* 

Rekers, 199246

Holtedahl, 199862

Ozerdogan, 2004116

Melville, 2005124* 

McGrother, 2006132

Rohr, 2005133

Kinchen, 2007148* 

20.6 

(18.3; 22.8) 

US* 

21.9 

(19.1; 24.9) 

6 studies Rekers, 199241

Roe, 200036

Eva, 200399

Lifford, 2005134* 

Harris, 2007146* 

Kinchen, 2007148* 

16 

(13.3; 18.7) 

US* 

17.3 

(14.2; 20.4) 

9 studiesBurgio, 199145* 

Goldberg, 2005136* 

Hannestad, 200080

Kinchen,2007148* 

Lagace, 199354

Ruff, 2005126

Samuelsson, 199757

Vandoninck, 2004122

Thom, 199759* 

8.1 

(6.3; 10) 

US* 

8.9 

(5.5; 

12.4)) 

7 studies Rekers, 19

Mommsen, Brieger, 19Swithinban

Finkelstein

Sze, 20028

Teleman, 2

65+ 4 studies 

O’Brien, 199143

Holtedahl, 199862

Teunissen, 2004111Rohr, 2005133

22.7 

(20.9; 24.5) 

US* 

17.5 

(12.3; 22.7) 

4 studies Kok, 199242Landi, 200294

Landi, 200397Kinchen, 2007148* 

16.9 

(15.1; 18.8) 

US* 

11.3 

(9.1; 13.5) 

10 studies Tseng, 200079

Espino, 2003110* Anger, 20062* Bradley, 2005125* 

Huang, 2007147* 

Jackson,2005128* 

Kinchen,2007148* 

Oskay, 2005121

Stoddart, 200182

Thom, 199759* 

17 

(13.2; 21) 

US* 

8.3 

(6.2; 10.5) 

5 studies Thom, 199

Gavira-Igle200076

Swithinban

Finkelstein

Jackson, 2

Jackson, 2

80+ 2 studies 

Rohr, 2005133

Teunissen, 2004111

25.3 

(14.1; 36.6) 

1 study Kok, 199242

29.9 

(25.4; 34.5) 

2 studies 

Anger, 20062* 

Brown, 199966* 

38 

(32.4; 44 

1 study Finkelstein

* Studies conducted in the U.S.
61 

Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women 

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Prevalence of UI Type in Women

Burgio, 199144 USA 42-50 years 541 47.9 11.7 35.8 Mommsen, 199451 Denmark 30-59 years 2,589 14.8 8.6 7.1 Nygaard, 199656 USA 65 years & 

over 

2,025 40.3 36.3 

Bogren, 199761 Sweden 65 years & 

over 

225 33 66 

Brieger, 199760 Hong Kong Mean age 45 

(SD 15) 

1,054 10 0.7 

Samuelsson, 199757

Sweden 20-59 years 491 15.7% overall 

2.0% 20-29 years 17.0% 30-39 years 28.7% 40-49 years 21.8% 50-59 years 

2.0% overall 2.5% 20-29 years 0% 30-39 years 3.8% 40-49 years 2.0% 50-59 years 

5.3% overall 1.3% 20-29 ye2.5% 30-39 ye4.6% 40-49 ye

12.8% 50-59 y

Schulman, 1997587 Belgium 30 years & 

over 

2,770 53 55 

Thom, 199759 USA 60 years & 

over 

939 16.9 23.9 23.6 

Damián, 199835 Spain 65 years & 

over 

589 women and women; women not reported separately 

13.5 12.3 61.8 

Koyama, 199863 Japan 66 years & 

over 

1,448 50.4 46.5 

Brown, 199966 USA Mean age 67 

(SD 7) 

2,763 12.8 14.4 14.4 

10.2 (stress-mi

5.9 (urge-mix

Foldspang, 199964 Denmark 20-59 years 4,710 15.1 8.7 6.8 Kuh, 199970 UK 48 years 1,378 50 22 20 
Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women (continued) 

62

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Muscatello, 199984 Australia 41 years & 

over 

262 35 all ages 

29 41-49 years 42 50-59 years 46 60-69 years 27 70+ years 

29 all ages 18 41-49 years 33 50-59 years 38 60-69 years 32 70+ years 

Stenberg, 199971 Sweden 71 and 81 

years 

2,245 36 (71 years) 

32 (81 (years) 

30 (71 years) 31 (81 years) 

20 (overall) 

Swinthinbank, 199977

UK 19 years & 

over 

2,075 60 46 

Bortolotti, 200072 Italy 50 years & 

over 

229 55 12 24 

Hannestad, 200080 Norway 20 years & 

over 

27,936 50 all ages 

48 20-24 years 54 25-29 years 59 30-34 years 60 35-39 years 60 40-44 years 65 45-49 years 55 50-54 years 52 55-59 years 42 60-64 years 38 65-69 years 33 70-74 years 34 75-79 years 32 80-84 years 28 85-89 years 28 90+ years 

11 all ages 13 20-24 years 13 25-29 years 10 30-34 years 7 35-39 years 8 40-44 years 7 45-49 years 7 50-54 years 9 55-59 years 10 60-64 years 16 65-69 years 16 70-74 years 19 75-79 years 21 80-84 years 23 85-89 years 12 90+ years 

36 all ages 33 20-24 years 28 25-29 years 27 30-34 years 29 35-39 years 29 40-44 years 27 45-49 years 36 50-54 years 37 55-59 years 46 60-64 years 44 65-69 years 48 70-74 years 44 75-79 years 40 80-84 years 40 85-89 years 48 90+ years 

Møller, 200073 Denmark 40-60 years 2,284 13.1 7.3 16.4 Temml, 200075 Austria 20 years & 

over 

332 39.8 26.5 

Ueda, 200074 Japan 40-75 years 818 33.9 all ages 

11.3 40-49 years 10.6 50-59 years 8.6 60-69 years 3.4 70+ years 

6.9 all ages 1.3 40-49 years 1.2 50-59 years 2.6 60-69 years 1.8 70+ years 

12.9 all ages 3.8 40-49 year4.1 50-59 year1.9 60-69 year3.1 70+ years 
Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women (continued) 

63

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Muscatello, 200184 Australia 41 years & 

over 

232 35% overall 

29% 41-49 years 42% 50-59 years 46% 60-69 years 27% 70+ years 

29% overall 18% 41-49 years 33% 50-59 years 38% 60-69 years 32% 70+ years 

Buchsbaum, 200290

USA 39-91 years 

(mean 68 

years) 

149 29.7 24.3 35.1 

Nuotio, 2002106 Finland 70 years & 

over 

227 All ages: 41.8 

70-79 years: 31.2 80-98 years: 45.6 

Peyrat, 200285 France 20-62 years 1,700 12.4: all ages 

3.0: <25 years 8.3: 25-39 years 17.3: 40-55 years 24.0 >55 years 

1.6: all ages 0: <25 years 8.3: 25-39 years 17.3: 40-55 years 0: >55 years 

13.5: All ages 3.0: <25 years 8.5: 25-39 yea19.0: 40-55 ye24.0: >55 year

Sze, 200289 USA 15-91 years 2,370 39 White 

27 Black 24 Hispanic 

19 White 16 Black 16 Hispanic 

Van der Vaart, 200287

Netherlands 35-70 years 1,625 50.5 nonhysterectomy 

57.0 hysterectomy 

22.6 nonhysterectomy 38.3 hysterectomy 

Van der Vaart, 200291

Netherlands 20-45 years 1,393 39.1 15.3 

Chen, 200395 Taiwan 20 years & 

over 

1,247 18.0 18.6 17.1 

Dallosso, 2003103 UK 40 years & 

over 

7,046 17.3 

Espino, 2003110 USA 65 years & 

over 

(Mexican 

Americans 

only) 

1,589 10 33 42 

Miller, 2003104 Australia Three age 

cohorts (21-

26 years; 48-

53 years, and 

73-79 years) 

933 10.7%: 21-26 years 

6.4%: 48-53 years 2.0%: 73-79 years 

2.7%: 21-26 years 6.4%: 48-53 years 2.0%: 73-79 years 

86.6%: 21-26 y92.3%: 48-53 y91.1%: 73-79 y
Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women (continued) 

64

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Nuotio, 2003106 Finland 60-99 years 227 23 6 30 Parazzini, 2003108 Italy 40 years & 

over 

2,2 24.3%: overall 

40.7%: ≤52 years 

36.4%: 53-61 years 22.9%: ≥62 years 

18.4%: overall 35.4%: ≤52 years 

30.8%: 53-61 years 33.9%: ≥62 years 

45.8%: overall 30.9%: ≤52 yea

29.4%: 53-61 y39.7%: ≥62 yea

Rortveit, 200398 Norway 20-64 years 15,307 12.2 1.8 5.9 Stewart, 2003102 USA 18 years & 

over 

2,735 9.3 

Adelmann, 200430 USA 65 years & 

over 

163 38.9 9.3 11.1 

Andersson, 200437 Sweden 18-79 years -- 77% of those 

incontinent 59% 18-34 years 83% 35-49 years 83% 50-64 years 71% 65-79 years 

46% of those incontinent 42% 18-34 years 38% 35-49 years 48% 50-64 years 53% 65-79 years 

Corcos, 2004117 Canada 35 years & 

over 

1,683 10.6% 5.5% 

McGrother, 200438 UK 40 years & 

over 

5,816 All ages: 17.3% 

16.7% 40-49 years 19.8% 50-59 years 16.2% 60-69 years 15.2% 70-79 years 18.1% ≥80 years 

Jackson, 2004123 USA 70-79 years 1,584 40% overall 

73% Whites 27% Blacks 

42% overall 64% Whites 36% Blacks 

 

Jackson, 2005128 USA 55-75 years 1,107 17 10 32 Ozerdogan, 2004116

Turkey 20 years & 

over 

625 42.9 27.3 29.8 

Vandoninck, 2004122

Netherlands 29-79 years 1,071 68.9 

Bradley, 2005125 USA 57-84 years 297 51.2 49.2 Fritel, 2005135 France 49-61 years 2,625 68.4 Goldberg, 2005136 USA 15-85 years 542 51.8% overall 

43% premenopausal 63% postmenopausal 
Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women (continued) 

65

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Kocak, 2005127 Turkey 18 years & 

over 

1,017 33.1 25.6 41.3 

Melville, 2005124 USA 30-90 years 3,536 33 13 50 Nygaard, 2005130 USA 18-60 years 3,562 46.5 9.7 41.9 Oskay, 2005121 Turkey 50 years & 

over 

500 37.2 32.3 30.5 

Rohr, 2005133 Denmark 45 years & 

over 

5,795 24.5%: overall 

15.5%: <60 years 21.8%: 60-80 years 32.4%: ≥80 years 

19.6% overall 9.1%: <60 years 16.4%: 60-80 years 8.0%: ≥80 years 

Ruff, 2005126 USA 19-82 years 233 76% Black 84% Black 68% Black Swanson, 2005143 Canada 45 years & 

over 

606 17.5 7.4 26.4 

Tegerstedt, 2005129 Sweden 30-79 years 5,489 63.2 50.5 3.2 Teleman, 2005131 Sweden 55-64 years 2,682 63 57.6 Wehrsberger, 2006139

Austria 20-84 years 441 34 13 53 

Altman, 2006597 Sweden 32-90 years 48 cases 

165 

controls 

17% abdominal rectal prolapse surgery patients 16% controls 

15% abdominal rectal prolapse surgery patients 10% controls 

Brown, 2006140 USA 20 years & 

over 

1,461 14.4% controls 

31.2% prediabetic 30.2% diabetic 

7.7% controls 24.6% prediabetic 26.4% diabetic 

Irwin, 2006145 Canada, 

Germany, 

Italy, Sweden, 

UK 

18 years & 

over 

1,675 48.9% of incontinent 

women 

6.4%: overall 3.7%: ≤39 years 7.9%: 40-49 years 8.0% ≥60 years 

1.5%: overall 1.0%: ≤ 39 years 1.1%: 40-49 years 2.5%: ≥ 60 years 

2.4%: overall 1.0%: ≤ 39 yea2.4%: 40-49 ye4.1%: ≥ 60 yea
Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women (continued) 

66

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Lukacz., 2006141 USA 25-89 years 4,103 

787 nulliparous 389 Cesarean delivery 2,927 vaginally parous 

15% overall 8% nulliparous 11% Cesarean delivery 18% vaginally parous 

McGrother, 2006132 UK 40 years & 

over 

12,570 6.7 

Tannebaum, 2006142

Canada 55 years & 

over 

2,361 32.0 22.0 35.0 

Thom, 2006137 USA 40-69 years 2,109 7.2% White 

9.0% Hispanic 2.3% Black 2.4% Asian 

4.8% White 4.2% Hispanic 6.0% Black 3.0% Asian 

Predominantly 4.0% White 5.8% Hispanic 7.6% Black 4.4% Asian 

Equal SUI and 3.3% White 5.3% Hispanic 1.9% Black 3.2% Asian 

Kinchen, 2007148 USA 21-75 years 3,344 42.5 12.7 43.4 Waetjen, 2007149 USA 40-55 years 3,302 15.9% Overall 

31.8% Whites 13.1% Blacks 23.3% Chinese 31.1% Japanese 21.2% Hispanic 

7.6% Overall 7.7% Whites 11.8% Blacks 3.2% Chinese 3.8% Japanese 1.4% Hispanic 

12.4% Overall 15.5% Whites 12.9% Blacks 7.2% Chinese 6.8% Japanes4.8% Hispanic 

Prevalence of UI Type in MenBogren, 199761 Sweden 65 years & 

over 

233 10 

Mozes 1997598 Israel 45-75 years 896 2.1 Schulman, 1997587 Belgium 30 years & 

over 

2,499 45 
Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women (continued) 

67

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Damián 199835 Spain 65 years & 

over 

589 men 

and 

women; 

men not 

reported 

separately 

 52.2 16.1 

Koskimaki, 1998584 Finland 50, 60, and 

70 years 

2,128 9 17 

Koyama, 199863 Japan 66 years & 

over 

856 11.4 54.3 

Temml, 200075 Austria 20-96 years 1,236 5.9 26.5 Muscatello, 200184 Australia 41 years & 

over 

232 9% overall 

7% 41-49 years 2% 50-59 years 25% 60-69 years 9% 70+ years 

9% overall 7% 41-49 years 2% 50-59 years 18% 60-69 years 17% 70+ years 

Ueda, 200074 Japan 40-75 years 1,836 1.3% overall 

0.2% 40-49 years 0.5% 50-59 years 0.5% 60-69 years 0.1% 70+ years 

7.7% overall 0.9% 40-49 years 0.7% 50-59 years 2.7% 60-69 years 3.4% 70+ years 

1.5% overall 0% 40-49 year0.4% 50-59 ye0.7% 60-69 ye0.4% 70+ year

Engstrom, 2003599 Sweden 40 years & 

over 

2,217 2% overall 

1% 40-49 years 2% 50-59 years 4% 60-69 years 5% 70-80 years 

Nuotio, 2003106 Finland 70 years & 

over 

171 23 6 30 

Stewart, 2003102 USA 18 years & 

over 

2,469 2.6 

Andersson, 200437 Sweden 18-79 years 13% overall 

18% 18-34 years 13% 35-49 years 11% 50-64 years 13% 65-79 years 

45% overall 18% 18-34 years 37% 35-49 years 43% 50-64 years 59% 65-79 years 

Corcos, 2004117 Canada 35 years & 

over 

1,566 10.6 5.5 

Irwin, 2006145 Canada, 

German, Italy, 

Sweden, UK 

18 years & 

over 

19,165 

(both 

genders) 

0.6% overall 0.1% ≤39 years 0.6% 40-59 years 1.6%: ≥60 years 

1.2% overall 0.4% ≤39 years 1.3%: 40-59 years 2.5%: ≥60 years 

0.6% overall 0.4% ≤39 year0.4%: 40-59 ye1.2%: ≥60 yea
Table 4. Prevalence of UI by incontinence type, age, and race in community dwelling women (continued) 

68

Author Country Age Number Stress Incontinence (%) Urge Incontinence (%) Mixed Incontinence 

Diokno, 2007589 USA 18 years & 

over 

21,590 24.5% overall 

38.1% 18-25 years 35.7% 35-45 years 30.8% 45-55 years 19.3% 55-65 years 16.7% 65-75 years 13.2% 76+ years 

44.6% overall 30.0% 18-25 years 35.4% 35-45 years 38.9% 45-55 years 46.8.3% 55-65 years 53.8% 65-75 years 56.3% 76+ years 

18.8% overall 14.8% 18-25 y12.6% 35-45 y16.5% 45-55 y21.0% 55-65 y22.6% 65-75 y22.4% 76+ yea
69 

Table 5. Pooled prevalence of UI in women by type of incontinence (random effects model, statistical test for heterogeneity bet

for all estimates) 

Age Stress Urge M

Prevalence (95% CI) Prevalence (95% CI) 

19-44 15 studies 

Samuelsson, 199757

Foldspang, 199964

Hannestad, 200080

Peyrat, 200285

Van der Vaart, 200291

Chen, 200395

Rortveit, 200398

Miller, 2003104

Parazzini, 2003108

Mawajdeh, 2003109

Andersson, 200437

Nygaard, 2005130* 

Rohr, 2005133

Irwin, 2006145

Melville, 2005124* 

12.8 

(8.3; 17.4) 

US* 

20.1 

(5.8; 34.2) 

14 studies Samuelsson, 199757Foldspang, 199964

Hannestad, 200080

Peyrat, 200285

Van der Vaart, 200291Chen, 200395Rortveit, 200398

Chen, 2003101Miller, 2003104

Parazzini, 2003108

Andersson, 200437

Nygaard, 2005130* Rohr, 2005133Irwin, 2006145

4.9 

(3.7; 6.1) 

US* 

4.2 (1.3; 7.1) 

10 studies Samuelsson, 199757

Foldspang, 199964

Hannestad, 200080

Peyrat, 200285

Chen, 200395Rortveit, 200398

Miller, 2003104

Parazzini, 2003108

Nygaard, 2005130* 

Irwin, 2006145

45-64 36 studies 

Burgio, 199144* Mommsen, 199451

Samuelsson, 199757

Bogren, 199761

Kuh, 199970

Moller, 200073

Ueda, 200074

Temml, 200075

Swithinbank, 1999 77

Alling Moller, 200078

Hannestad, 200080

Muscatello, 200184

Peyrat, 200285

van der Vaart, 200287

Sze, 200289* 

Chen, 200395

Miller, 2003104

McGrother, 200438

Andersson, 200437

Ozerdogan, 2004116

21.5 

(18.9; 24.1) 

US* 

20.2 

(15.7; 24.8) 

32 studies Burgio, 199144* 

Mommsen, 199451

Samuelsson, 199757

Bogren, 199761

Kuh, 199970

Moller, 200073Ueda, 200074

Temml, 200075

Swithinbank, 199977

Alling Moller, 200078

Hannestad, 200080

Muscatello, 200184

Peyrat, 200285

van der Vaart 87

Sze, 200289* 

Chen, 200395

Stewart, 2003102* 

Parazzini, 2003108

Andersson, 200437

10.2 

(8.9; 11.5) 

US* 

8.2 

(6.3; 10) 

20 studies Burgio, 199144* 

Mommsen, 199451

Samuelsson, 199757

Kuh, 199970

Moller, 200073

Ueda, 200074

Hannestad, 200080

Peyrat, 200285

Chen, 200395Miller, 2003104

Parazzini, 2003108

Ozerdogan, 2004116

Melville, 2005124* 

Kocak, 2005127Tegerstedt, 2005129Thom, 2006137* 

Wehrberger, 2006139* 

Irwin, 2006145

Waetjen, 2007149* 

Kinchen, 2007148* 
Table 5. Pooled prevalence of UI in women by type of incontinence (random effects model) (continued) 

70

Age Stress Urge M

Prevalence (95% CI) Prevalence (95% CI) 

Corcos, 2004117

Vandoninck, 2004122

Melville, 2005124* 

Kocak, 2005127

Tegerstedt, 2005129

Teleman, 2005131Fritel, 2005135Goldberg, 2005136* 

Thom, 2006137* 

Wehrberger, 2006139* 

Lukacz, 2006141* 

Irwin, 2006145Waetjen, 2007149* Kinchen, 2007148* 

Ozerdogan, 2004116Corcos, 2004117Melville, 2005124* 

Ruff, 2005126* 

Kocak, 2005127

Tegerstedt, 2005129

Teleman, 2005131

Thom, 2006137* 

Wehrberger, 2006139* 

Irwin, 2006145

Waetjen, 2007149* 

Kinchen, 2007148* 

65+ 31 studies 

Nygaard, 199656* Thom, 199759* 

Bogren, 199761

Koyama, 199863

Damian, 199835

Brown, 199966* 

Stenberg, 199971

Bortolotti, 200072

Ueda, 200074

Hannestad, 200080

Muscatello, 200184

Peyrat, 200285

Buchsbaum, 200290* 

Dallosso, 2003103

Miller, 2003104

Nuotio, 2003106Parazzini, 2003108

Espino, 2003110* 

Andersson, 200437

Jackson, 2004118* 

Adelmann, 200430* 

Oskay, 2005121

Jackson, 2004123* Bradley, 2005125* 

Jackson, 2005128* 

McGrother, 2006132

16.1 

(13.7; 18.6) 

US* 

15.9 

(12.4; 19.5) 

28 studies Nygaard, 199656* Thom, 199759* 

Bogren, 199761

Koyama, 199863

Damian, 199835

Brown, 199966* 

Stenberg, 199971

Bortolotti, 200072

Ueda, 200074Hannestad, 200080

Muscatello, 200184

Peyrat, 200285

Buchsbaum, 200290* 

Miller, 2003104

Nuotio, 2003106Parazzini, 2003108

Espino, 2003110* 

Andersson, 200437

Jackson, 2004118* 

Adelmann, 200430* Oskay, 2005121Jackson, 2004123* Bradley, 2005125* Jackson, 2005128* Rohr, 2005133

Tannenbaum, 2006142

12.2 

(9.9; 14.5) 

US* 

13.3 

(9.7; 16.8) 

19 studies Thom, 199759* 

Damian, 199835

Brown, 199966* 

Stenberg, 199971

Bortolotti, 200072

Ueda, 200074Hannestad, 200080

Peyrat, 2002 85

Buchsbaum, 20090* Miller, 2003 104

Nuotio, 2003106

Parazzini, 2003108

Espino, 2003110* 

Adelmann, 200430* 

Oskay, 2005121Jackson, 2005128* 

Tannenbaum, 2006142

Swanson, 2005143

Irwin, 2006145
Table 5. Pooled prevalence of UI in women by type of incontinence (random effects model) (continued) 

71

Age Stress Urge M

Prevalence (95% CI) Prevalence (95% CI) 

Rohr, 2005133

Tannenbaum, 2006142

Swanson, 2005143

Irwin, 2006145

Melville, 2005124* 

Swanson, 2005143

Irwin, 2006145

80+ 7 studies 

Melville, 2005124* 

Stenberg, 199971

Ueda, 200074

Hannestad, 200080

Muscatello, 200184

McGrother, 200438

Rohr, 2005133

15.9 

(7.9; 23.9) 

US* 

8.4 

(8.3; 8.4) 

4 studies Stenberg, 199971

Ueda, 200074

Hannestad, 200080

Melville, 2005124* 

11.4 

(5.5; 17.4) 

US 

10.9 

(10.9; 10.9) 

7 studies Stenberg, 199971

Ueda, 200074

Hannestad 80

Muscatello, 200184Nuotio, 2003106

Rohr, 2005133

Melville, 2005124* 

* Studies conducted in the U.S.
72 

Table 6. Incidence of UI in community dwelling adults 

Author Country Ages (years) Response Rate Number Followup Urinary Incontinence Definition Incidence (%) 

Women and Men Combined 

Liu, 200233 China 70 years & 

over 

53.4 2,087 1 and 2 

years 

Difficulty holding urine until getting to the toilet (urge UI) and accidentally passing urine (stress UI) 

1-year: 19.8% urge UI at least occasionally 3.1% urge UI often 14.5% stress UI at least occasionally 1.9% stress UI often 

2-years: 33.7% urge UI at least occasionally 25.4% stress UI at least occasionally 

McGrother, 200438 UK 40 years & 

over 

60.2% 39,602 1 year Daytime or 

nighttime leakage 

6.3% 

Mardon, 200639 USA 65 years & 

over 

67% to initial survey 82% to followup survey 

58,658 2 years Urine loss in past 

6 months 

37.3% 

Women Herzog, 199047 USA 60 years & 

over 

66-72 1,956 1 and 2 

years 

Urine loss over past 12 months 

22.4% at 1 year 18.6% at 2 years 

Burgio, 199145 USA 42-51 years 60 486 3 years Urine leakage at 

least monthly 

8% 

Nygaard, 199656 USA 65 years & 

over 

-- 2,025 3 years Difficulty holding 

urine until getting to toilet or urine leakage with exertion 

28.6% Stress UI 28.5% Urge UI 

Thom, 199759 USA 65 years & 

over 

-- 3,004 9 years UI diagnosis in 

medical record 

Rate/1,000 personyears: 23.0 overall 7.7 65-74 years 20.2 75-79 years 30.9 80+ years 
Table 6. Incidence of UI in community dwelling adults (continued)

73

Author Country Ages (years) Response Rate Number Followup Urinary Incontinence Definition Incidence (%) 

Holtedahl, 199862 Norway 50-74 years 70% 489 1 year Any urine leakage, 

regular leakage (≥2 episodes/ month) with or without objective demonstration; and regular incontinence, ICS definition fulfilled 

0.6% 

Møller, 2000150 Denmark 40-60 years 71.5 2,284 1 year Stress, urge, and 

mixed incontinence 

4.0% Stress UI 2.7% Urge UI 5.8% Mixed UI 

Samuelsson, 2000151

Sweden 20-59 years 77 491 5 years Involuntary urine 

loss 

13.7% 

Sherburn, 2001152 Australia 45-55 years -- 1,897 7 years Involuntary urine 

loss 

35% 

Liu, 200233 China 70 years & 

over 

53.4 2,087 

women and men combined 

1 and 2 

years 

Difficulty holding urine until getting to the toilet (urge UI) and accidentally passing urine (stress UI) 

Stress UI at 1 yea1.9% often 15.9% occasional 16.5% at least occasional 

Urge UI at 1 year: 2.1% often 12.6% occasional 14.5% at least occasional At 2-years (at least occasionally): 30.8% Stress UI 37.5% Urge UI 

Dallosso, 2003103 UK 40 years & 

over 

65.3% Baseline 91.2% at 1 year 

6,426 1 year Stress urinary 

leakage several times a month 

8.3% 

Grodstein, 2004153 USA 50-75 years Prospective 

cohort with mailed questionnaire 

39,436 4 years Urine leakage 1-3 

times/month; frequent UI over past 12 months: at least once/week 

3% ages 50-55 
Table 6. Incidence of UI in community dwelling adults (continued)

74

Author Country Ages (years) Response Rate Number Followup Urinary Incontinence Definition Incidence (%) 

Hagglund, 2004155 Sweden 22-50 years 73% 248 4 years Involuntary urine 

loss at present time 

17% 

McGrother, 200438 UK 40 years & 

over 

79.8% 9,598 1 year Involuntary urine 

leakage (day or night) ever 

8.8% overall 8.4% 40-49 years 7.9% 50-59 years 8.5% 60-69 years 9.4% 70-70 years 14.7% ≥ 80 years 

Lifford, 2005134 USA 50-75 years 88.5% 47,461 4 years Urine leakage at 

least weekly 

6.2% 7.0% without diabetes 10.5% with diabetes 

Jackson, 2006144 USA 55-75 years -- 1,107 1 and 2 

years 

Urine leakage during past year 

At 1-year: 21% without diabetes 26% with diabetes At 2-years 24% without diabetes 20% with diabetes 

Wehrberger, 2006139

Austria 20-84 years 47.7% 441 6.5 years Urine leakage 

during past 4 weeks 

25.6% 

14.8% 20-39 years 25.7% 40-49 years 23.6% 50-59 years 23.9% 60-69 years 47.3% ≥70 years 

Danforth, 2007156 USA 54-79 years -- 31,355 2 years Urine leakage 2,355 cases Waetjen, 2007149 USA 40-55 years 81.8 3,302 

Baseline 2,702 Followup 

Annually for 

5 years 

Urine leakage at least monthly 

55.7% Overall 65.2% White 58.2% Blacks 43.8% Japanese 34.0% Hispanic 

Men Herzog, 199047 USA 60 years & 

over 

69% and 

72% 

1,956 1and 2 years Urine loss over 

past 12 months 

9.0% at 1 year 9.2% at 2 years 
Table 6. Incidence of UI in community dwelling adults (continued)

75

Author Country Ages (years) Response Rate Number Followup Urinary Incontinence Definition Incidence (%) 

Thom, 199759 USA 65 years & 

over 

-- 2,982 9 years UI diagnosis in 

medical record 

Rate/1,000 personyears: 23.8 overall 7.0 65-74 years 17.8 75-79 years 37.2 80+ years 

Liu, 200233 China 70 years & 

over 

53.4 2,087 

women and men combined 

1 and 2 

years 

Difficulty holding urine until getting to the toilet (urge UI) and accidentally passing urine (stress UI) 

Stress UI at 1 year2.2% often 9.7% occasional 11.9% at least occasional 

Urge UI at 1 year: 3.9% often 13.5% occasional 17.4% at least occasional At 2-years (at least occasionally): 20.7% Stress UI 30.4% Urge UI 

McGrother, 200438 UK 40 years & 

over 

77.6% 7,823 1 year UI as involuntary 

leakage of urine 

3.8% overall 2.2% 40-49 years 2.5% 50-59 years 4.0% 60-69 years 7.1% 70-79 years 

10.9% ≥80 years 
76 

Table 7. Pooled annual incidence of UI in women (random effects model) 18 studies 

Age categories Annual incidence (95% CI) 

19-44 1.64 (0.76; 2.52) 

45-64 5.80 (5.02; 6.57) 

65+ 7.74 (6.12; 9.37) 

80+ 8.52 (3.07; 13.98) 

All ages 6.25 (5.57; 6.93) 

Burgio, 199145

Herzog, 199047

Nygaard, 199656

Thom, 199759

Holtedahl, 199862

Moller, 2000150

Samuelsson, 2000151

Sherburn, 2001152

Dallosso, 2003103

Grodstein, 2004153

McGrother, 200438

Dallosso, 2004154

Hagglund, 2004155

Lifford, 2005134

Wehrberger, 2006139

Waetjen, 2007149

Danforth, 2007156

Townsend, 2007157

Figure 2. Annual incidence of UI in women by type of incontinence (random effects model) 

Annual Incidence 

0 20

Author (age category)

Annual Incidence

(95% CI)

Mixed

Møller (45-64) 5.80 (5.79, 5.81)

Danforth (65+) 9.34 (9.33, 9.35)

Subtotal 7.57 (4.10, 11.04)

Stress

Møller (45-64) 4.00 (3.99, 4.01)

Dallosso (65+) 8.30 (8.29, 8.31)

Nygaard (65+) 9.53 (9.52, 9.55)

Danforth (65+) 16.79 (16.78, 16.81)

Subtotal 9.66 (5.39, 13.93)

Urge

Møller (45-64) 2.70 (2.69, 2.71)

Nygaard (65+) 9.50 (9.49, 9.51)

Danforth (65+) 7.11 (7.10, 7.12)

Subtotal 6.44 (2.30, 10.57)
77 

Table 8. Pooled prevalence of total, mixed, stress, and urge male 

UI among age categories (random effects model) 

Age (studies) Prevalence (95% CI) 

19-44 years 

Total UI (11) 4.81 (3.69; 5.94) 

Mixed UI (3) 0.70 (0.11; 1.29) 

Stress UI (5) 0.74 (0.14; 1.34) 

Urge UI (7) 3.09 (1.96; 4.21) 

45-64 years 

Total UI (27) 11.20 (10.14; 12.26) 

Mixed UI (4) 1.53 (0.94; 2.12) 

Stress UI (13) 3.78 (1.56; 6.00) 

Urge UI (14) 7.75 (4.99; 10.50) 

65+ years 

Total UI (41) 21.13 (19.90; 22.35) 

Mixed UI (10) 6.13 (2.53; 9.74) 

Stress UI (15) 2.67 (1.95; 3.39) 

Urge UI (20) 11.70 (9.27; 14.14) 

80+ years 

Total UI (17) 32.17 (29.62; 34.73) 

Mixed UI (1) 9.40 (9.34; 9.46) 

Urge UI (3) 18.18 (6.84; 29.51) 

Table 9. Pooled prevalence of UI in American males by definition and 

age categories (random effects model) 

Time when Involuntary leakage of urine 

was reported (months) (studies) Prevalence (95% CI) 

Total UI 19-44 years

During last month (1) 7.21 (7.13; 7.29) 

During last year (2) 18.35 (4.53; 32.17) 

45-64 years

During last month (2) 15.52 (11.57; 19.47) 

During last year (3) 24.64 (19.92; 29.35) 

Ever (2) 6.40 (2.62; 15.42) 

65+ years

During last month (2) 29.21 (24.44; 33.97) 

During last year (5) 24.38 (19.44; 29.31) 

Ever (3) 16.84 (13.05; 20.63) 

80+ years 

During last month (2) 42.39 (32.80; 51.99) 

During last year (3) 27.70 (15.49; 39.91) 

Ever(3) 33.98 (27.34; 40.61) 

Stress UI 45-64 years

During last month (1) 1.00 (1.11; 2.29) 

During last year (1) 1.40 (1.39; 1.41) 

Ever (1) 2.00 (1.99; 2.01) 

Urge 45-64 years

During last month (1) 2.00 (3.41; 3.43) 

During last year (1) 6.70 (6.68; 6.72) 

Ever (1) 2.60 (2.59; 2.61) 

65+ years

During last month (1) 10.60 (10.58; 10.62) 

During last year (2) 8.46 (8.45; 8.48) 

Ever (1) 9.62 (9.58; 9.65) 

80+ years 

During last year (1) 3.50 (3.46; 3.54) 
78 

Table 10. Pooled prevalence of UI in American males by severity and age categories 

(random effects model) 

Frequency and Severity of Leakage Episodes 

(Studies) Prevalence (95% CI) 

Daily 

19-44 years (2) 3.02 (2.39; 3.66) 

45-64 years (1) 4.80 (4.77; 4.83) 

65+ years (2) 8.30 (7.04; 9.56) 

80 and over (2) 9.33 (4.53; 14.14) 

Minimal 

19-44 years (1) 9.00 (8.93; 9.07) 

45-64 years (2) 14.44 (5.74; 23.14) 

80 and over (1) 4.00 (3.93; 4.07) 

Moderate 

19-44 years (1) 10.80 (10.79; 10.81) 

45-64 years (1) 8.90 (7.13; 10.67) 

65+ years (1) 5.95 (5.26; 6.64) 

80 and over (1) 12.00 (11.88; 12.12) 

Severe 

19-44 years (1) 3.00 (2.96; 3.04) 

45-64 years (2) 2.00 (1.13; 2.87) 

65+ years (1) 1.55 (1.13; 1.98) 

80 and over (1) 4.00 (3.93; 4.07) 
79 

Table 11. Prevalence of UI and incontinence types in LTC populations by age, gender, and race 

Author Country Gender Ages (years) Design Urinary Incontinence Definition Response Rate (%) Number 

Palmer, 199128

USA Men and 

women 

≥65 years Prospective cohort 

with 1-year follow-up 

Any daytime urinary incontinence reported by nursing assistants; those with indwelling catheters were considered incontinent 

45 196 

Borrie, 199234 Canada Men and 

women 

 Urinary incontinent episodes 

occurring 1-2 times a week or more 

-- 457 

Ouslander, 1993166

USA Men and 

women 

≥65 years Prospective cohort of 

new admissions in 8 nursing homes 

Any daytime urinary incontinence reported by nursing assistants; those with indwelling catheters were considered incontinent 

81 of 

eligible 

residents 

454 

Brandeis, 1997164

USA Men and 

women 

≥60 years Random sample from 

270 nursing homes in 10 states; used MDS data 

At least 2 episodes of involuntary urine loss within past 2 weeks 

92.6 2,014 

Adelmann, 200430

USA Men and 

women 

≥65 years Random sample of 

Medicaid enrollees in one metropolitan area; used MDS data 

Any non-zero response on MDS question related to bladder incontinences 

 380 

Aggazzotti, 200029

Italy Men and 

women 

Not 

reported 

Cross-sectional survey using clinical records and questionnaires 

Involuntary urine loss at least twice a month 

89.8 839 
Table11. Prevalence of UI and incontinence types in LTC populations by age, gender, and race (continued) 

80

Author Country Gender Ages (years) Design Urinary Incontinence Definition Response Rate (%) Number 

Jumadilova, 200531

USA Men and 

women 

20-109 years; mean age 78 

Cross-sectional database analysis using MDS data from 378 nursing homes 

The MDS question on bladder incontinence (Section H, 1.b) was used to classify patients on level of UI, with 0 (no incontinence) to 4 (incontinent most of the time). 

-- 29,645 

Anger, 20062 USA Women Not 

reported 

National populationbased survey using the National Nursing Home Survey 

Admission or current diagnosis of urinary incontinence in medical records; also staff survey on residents who had difficulty in controlling urination 

Not 

reported 

1,125, 163 in 1995 1,156, 1,134 in 1997 1,170,065 in 1999 

Boyington, 200732

USA Men and 

women 

≥65 years Population-based 

sampling involving nursing homes from 8 states 

Any non-zero response on the MDS bladder incontinence item indicating incontinent episodes occurring once a week or more 

NA 95,911 

Liu33 Australia Men and 

women 

≥70 years The State Electoral 

Data Base survey at three years 

SUI, UUI, or MUI 53.4 4187 
Table11. Prevalence of UI and incontinence types in LTC populations by age, gender, and race (continued) 

81

Author Country Gender Ages (years) Design Urinary Incontinence Definition Response Rate (%) Number 
Table11. Prevalence of UI and incontinence types in LTC populations by age, gender, and race (continued) 

82

Author Country Gender Ages (years) Design Urinary Incontinence Definition Response Rate (%) Number 

Borrie, 199234 UK Men and 

women 

Mean age: men 73.6 years; women 73.8 years 

Prevalence survey in long-term care hospital 

1) Fully continent (completely independent); 2) Dry but staff assistance required; 3) One to two incontinent events/week; 4) 3 to 7 incontinent events per week; 5) 2 to 4 incontinent events/24 hours; 6) Always incontinent (includes the need for an indwelling urinary catheter and an external urinary drainage device). 

95% 457 
Table11. Prevalence of UI and incontinence types in LTC populations by age, gender, and race (continued) 

83

Author Country Gender Ages (years) Design Urinary Incontinence Definition Response Rate (%) Number 

Nelson, 20054 USA Men and 

women 

Mean age 

85.9 years 

Wisconsin annual nursing home survey 

Resident-based MDS definition; continence of urine - complete control of the bladder and no indwelling urinary catheter. UI - usually, occasionally, frequently or always incontinent, or had an indwelling urinary catheter. 

Lost to 

followup 

from 1992 

to 1993 

43.2% 

18,170 nursing 

Peet, 1995519 UK Men and 

women 

>65 years; 

Mean age 

82.7 years

Survey of long term care in Leicestershire

Urine incontinence 95% 627 

446 397 

1,704 1,244 

946 192 202 

5,758 

Chiang, 2000600

USA Men and 

women 

Mean age 

84 years 

Survey of 20 nursing homes in 3 West Coast states using chart abstraction or review of Minimum Data Set

Incontinence status using MDS 6-point scale, dichotomized as being present to any degree versus absent of complete urinary control. 

 464 

Buchanan, 2002601

USA Men and 

women 

Mean age 

76.4 years 

Retrospective analysis of MDS admission assessments from June 23, 1998 through September 11, 2000, for nursing home residents receiving hospice care

Incontinence status using MDS scale 

 40,622 

Bliss, 20065 USA Men and 

women 

Mean age 

83 years 

Cross-sectional analysis of MDS data base in 1999

Incontinence status using MDS 3-point scale 

 59,558 
84

Question 1. What are the Prevalence and Incidence of FI in 

the Community and LTC Settings? 

 The absence of a standard and accepted definition of FI has hampered drawing conclusions 

about the epidemiology of both fecal and dual incontinence. Definitions vary by the inclusion of 

flatus, severity characteristics of FI, and subjective significance (e.g., requiring FI to be a social 

or hygienic problem). There is often a lack of data to determine whether dual incontinence is 

actually present. The ICS recommended analyzing the prevalence of AI, including involuntary 

loss of flatus, in all age groups because this extended definition gives a more precise estimation 

of impact of incontinence on quality of life in young adults.21 In this review, prevalence and 

incidence are reported for any FI (i.e., with or without UI), any AI (i.e., FI and flatus 

incontinence), dual incontinence, and FI only (without UI) when data are available The authors 

also reported the prevalence of different types of incontinence (including loss of solid or liquid 

feces) and severity of incontinence. 

Prevalence of Combined UI and FI in Adults in LTC Settings

 Prevalence of combined UI and FI in adults in LTC settings varied from 4 percent519 to 44 

percent34 across the studies (Table 12). One of the largest cross-sectional studies of 10,215 older 

nursing home residents in the United States, identified from the MDS, reported 40 percent 

prevalence of combined incontinence.5 By contrast, another study found a prevalence of 18 

percent, analyzing data from the regional census of older residents.

519 Almost half the residents 

in Canadian LTC hospitals had combined incontinence.34 The prevalence was lower in nursing 

homes in the United Kingdom (4 percent), and in short-term nursing homes (9 percent).519

Residents in geriatric (27 percent), private nursing (33 percent), and psycho-geriatric nursing 

homes had higher rates of combined incontinence.519

Prevalence of FI with or without UI in Adults in LTC Settings

 Prevalence of FI with or without UI in adults in LTC settings varied from less than 5 percent 

across nursing homes in the United Kingdom519 to 12 percent in the largest national American 

study.5

 One study at the state level reported a prevalence of 46 percent3 and an annual incidence 

of FI in nursing homes of 14 percent.4

 The prevalence varied depending on baseline disease, 

from 27 percent in residents who needed supervision to 83 percent in patients with severe mental 

impairment.34 More than half of the residents in geriatric and psycho-geriatric LTC facilities 

wear pads for FI.519 The prevalence depended on the definitions of incontinence and whether 

having only FI (versus combined UI and FI) was reported (Appendix Table F5). Moderate FI 

was reported in 8 percent of women in nursing homes.161 Thirteen percent of residents 

experienced incontinent episodes 1-3 days per week, 16 percent 4-7 days per week, and 23 

percent less than once a week.602 Frail residents (16 percent) and patients with stroke (25 

percent) and dementia (45 percent) had the highest prevalence of frequent FI.602

 In conclusion, fecal and combined incontinence is prevalent in LTC facilities. Combined 

incontinence is more prevalent than FI alone. Rates depend on the data set, definitions and 

severity of incontinence, and baseline diseases status. The prevalence among race, age, and 

ethnic groups needs future research. 
85

Prevalence of FI in Community Dwelling Elderly Adults

 Three percent111 to 6 percent158 of older adults living at home suffer from combined UI and 

FI (Table 13). The prevalence in elderly men varied substantially from 2 to 6 percent in 

Europe111 to 39 percent in the United States.6

 The same prevalence of 4 to 6 percent of combined 

incontinence was found in European elderly women111 with a rate several times higher in 

American females (27 percent).6

 The prevalence of FI varied from 6 to 10 percent in Europe111,603 to 15 percent in Japan58 to 

26 percent in the United States.158 The prevalence of solid FI was around 2 percent in two 

studies,111,158 while liquid FI was more than ten times higher in the American study (17 

percent)158 than in Europe (1 percent).111 The prevalence did not show consistency in elderly 

males with ranges in FI from 3 percent6 to 16 percent.219 The prevalence of FI in elderly women 

averaged 6 to 8 percent in Europe111 and 12 percent in the United States.219

Prevalence of FI in Community Dwelling Men

 Prevalence of FI in community dwelling men varied across the studies depending on 

definitions of incontinence and population characteristics, including the proportion of subjects 

with FI only in the samples when anal or combined incontinence were analyzed.(Table 14). 

 Combined UI and FI were reported in 6 to 15 percent of younger men, while 7 to11 percent 

experienced FI in a cross-sectional, community-based study.6 Less than 2 percent of younger men 

were incontinent with solid or liquid feces;604-606 6 percent605 to 21 percent604 reported stains in 

underwear. Older European men had combined incontinence less often (1-4 percent)111 than 

American men (15 to 25 percent).6 

 The prevalence of FI was consistently <10 percent in several studies of men older than 60 

years6,50,111,508,604,606-609 and in studies with combined age groups.7,217,610-612 One Portuguese study 

reported the highest rate (16 percent) of FI in patients of a geriatric ambulatory service.613

 Pooled prevalence of FI in community dwelling men varied across the studies with a less 

expected fact that the addition of flatus incontinence did not increase the prevalence of AI 

compared to reported prevalence of FI only (Table 15).p The lowest prevalence of AI (1.6 

percent) was reported in two studies with the median age of participants between 45 and 64 

years. The prevalence of FI was less than 10 percent in all age groups and increased from 6.4 

percent in those 45-64 years old to 9.6 percent in elderly men. The prevalence of solid feces 

incontinence was reported by 1.4 percent of men 45-64 years of age and by 2 percent of elderly 

males. The most prevalent was combined incontinence in elderly persons; 16 percent of men 

over 80 years experienced UI and FI. 

Prevalence of FI in Community Dwelling Women

 Although no study investigated FI vs. AI in the same sample, there was a consistent pattern 

of a higher prevalence (two to four-fold) of AI than that of FI in women across age categories; 

this suggests that combining incontinence of flatus and feces in the same definition may 

contribute to increased prevalence estimates. 

Less than 10 percent of females in the community experienced combined incontinence (Table 

16).6,111,162,212,614 Older women had higher rates of combined incontinence, but only in one 
86

study.6

 The prevalence of AI increased with age from 11 percent in females under 40 to 36 to 45 

percent in older women.615 

 The prevalence of FI also increased with age from 6 percent in women younger than 40 

years,161 to 9 percent in those 50-59 years and 13 to 18 percent in older women.6,42 Association 

with age was found in two studies,6,111 but the rates were not consistent across studies. The 

prevalence of FI varied by the type of incontinence (Appendix Table F6). The prevalence of 

flatus was less than 10 percent in the majority of the studies.162,205,232,604,612,613,616-618 Only four 

studies reported flatus incontinence in more than 20 percent of women.99,125,212,619 The 

prevalence of incontinence of liquid feces was less than 10 percent in 50 percent of the 

studies.163,205,604,612,616,617,619 Few studies reported a prevalence of more than 10 percent125 or 20 

percent.99 The prevalence of incontinence of solid and liquid feces was <10 percent in four of 12 

studies that reported this outcome.163,508,604,606 Most of the studies found that 5-10 percent of 

women were incontinent of solid and liquid feces.42,50,99,607-609,613 The prevalence of solid feces 

was <5 percent in 10 of 15 studies that assessed this outcome.125,163,205,217,604,612,616,617,619,620 Four 

studies found that 5-10 percent experience incontinence of solid feces.99,161,615,621 Severity of FI 

in females increased with age (Appendix Table F7).161 The prevalence of monthly FI varied from 

6 percent162 to 25 percent;125 One percent162 to 5 percent163 of women had more than one FI 

episode per month. The prevalence of weekly FI was less than 7 percent in the majority of the 

studies.125,160,161,163 Less than 2 percent of community dwelling women reported daily FI.125,161 

 Pooled prevalence of AI was the highest in women compared to other definitions and 

increased from 22 percent to 45 percent with aging (Table 17) An inclusion of flatus 

incontinence in the definition contributes to increased prevalence estimates in females. 

Prevalence of FI was higher than in males and increased from 7 percent in those 45-60 years of 

age to 10 percent among elderly women. Combined UI and FI were experienced by 10 to 12 

percent of women. The prevalence of monthly FI varied from 6 percent to 25 percent; 1 percent 

to 5 percent of women had more than one FI episode per month. The prevalence of weekly FI 

was less than 7 percent in four studies. Less than 2 percent of community dwelling women 

reported daily FI in three studies. 

Prevalence of FI in Community Dwelling Adults

 Several studies did not differentiate prevalence of FI by gender (Appendix Table F8). 

Combined UI and FI increased with age111 and varied from 1 percent to 6 percent in older 

adults.222 The prevalence of FI was 2 percent in an American study622 and 5 percent in a French 

study.623 The prevalence of FI also increased with age and sample;111,159 it varied from 

approximately 5 to 8 percent in a community based study111 to 12-19 percent among adults 

visiting primary care physicians or gastroenterologists.159 The prevalence of FI of liquid feces 

was 7 percent,624 higher than FI of solid or liquid feces (3 percent625 to 4 percent626). Daily FI 

was reported by 3 percent of adults,159 weekly FI by 4 percent160 to 5 percent,159 and monthly FI 

by 7 percent159 (Appendix Table F9). Daily incontinence of solid feces was found in 0.4 percent 

of adults;627 weekly incontinence was experienced by 0.1 percent623 to 3 percent627 of adults. 

Prevalence of FI in Community Dwelling Adults by Race

 African American and White men had the same prevalence of FI (14 percent vs. 11 percent, 

respectively) (Appendix Table F10).219 Prevalence of FI varied in African American women 
87

from 9 percent219 to 19 percent628 and in White women from 7 percent187 to 21 percent,628 being 

lowest in Asian American women (4 percent).187 The prevalence of combined UI and FI was 11 

percent in Asian women and 20 percent in White women.187

Limitations

Variations in definitions of FI and its severity, few population level studies with multivariate 

analyses, differences in samples, and inconsistency in factors adjusted in statistical modeling 

prevent firm conclusions; pooled estimates and meta-analysis procedures could not be conducted 

in many instances. Data were inconsistently reported for FI severity characteristics (frequency, 

amount, consistency of leakage, and duration) and analyses of associated factors were few, so 

knowledge is limited. Use of a standard definition of FI that excludes flatus and determination of 

a minimum set of variables to be collected and used in multivariate analyses are recommended. 

Summary

 In conclusion, the published evidence, level IIB-III, suggests that the prevalence of FI 

increases with age and varies, depending on the country where studies were conducted; 

population-based, clinic-based, or administrative sampling of the adults; and definitions of FI 

with increased prevalence of AI in women but not in men.. Data were inconsistently reported for 

FI severity characteristics (frequency, amount, consistency of leakage, and duration), and 

analyses of associated factors were few, so knowledge is limited. Use of a standard definition of 

FI that excludes flatus and determination of a minimum set of variables to be collected and used 

in multivariate analyses are recommended. 

 Less than 10 percent of females in the community experienced combined incontinence. The 

prevalence of combined incontinence in men was not consistent and varied by age and residency 

categories. The prevalence of FI was consistently <10 percent in men of different age groups. 

Most of the studies found that 5 to 10 percent of women were incontinent of solid and liquid 

feces and <5 percent of solid feces. The prevalence of FI was the same among race categories. 

Heterogeneity in prevalence across studies does not allow valid pooled estimates. The primary 

cause for FI; risk factors, age, and gender may contribute to differences in results. Adjusted 

prevalence and incidence of FI should be investigated in prospective studies. Studies with older 

adults identified through medical records and administrative databases reported higher 

prevalence of FI. Differences between quantitative definitions of FI account for variation in the 

results. Studies of FI incidence and risk factors are greatly needed. 
88 

Table 12. Prevalence of FI in LTC settings 

Author Population Subgroup Sample Size Prevalence (%) 

Combined UI and FI 

LTC hospitals 202 7.9 

Nursing homes, local authority 1,704 13.9 

Nursing homes, total 5,758 17.7 

Nursing homes, acute 627 9.4 

Nursing homes, geriatric 446 26.5 

Nursing homes, private nursing 946 32.6 

Nursing homes, private residential 1,244 10.2 

Nursing homes, psychogeriatric 397 36.5 

Peet, 1995519

Nursing homes, voluntary sector 192 4.2 

Borrie, 199234 LTC hospital 457 44.0 

Nelson, 20054 Nursing homes, incidence 3,859 12.4 

Bliss, 20065 Nursing homes 10,215 39.7 

FI

LTC hospitals 202 4.5 

Nursing homes, local authority 1,704 2.9 

Nursing homes, total 5,758 3.1 

Nursing homes, acute 627 4.2 

Nursing homes, geriatric 446 2.7 

Nursing homes, private nursing 946 4.3 

Nursing homes, private residential 1,244 2.9 

Nursing homes, psychogeriatric 397 1.8 

Peet, 1995519

Nursing homes, voluntary sector 192 0.5 

LTC hospital 457 46.0 

LTC hospital, Assistance required 59 42.0 

LTC hospital, Cerebrovascualr diseases 113 42.0 

LTC hospital, COPD 52 31.0 

LTC hospital, Dementia 139 66.0 

LTC hospital, Diabetes 51 45.0 

LTC hospital, Hypertension 40 45.0 

LTC hospital, Immobile 233 67.0 

LTC hospital, Independent 110 13.0 

LTC hospital, residents with Ischemic heart disease 58 41.0 

LTC hospital, residents with malignant neoplasm 34 32.0 

LTC hospital, residents with mild mental impairment 96 31.0 

LTC hospital, residents with moderate mental impairment 78 68.0 

LTC hospital, residents with multiple sclerosis 25 48.0 

LTC hospital, residents with no mental impairment 140 14.0 

LTC hospital, residents with Parkinson's disease 40 62.0 

LTC hospital, residents with prostate disease 28 50.0 

LTC hospital, residents with severe mental impairment 123 83.0 

Borrie, 199234

LTC hospital, supervised residents 33 27.0 

Brocklehurst, 1998602 Nursing homes 497 52.0 

Nelson, 19983 Nursing home 18,170 46.0 

Nelson, 20054 Nursing homes, incidence 3,850 14.7 

Bliss, 20065 Nursing homes 10,215 12.4 

Wear Pad

Long term care hospitals 202 45.2 

Nursing homes 1,704 45.5 

Nursing homes 5,758 49.3 

Nursing homes, acute 627 17.4 

Nursing homes, geriatric 446 48.7 

Nursing homes, private nursing 946 52.5 

Nursing homes, private residential 1,244 55.6 

Nursing homes, psychogeriatric 397 67.7 

Peet, 1995519

Nursing homes, voluntary sector 192 51.5 
89

Table 13. Prevalence of FI in community dwelling elderly adults 

Author 

Sample Definition Prevalence 

(%) 95% CI 

Men and Women 

Combined UI and FI, >80 years old 6.0 4.0; 8.9 

Combined UI and FI, total 3.0 2.6; 3.5 

FI, >80 years old 10.0 7.4; 13.4 

FI, Total 6.0 5.4; 6.7 

Liquid feces 1.1 

Teunissen, 2004111

N = 4,650 

Solid feces 2.0 

Combined UI and FI 1.7 

FI 26.3 

FI one or more times within the past year 19 

FI daily 1.5 

Liquid feces 16.6 

Soils underwear 21.6 

Bliss, 2004158

N = 1,352 

Solid or liquid feces 1.97 

Nakanishi, 199758

N = 1,405 

FI 15.3 13.5; 17.3 

Prosser, 1997603

N = 527 

FI 9.3 7.1; 12.1 

Goode, 2005219

N = 1,000 

FI 12.0 

Men 

Roberts, 1999 Combined UI and FI 39.1 19.1, 59.0 6

N = 23 Fecal incontinence 3.1 2.9, 9.1 

Combined UI and FI 6.0 2.8; 11.9 

Combined UI and FI 2.0 1.5; 2.6 

FI 16.0 10.4; 23.7 

FI 7.0 6.0; 8.2 

Liquid feces 0.6 

Teunissen, 2004111

N = 2,137 

Solid feces 1.9 

Goode, 2005219

N = 1,000 

FI 12.4 

Women 

Roberts, 19996

N = 33 

Combined UI and FI 27.3 12.1; 42.5 

Combined UI and FI 6 3.6; 9.7 

Combined UI and FI 4 3.3; 4.8 

FI 8 5.1; 12.1 

FI 6 5.1; 7.0 

Liquid feces 1.5 

Teunissen, 2004111

N = 2,513 

Solid feces 2.1 

Goode, 2005219

N = 1,000 

FI 11.6 

Bharucha, 2005161

N = 2,800 

Moderate FI 0.8 

Bradley, 2005125

N = 297 

Strain with defecation 25 
90

Table 14. Prevalence of FI in community dwelling men 

Author (Sample) Definition Prevalence (95% CI) 

<60 Years

Roberts, 19996 (N = 38) Combined UI and FI 15.8 (4.2; 27.4) 

Roberts, 19996 (N = 188) FI 6.9 (3.3; 10.5) 

Roberts, 1999 Combined UI and FI 5.9 (4.1; 7.6) 6 (N = 778) 

FI 11.1 (8.8; 13.5) 

Walter, 2002 Flatus 17.8 (15.3; 20.7) 604 (N = 758) 

Underwear staining 21.0 (18.2; 24.0) 

Walter, 2002 Liquid feces 0.7 (0.3; 3.4) 604 (N = 758) 

Solid feces 0.2 (0.0; 1.0) 

Enck, 1991 Solid or liquid feces 1.5 (0.3; 8.2) 605 (N = 65) 

Underwear staining 6.2 (2.4; 14.8) 

Thomas, 1984606 (N = 5,975) Solid or liquid feces 1.0 (0.8; 1.3) 

>60 Years

Roberts, 19996 (N = 65) Combined UI and FI 15.4 (6.6; 24.2) 

Roberts, 19996 (N = 80) Combined UI and FI 25.0 (15.5; 34.5) 

Roberts, 19996 (N = 141) FI 12.1 (6.7; 17.5) 

Roberts, 19996 (N = 206) FI 5.8 (2.6; 9.0) 

Roberts, 19996 (N = 778) FI 11.1 (9.0; 13.5) 

Combined UI and FI 1.0 (0.5; 1.8) 

Combined UI and FI 1.0 (0.5; 2.0) 

Combined UI and FI 2.0 (1.0; 3.9) 

Combined UI and FI 4.0 (2.1; 7.2) 

FI 6.0 (4.4; 8.1) 

FI 6.0 (4.2; 8.4) 

FI 8.0 (4.6; 11.3) 

Teunissen, 2004111 (N = 2,137) 

FI 9.0 (5.9; 13.3) 

Constipation 9.0 

Solid or liquid feces 4.0 

Adolfsson, 1998180 (N = 661) 

Urgency 10.0 

Lopes, 1997613 (N = 43) FI 16.3 (8.1; 30.0) 

Walter, 2002604 (N = 213) FI 1.0 (0.3; 3.4) 

O’Keefe, 1995608 (N = 270) FI 8.1 (5.4; 12.0) 

Diokno, 1990607 (N = 666) FI 5.4 (3.9; 7.4) 

Thomas, 1984606 (N = 1,102) FI 4.1 (3.1; 5.4) 

Wetle, 199550 (N = 1,449) FI 8.5 (7.2; 10.0) 

Edwards, 2001508 (N = 1,625) FI 1.0 (0.6; 1.5) 

Verhagen, 2001609 (N = 3,345) FI 8.0 (7.1; 9.0) 

Talley, 1992 FI more than once a week 4.5 (1.3; 7.7) 160 (N = 328) 

FI more than once a week 4.6 (1.4; 7.8) 

Combined Age Groups

Damon, 2006623 (N = 706) AI 2.4 (1.1; 4.7) 

Nelson, 1995622 (N = 6,959) AI 0.8 

Lam 1999 FI 15.1 (11.2; 19.9) 618 (N = 259) 

Flatus 8.1 (5.4; 12.1) 

FI 3.0 (1.5; 5.8) 

Flatus 3.0 (1.5; 5.9) 

Liquid feces 2.6 (1.3; 5.3) 

Roche, 2002612 (N = 268) 

Solid feces 0.4 (0.1; 2.1) 

FI 10.8 (7.7; 15.0) 

Solid feces 3.1 (1.7; 5.9) 

Kalantar, 2002217 (N = 286) 

Liquid feces 9.4 (6.6; 13.4) 

MacLennan, 2000 FI 2.3 (1.6; 3.2) 7 (N = 1,464) 

Flatus 6.8 (5.7; 8.2) 

Drossman, 1993610 (N = 2,639) FI 0.5 (0.3; 0.8) 

Perry, 2002 FI 2.8 (2.4; 3.3) 611 (N = 4,633) 

Underwear staining 9.6 (8.8; 10.5) 
91

Table 15. Pooled prevalence of AI (FI) in males by type and age categories (random effects model) 

Type Age (Studies) Prevalence (95% CI)

AI 45-64 years (2) 1.6 (0.0; 3.2) 

FI 45-64 years (8) 6.43 (4.8; 8.1) 

FI 65+ years (12) 7.18 (5.3; 9.1) 

FI 80 and over (3) 9.63 (4.5; 14.8) 

Liquid feces 45-64 years (3) 3.34 (2.0; 4.7) 

Solid feces 45-64 years (3) 1.39 (0.4; 2.4) 

Solid feces 80 and over (1) 1.92 (1.9; 1.9) 

Solid or liquid feces 45-64 years (2) 2.17 (<0.01; 4.3) 

Solid or liquid feces 65+ years (1) 4 (4.0; 4.0) 

FI+UI 45-64 years (2) 9.53 (5.4; 13.6) 

FI+UI 65+ years (2) 8 (6.3; 9.7) 

FI+UI 80 and over (2) 15.70 (12.0; 19.4) 

Table 16. Prevalence of FI in community dwelling women 

Author Age Sample Size Prevalence (95 % CI) 

Combined UI and FI

50-59 114 17.5 (10.5; 24.5) 

60-69 117 21.4 (14.0; 28.8) 

70-79 91 15.4 (8.0; 22.8) 

Roberts, 19996

>50 762 9.4 (7.1; 11.6) 

60-64 3.0 (1.9; 4.6) 

65-69 4.0 (2.6; 6.0) 

70-74 5.0 (3.3; 7.4) 

Teunissen, 2004111

75-79 

2,513 

7.0 (4.6; 10.4) 

Griffiths, 2006614 321 8.4 

Ballester, 2005162 115 9.7 

Boreham, 2005212 457 9.9 

AI

Gordon,1999615 <30 9 11.0 

Kahn, 2005629 >18 1,004 20.0 

Gordon,1999615 >80 22 45.0 

Boreham, 2005212 18-65 457 28.4 (24.4; 32.8) 

31-40 17 29.0 

41-50 40 28.0 

51-60 58 19.0 

61-70 73 30.0 

Gordon,1999615

71-80 64 36.0 

Nelson, 1995622 6,959 1.4 

Damon, 2006623 706 7.5 (5.0; 10.7) 

Gordon,1999615 283 29.0 

50-59 114 8.8 (3.6; 14.0) 

60-69 157 14.0 (8.6; 19.4) 

70-79 105 10.5 (4.6; 16.4) 

Roberts, 19996

>80 24 12.5 (0.0; 25.7) 

Bharucha, 2005 <40 5.6 161 

<60 

2,800 

6.7 

Roberts, 19996 >50 762 15.2 (12.5; 17.9) 

Bharucha, 2005161 >61 2,800 5.8 

60-64 4.0 (2.8; 5.7) 

65-69 5.0 (3.5; 7.1) 

70-74 7.0 (5.0; 9.7) 

Teunissen, 2004111

75-79 

2,513 

8.0 (5.4; 11.5) 

Melville,2005163 3,444 7.2 

Bharucha, 2005161 2,800 12.1 (11.0; 13.1) 

Ballester, 2005162 115 13.6 
92

Table 17. Pooled prevalence of AI (FI) in females by type and age categories (random effects model) 

Type Age Categories (Studies) Prevalence (95% CI) 

Anal 19-44 years (3) 22.10 (16.10; 28.10) 

Anal 45-64 years (3) 16.98 (9.61; 24.35) 

Anal 65+ years (1) 33.00 (27.12; 38.88) 

Anal 80 and over (1) 45.00 (44.81; 45.19) 

FI 45-64 years (5) 7.31 (5.29; 9.32) 

FI 65+ years (3) 8.53 (7.32; 9.75) 

FI 80 and over 9.52 (7.26; 11.79) 

Solid feces 45-64 years (14) 3.59 (2.75; 4.43) 

Solid feces 80 and over (1) 2.07 (2.06; 2.08) 

Liquid feces 45-64 years (12) 6.79 (5.15; 8.42) 

Liquid feces 80 and over (1) 1.47 (1.47; 1.48) 

Solid and liquid feces 45-64 years (1) 2.17 (2.16; 2.17) 

Solid and liquid feces 65+ years (10) 7.18 (5.13; 9.24) 

Solid or liquid feces 45-64 years (18) 5.03 (4.17; 5.89) 

Flatus 19-44 (2) 16.28 (1.99; 34.55) 

Flatus 45-64 years (12) 14.23 (10.73; 17.72) 

FI+UI 45-64 years (3) 9.63 (1.67; 20.93) 

FI+UI 65+ years (2) 10.37 (8.49; 12.24) 

FI+UI 80 and over 12.43 (10.23; 14.62) 
93

Question 2. What are the Independent Contributions of Risk 

Factors for Urinary, Fecal, and Combined Urinary and Fecal 

Incontinence? 

Overview of Risk Factors for UI 

 Early epidemiological studies identified a number of potential risk factors of UI in a variety 

of adult populations (childbearing women, nonchildbearing women, men, men following prostate 

surgery) using univariate or bivariate analyses. In the past decade, there have been an increasing 

number of large population-based studies that incorporate multivariate analyses enabling the 

determination of the independent effect of a particular risk factor. However, the majority of 

studies have been cross-sectional in design which provides data only on risk factors for prevalent 

incontinence (Appendix F Table 1). Many of these studies are national population-based surveys 

on the general health of a particular population and are limited by the variables included in the 

study. Longitudinal studies incorporating multivariate analyses that provide data on the risk 

factors for incident incontinence are scarce. 

 In women, the major modifiable risk factors included obesity, vaginal trauma, and vaginal 

prolapse. Studies on risk factors such as lifestyle factors, selected chronic diseases, and 

medication use are limited. Inconsistencies in findings related to particular risk factors might be 

explained, in part, by the differences in the age of the study populations, the definition and 

measurement of UI, and the risk factors available for analysis. Longitudinal studies have found 

that risk factors for prevalent vs. incident UI vary.149 In general, the risk factors for the various 

types of UI (stress, urge, and mixed) also vary. Aging tends to be associated with changing risk 

profiles associated with UI and UI type. The evidence presented next includes only those studies 

that incorporated multivariate analyses. 

Risk Factors for UI in Community Dwelling Women 

Age. Age tends to be linearly associated with UI, with prevalence and incidence rates 

increasing steadily with advancing age.7,41,53,55,56,62,65,80,81,83,85,99,105,133,138,143,184 However, in older 

women an increase in incidence of weekly123 UI was not significant when women 75-79 years 

were compared to those 70-74 years of age (Appendix Table F11). The large Canadian Study of 

Health and Aging cohort reported no significant increase in annual incidence of UI in women 75-

84 or older than 85 years compared to women younger than 75 years of age.186 

 Prevalent UI significantly increased with age in 207,55,66,67,73,74,81,84,92,96,97,105,118,124,133,138,149,185-

187 of 28 studies that reported the association.7,55,62,66,67,73,74,81,84,92,93,95-97,105,118,124,132,133,138,140,144, 

149,185-189 Only one population-based cross-sectional study of 5,701 female participants in the 

Health and Retirement Study showed a decrease of 3 percent per 1 additional year in prevalence 

of moderate UI with 15 or fewer days with incontinence episodes in the last month.189 Adjusted 

odds of prevalent stress UI increased by 110 percent per 5 year incremental increase in age in 

participants of the Heart & Estrogen/Progestin Replacement Study66 with nonsignificant dose 

response association in the British cohort of 12,570 female respondents older than 40 years.132

The largest increase in odds of stress UI (239 percent) was reported among women over 80 years 

compared to those younger than 60 years133 in the European population-based study of 5,795 

elderly community dwelling females.133
94

 Prevalence of total weekly UI significantly increased by 106 percent per additional 1 

year96,149 and daily UI by 103 per additional 5 years of age.140 Adjusted odds of occasional 

monthly UI was 1.2 and odds of severe UI 1.3 times in women 40-44 years compared to those 

younger than 40 years old.138 Women 45-54 years old experienced UI 2.1 times more often and 

those older than 55 years of age 3.1 time more often than those 15-34 years old.7

 Odds of 

reporting any UI was 3.7 times greater in women 50-59 than those 41-49 years old.84 Women 

older than 70 years experienced UI 1.4981 to 2.9 times84 more often than women under 50. The 

dose response association with severity of UI was shown in the Nurses' Health Study with odds 

ratio 1.45 for occasional, 1.56 for occasional severe, 1.67 for frequent and severe, and 1.81 for 

weekly severe UI in women older than 70 compared to those under 50.84 Women 75-84 years old 

had 1.47186 to 6.792 times higher odds of UI compared to women under 75 years and those 15-24 

years old, respectively. 

Adjusted prevalence rates of weekly urge UI increased by 1.266 per 5 additional years of age 

and by 1.8 times 187 per 10 additional years of age in a dose response model. Monthly urge UI 

was 1.8 time more frequent133 among women 60-80 years old than for those under 60. Elderly 

women older than 80 years reported monthly UI four times more often than women younger than 

60.133 One community base Japanese survey of 968 women older than 40 years reported lower 

odds of urge UI among those older than 60.74

 Maternal age at the time of either the first or last delivery has been examined as a risk factor 

for subsequent UI; however, the effect age has on the development of UI appears to lessen by 

age 50.630 Several studies have found that age 35 years or older at first delivery increased the risk 

of UI or frequent UI when compared to younger women.105,197 Similarly, one study found a 

lower risk in women who were 25 years or younger at their first delivery than their older 

counterparts (23 percent vs. 28 percent, respectively).630 Another study found that being age 30 

or more at the second delivery doubled the odds of becoming incontinent.197 Two studies 

reported that the strongest associations with UI were for women who were under the age of 22 

years at their first delivery.105,135 In one study examining maternal age at subsequent deliveries, 

women older than 30 and 40 years at a second vaginal delivery had lower rates of UI and urge 

UI.64 Other studies have not been able to demonstrate an independent effect of age on UI in the 

immediate postpartum period.198 Age at last delivery appears to be less of a risk factor.630

Gender. Female gender has been consistently documented as a strong predictor of UI in 

bivariate analyses,30,36,39,47,61,74,92,97,107,114 with an age-adjusted odds of UI of 3.1.92 One in six 

women after age 30 have UI, compared to 1 in 20 men.587 Women have higher rates of UI than 

men in all age groups.81,86 In early adult years, women have a two to four times higher rate of UI 

than men; however, in advanced years (e.g., ages 75 or 85 and over), even though women 

continue to have higher rates, the prevalence rates are more similar.81 In a study of 54,920 adults 

≥30 years, the UI rate in women was 2.5 per 100 versus 1.4 per 100 in men.86 Other studies find 

that UI prevalence is 6.8 times higher in women.75

Race/Ethnicity. There is growing evidence that race/ethnicity is a predictor of UI, UI 

severity, and UI type in nonchildbearing and childbearing women (Appendix Table F12). In 

earlier studies, White women tended to have higher rates of UI than other ethnic/racial groups 

(Blacks, Asian Americans, including Japanese and Chinese, and Hispanics).30,59,89,93,105,120,138 In 

more recent studies, being non-White was associated with lower odds of having UI and severe 

UI,144 with the exception of being Hispanic.138 A higher UI incident rate in Whites was reported 

in two studies (OR 3.1, 95 percent CI 2; 4.8) (Figure 3).123,149 African American women had 
95

higher odds of incident urge but lower odds of incident stress UI. Hispanic women developed 

weekly UI more often compared to Caucasian (OR 2.96, 95 percent CI 1.06; 8.18). 

 Prevalence of mild, moderate, and severe UI was lower among African American women 

than White women in all six studies that examined the association (Figure 4).93,105,137,138,149,189

Prevalence of moderate UI was lower among Hispanic women compared to Caucasian women in 

four of five studies (Figure 5).93,105,138,149,189 However, evidence was not consistent. Prevalence of 

mild or severe UI was either less or the same in Hispanic women than in White women. Asian 

women had lower odds of moderate or severe UI (Appendix Figure F1) in two studies.105,138

 Race/ethnicity was associated with different types of UI, including stress, urge, or mixed UI 

(Appendix Table F12). After multiple adjustments, the risk of stress UI was higher in White 

women than in Black and Asian American women.118,137 In one study White women had a 2.8 

times higher risk of stress UI than Black women.66 In contrast, the risk of urge UI was similar in 

Black and Asian American women compared to White women.59 In other studies, White women 

had three times the risk of Black women with respect to urge UI.118 

Obesity. Obesity has been consistently established as a strong predictor of UI, especially 

severe UI (Appendix Table F13). Incident monthly UI was 110 percent higher and daily 112 

percent higher per one unit increase in BMI.149 Obese females developed monthly UI 1.7 times 

more often (95 percent CI 1.2; 2.5) than women with normal weight.103 

 Prevalent urge UI showed a positive dose response association 1.1 times per one unit 

increase in BMI,51 (OR 1.08, 95 percent CI 1.1; 1.1), 1.4 times in women with BMI 25-30 than 

<25 kg/m2

,

133 and 1.8 times (OR 1.8 95 percent CI 1.4; 2.4) in those with BMI >30 kg/m2.133

Asian overweight women experienced urge UI three times more often than those with normal 

weight (OR 3.4, 95 percent CI 1.2; 9.2).187

 The largest increase in stress UI was shown in obese women with uterovaginal prolapse 

compared to normal weight females without prolapse (OR 33.0, 95 percent CI 12.5; 87.1).95 In 

contrast, underweight women after surgery for UI reported stress UI more often than females 

with greater BMI.631 Severe UI was more prevalent in overweight women (BMI 25-29kg/m2 OR 

1.5, 95 percent CI 1.4; 1.6) and obese women (BMI >30 OR 3.1, 95 percent CI 2.9; 3.3).138

 The effect of BMI differed depending on definitions of UI (Figure 6). Odds of ever having 

UI were higher in underweight and overweight women.116,191 Adjusted odds of UI in the past 

month were higher in overweight and obese females.83,92,133,143 Weekly UI was more prevalent in 

obese but not overweight women with a dose response increase per one unit of 

BMI.66,90,92,96,138,189 With the definition of UI in the past year (Figure 7), the majority of the 

studies showed a significant increase in UI corresponding to greater BMI.7,51,59,68,72,144

 The association between BMI and UI varied depending on frequency of leakage episodes 

(Figure 8) The majority of the studies reported a significant raise in daily UI corresponding to an 

increase in BMI per one unit (OR 1.44, 95 percent CI 1.3; 1.6), per five units (OR 1.6, 95 percent 

CI 1.4; 1.7), or in overweight women (OR 1.65, 95 percent CI 1.3; 2.1).55,67,70,149,189 Incremental 

increase per one unit in BMI was not associated with higher adjusted rates of at least monthly 

UI; however, obese women had greater odds of UI compared to women with normal 

weight.67,104,121,124,138,149,190 Underweight and obese women had increased odds of having at least 

weekly UI.67,92,138,185 Daily and weekly stress UI were significantly associated with an increase in 

BMI in all studies (Figure 9).51,66,70,118,132,133,135,149,187 The association with UI at least monthly or 

in the past year was less consistent. 

 Studies in older women have found that a higher BMI (OR 1.3 per 5kg/m2, CI 1.1; 1.6) was 

associated with stress UI but not urge UI.118 Other studies found that increasing BMI was 
96

associated with urge UI in women ages 40-60 years, whereas one study did not find an 

association.66

 Some studies have incorporated alternative anthropomorphic measures such as waist 

circumference, visceral fat area measured by computed tomography scan of the abdomen, and 

sagittal diameter66,118,149 with mixed outcomes (Appendix Table F14). One study found that waist 

to hip ratio was predictive of stress UI.66 Other studies found increasing waist circumference is 

weakly associated with prevalent mixed UI (OR 1.0, 95 percent CI 1.0; 1.1 per 1cm increase in 

waist circumference), stress UI (OR 1.0, 95 percent CI 1.0; 1.1), and total monthly UI (OR 1.1, 

95 percent CI 1.0; 1.1).149 

 Evidence on maternal weight and maternal weight gain during pregnancy is conflicting. In 

one study, women with higher BMIs (>25kg/m2

) and higher maternal BMIs (during pregnancy) 

increased their odds by 168 percent in developing UI at 3 months postpartum as compared to 

women with lower BMIs.197 In another study, higher predelivery BMI (per 5kg/m2) increased the 

odds of UI at 6 months postpartum by 20 percent.203 In other studies, maternal weight gain was 

not associated with UI199 or the development of stress UI 10 years after the index delivery.196

 Genetic influence. Evidence from four studies suggests a genetic influence on UI.632-635 In 

one study, daughters of mothers with stress UI had a higher prevalence of stress UI than agematched controls, 71.4 percent versus 40.3 percent, respectively.632 Furthermore, UI symptoms 

appeared 7 years earlier in “incontinent families” than in those without a history of 

incontinence.632 In a case-control study examining relatives of women with urodynamically 

diagnosed UI, first-degree relatives had a UI prevalence of 20.3 percent versus 7.8 percent in 

relatives of the control group.635 Both mothers and sisters had significantly higher prevalence 

rates of stress UI than controls. Although daughters had a UI prevalence rate twice as high as 

controls, the difference was not significant. 635 In a population-based study, daughters of mothers 

with any type of UI had a 1.3 times higher risk of being incontinent, (95 percent CI 1.2; 1.4), a 

1.5 times higher risk (95 percent CI 1.3; 1.8) of stress UI and 1.8 times higher risk (95 percent CI 

0.8; 3.9) of urge UI.633 Daughters were also at higher risk of having severe incontinence if the 

mother had severe incontinence (1.9; 95 percent CI 1.3; 3.0). 633 Younger sisters of female 

siblings with UI, stress UI, or mixed UI had increased relative risks, respectively of 1.6 (95 

percent CI 1.3; 1.9), 1.8 (95 percent CI 1.3; 2.3), and 1.7 (95 percent CI 1.1; 2.8).633 In another 

population-based study involving 548 monozygotic and 620 dizygotic twin pairs, the heritability 

for urge UI was 42 percent (95 percent CI 16; 63) among women ages 48-64 years and 49 (95 

percent CI 29; 65) in those ages70-94 years.634 Mixed UI also had a substantial genetic 

component; however, the role of genetic factors was less clear.634

Lifestyle Factors 

Physical activity. There is limited data on the role of physical activity as a risk factor for UI 

(Appendix Table F14). Intensive physical activity in women 50-79 years of age in the Nurses' 

Health Study was associated with a significant reduction in incident UI (OR 0.9, 95 percent CI 

0.8; 1.0).156 Physically active women developed stress UI less frequently (OR 0.71, 95 percent 

CI 0.56; 0.91).156 The same study reported a significant negative association between walking 

and incident urge UI (OR 0.7, 95 percent CI 0.5; 0.9).156

 In a large study of women ≥20 years, after adjusting for age, number of children, coughing, 

and wheezing/dyspnea, increasing levels of low physical activity had weak and negative 

associations with UI.192 No significant effects were noted for high intensity physical activity with 
97

respect to stress, urge, and mixed UI. Similarly, a large study of women ≥40 years did not find an 

effect for those with different levels of physical activity or participating in vigorous activities.103

In a study examining the impact of physical activity on urine leakage in 665 primiparous women, 

high impact exercise before pregnancy was significantly associated with UI 1 year after 

childbirth, increasing the odds of UI by 40 percent.636 In two surveys, physical exercise in the 

past year was not associated with UI.55,83

Education and occupational status. Studies on occupational factors and UI risk are rare. In 

a study involving 1,581 Taiwanese women ≥20 years, having an occupation that involved weight 

lifting or other labor was not significantly associated with stress UI.95 Women without private 

health insurance had higher adjusted odds of urinary symptoms (OR 2.6, 95 percent CI 1.4; 5).84

 Surprisingly, higher education was associated with increased odds of prevalent UI in the 

majority of the studies.67,70,72,83,93,149,189,191 College graduates 42-52 years old experienced UI 

1.31 times more often compared to women without degrees;93 university graduates 50-64 years 

old reported UI 2 times more often (OR 2.0; 95 percent CI 1.8; 2.3)191 than females with lower 

education. One study found that higher education was an independent risk factor for UI for all 

ethnic groups except Chinese Americans but that educational level was not associated with 

moderate/severe UI.93 However, in contrast to these studies, one study of postpartum 

incontinence reported that having less than a college education doubled the risk of UI.203

Marital status and social support. Married women had the same prevalence of UI as 

women who were widowed, divorced, or never married.84 A large Study of Women's Health 

Across the Nation149 suggested no association between level of social support and incident 

monthly UI. However, the same cohort reported higher prevalence rates of UI among women 

within the lower quartile of social support.149 Psychological stress was associated with greater 

urinary symptoms including UI (OR 2.7, 95 percent CI 1.1; 7)84 but not with UI in the past 

month.83 Low social activity was not associated with risk of stress, urge, or mixed UI in women 

≥70 years.106 The interpretation of whether decreased social activity and poor social support 

precipitates UI or is a result of UI is unclear. 

 Dietary factors. 

Caffeine. Evidence of caffeine consumption as a risk factor for UI is limited and conflicting. 

In a Norwegian study of 34,755 women ≥20 years of age, coffee consumption (number of 

cups/day) was not associated with UI in a multivariate analysis, whereas tea drinkers were at a 

slightly higher risk for all types of UI. (Appendix Table F15).192 In other studies, coffee 

consumption has either not been associated with UI risk55,103 or was shown to reduce the odds by 

50 to 60 percent, depending on the amount consumed.72 One large study in the United Kingdom 

did not find an association between tea consumption and UI risk.103

Carbonated beverages. Data on the type and amount of beverages consumed is scarce. In one 

study involving 6,424 women, daily consumption of carbonated beverages increased the odds of 

stress UI in women ≥40 years by 62 percent.103 Although this study also examined the effect of 

carbonated beverages in women with overactive bladder, it was not possible to determine the 

effect in those who had urge UI alone. 

Food consumption. Only one study has examined the role of different food groups on the risk 

of stress UI.103 Consumption of various amounts of vegetables and chicken were not associated 

with stress UI, whereas eating bread daily or more was associated with decreasing the odds of 

stress UI by 24 percent.103

 Alcohol use. Few studies have examined the effect of alcohol consumption on 

UI.55,67,72,83,84,92,190 Some studies that did examine alcohol use, including the type of alcohol 
98

consumed, did not include it in a multivariate analysis.103,118 Alcohol consumption, as measured 

by number of glasses of alcoholic beverages consumed over a two-week period and the number 

consumed each week, has not been found to be a risk factor for UI.55,72,83,192 Only one study 

reported a greater odds of weekly UI among women with daily alcohol use compared to never 

drinkers.83 Women with low and moderate alcohol consumption had lower adjusted rates of 

occasional UI.190

Smoking. Smoking as a risk factor for UI has been assessed in several 

studies.55,72,83,93,103,118,138,192 (Appendix Table F16). Six studies92,93,138,186,189,192 of 1267,72,83,92,93, 

138,143,186,189,191,192 found a significant positive association between smoking and UI. One study 

suggests that smoking status per se is not associated with UI, but rather examining the doseresponse relationship between numbers of cigarettes smoked, either as a former or current 

smoker, may be more relevant.192 In this study both former and current smoking was associated 

with UI, but only for those who smoked more than 20 cigarettes per day, raising the odds of UI 

by 2.7 and 3.0, respectively.192 However, severe incontinence was weakly associated with 

smoking, regardless of number of cigarettes. Interestingly, adjusted odds of current smokers in 

the same study192 had higher odds of mixed and total but significantly lower odds of stress UI. 

Neither smoking status nor a dose response between numbers of cigarettes smoked per day was 

found to be a risk factor in a survey involving 2,767 Italian women.72 Although a survey of 1,262 

women in the United Kingdom found that the number of cigarettes was not associated with UI, 

being a former smoker did increase the odds by 30 percent.83 In a large study of 83,355 

American women ages 37-54 years, former smoking was not associated with UI, whereas current 

smoking was significantly associated with frequent and severe UI.138 Current smoking increases 

the odds of moderate/severe UI by 20-55 percent.93,138 Smoking during pregnancy independently 

increased the odds of UI by 290 percent (odds ratio 2.9, 95 percent CI 1.4; 3).198

Functional status. 

Cognitive function. Studies on the role of cognitive function as a predictor of UI in 

community dwelling women are scarce (Appendix Table F17). The prospective Canadian Study 

of Health and Aging did not find a significant association between impaired cognitive function 

and incident UI in elderly community dwelling women.186 However, another prospective study, 

Study of Osteoporotic Fractures, reported an increase in odds of developing UI by 1.3 times (OR 

1.3, 95 percent CI 1.1; 1.6) among older women with decline in walking speed, by 1.4 times (OR 

1.4, 5 percent CI 1.2; 1.6) among those with decline in chair stand speed, and by 1.6 times in 

females with reduced Mini-Mental State Examination scores (OR 1.6, 95 percent CI 1.1; 2.1).147

 Prevalence of UI was higher by 166 percent in frail community dwelling elderly with 

impaired cognitive status (OR 1.7, 95 percent CI 1.3; 2.1), who were participants in the Italian 

Silver Network Home Care project.97 However, the Canadian Study of Health and Aging did not 

find a significant association between cognitive decline and prevalent UI.186 In a survey of adults 

≥75 years, memory problems significantly increased the odds of UI by 70 percent.114 One study 

found that memory difficulties significantly increased the odds of having stress UI in a crosssectional analysis but not in a longitudinal analysis at 1 year.132

 Depression. An increasing number of studies are examining depression as a risk factor for UI 

(Appendix Table F17).59,90,106,118,191 Postmenopausal women with depressive symptoms 

developed UI 2.7 time more often (OR 2.7, 95 percent CI 1.4; 5.3) during 2 years of followup in 

a prospective cohort study.123 The association was random in another large cohort of the Study of 

Women's Health Across the Nation with 6 years of followup.149
99

 Prevalence of UI was significantly higher in depressed women in five studies90,124,149,189,191 of 

eight90,97,106,118,124,149,189,191 that examined the association in multivariate analysis. The largest 

increase in adjusted odds of UI was observed in women with current depression (OR 2.0, 95 

percent CI 1.2; 7.6)90 or current major depression (OR 2.5, 95 percent CI 1.7; 3.7).124 Some 

studies indicated that depressive symptoms are a risk factor for a particular type of UI rather than 

UI in general. Depressive symptoms have been strongly associated with urge UI in some studies, 

raising the risk by 2.7 times in women ages 70-79 years.118 

 Physical function. Decreased physical function measured by self report and physical 

performance tests has been consistently documented as a strong predictor for UI in six 

studies67,81,92,97,144,189 of eight67,81,92,97,106,132,144,189 that examined this association (Appendix Table 

F17). Poor mobility increased the odds of UI by 4.7 times in women over the age of 6042 and in 

other studies mobility limitations, including difficulty walking, increased the odds of UI ranging 

from 23 to 81 percent in older women.81,114 

 ADL impairments strongly increase the risk of UI and UI types, although findings vary. 

Physical impairment was associated with increased odds of stress UI by 40 to 70 percent, except 

in the worst level of functioning, where it was not significantly associated.132 However, in 

another study, it was not associated with stress UI but strongly associated with urge UI.98 In a 

study of women ages 55-75 years, lower scores on the SF-36 physical function scale were 

significantly associated with any and severe UI.144 In another study involving women ≥65 years, 

ADL disability increased the odds of UI by 175 percent.81 The strongest association was reported 

in the national health survey in Belgium with increased prevalence of UI by 415 percent (OR 4.2, 

95 percent CI 1.9; 6.0) in women with moderate physical limitations and by 521 percent (OR 

5.2; 95 percent CI 1.2; 8.6) among those with severe physical limitations.92

 Decreased physical performance measured with an objective Health ABC Performance Scale 

(performance on repeated chair stands, gait speed, standing balance, and a narrow walk test of 

balance), was associated with urge UI (OR 1.6 per point on 0-4 scale, 95 percent CI 1.1; 2.3), 

whereas it was not associated with stress UI.118 Muscle strength as measured by grip and 

quadriceps strength was not associated with daily UI; however, faster gait speed (OR 0.8 per 2 

units, 95 percent CI 0.6; 1.0) was associated with decreased incontinence.55

 The variability in populations, definitions, and measurement of UI and functional status 

contributed to the differences in the results from individual studies. 

Gynecological Factors 

Parity. We identified 24 observational studies that reported odds ratios of UI in association 

with parity (Table 18).55,59,64,68,70,72,83,92,93,95,96,105,119,124,133,135,138,149,185,191,193-196 Incident UI was 

not associated with parity.149,193 A positive significant association between prevalent UI and 

parity was reported in 13 studies,68,72,83,93,96,105,119,124,138,185,191,193,195 while six studies did not find 

a significant increase in prevalent UI in relation to parity (Figure 10).59,64,92,133,149,194 The number 

of births did not show a dose response association with prevalent UI (odds ratio per one 

additional birth 1.0, 95 percent CI 1.0; 1.1) but did with moderate severe UI (odds ratio per one 

additional birth 1.1, 95 percent CI 1.0; 1.1) and severe UI (odds ratio per one additional birth 1.1, 

95 percent CI 1.0; 1.1). All six studies that measured prevalent stress UI reported a significant 

positive association with parity (Figure 11).72,95,133,149,195,196 Prevalent stress UI and severe stress 

UI did not show a significant dose response association with the number of births. Only one 

study195 of four 72,133,195,196 found an increase in urge UI corresponding to parity. 
100

 The role of parity is complex and changes as a woman ages. One study reported that age 

modified the association between parity and UI with a significant association in young and 

middle aged women and attenuation of the association in older females.195 Particularly in studies 

of perimenopausal and postmenopausal an association has not been found between parity and UI 

or with UI type,118,128 suggesting that aging tends to diminish this effect. In a study involving 

separate multivariate analyses in three age cohorts (ages 18-23, 45-50, and 70-75 years), the 

effect of increasing parity declined with age.68 In other studies involving both cross-sectional and 

longitudinal analyses, the role of parity changes after 1 year. Odds ratios associated with parity 

are higher in women <60 years than in women ≥60 years.105 Certain risk factors, such as vaginal 

delivery, are strong predictors of UI in younger women, but with changes associated with aging 

and menopause, this effect seems to disappear. In premenopausal women, the number of vaginal 

childbirths was strongly associated with UI.96 In other studies, the relative risk of having stress 

UI 10 years after childbirth was not associated with the number of vaginal deliveries.196

Obstetric and fetal factors. 

UI during and following pregnancy. Evidence suggests that UI developing during pregnancy 

is a risk factor for UI in the immediate postpartum period197 and in subsequent years64,96 raising 

the odds of UI by two to 11 times96,198 (Appendix Table F18). One study found that the odds of 

developing UI, stress, urge, and mixed UI were 2.2, 3.4, and 3.2 times higher, respectively, for 

women who had UI during pregnancy than women who did not.64 

 Women who experienced postpartum UI had four to five times higher odds of developing 

UI,64,119 with four times higher odds for developing stress UI, and 2.6 and 3.2 odds for 

developing urge and mixed incontinence, respectively.64

Mode of Delivery. The majority of the studies report that spontaneous vaginal deliveries are 

more likely to be associated with UI,7,197,199 stress UI and severe stress UI,135 and subsequent 

stress UI surgery631 compared to Cesarean delivery (labored and unlabored). Cesarean section 

was associated with lower odds of UI in seven studies,119,197,199-203 by 80 percent201 to 41 

percent200 and did not show a significant association in five studies135,141,196,204,205 (Table 19). 

Two studies reported higher odds of UI when women after Cesarean section were compared with 

nulliparous females (Figure 12).7,206 Vaginal delivery compared to Cesarean increased the risk of 

total UI with little evidence of association with stress and urge UI. Adjusted odds of UI was 

higher after forceps delivery by 150 percent199 to 187 percent198 compared to vaginal delivery 

(Figure 13), by 310 percent to 430 percent199 compared to Cesarean section, and by 430 percent 

compared to nulliparous women.206 Vacuum delivery was associated with random changes in UI 

in the majority of the studies (Table 19). One study found that previous pregnancy was a risk 

factor for severe stress UI in women who reached the age of 50, although the mode of delivery 

had less effect.135 Breech delivery was not associated with an increased risk of UI or any UI 

type.98

 Few prospective studies reported protective effects of Cesarean section on UI compared to 

vaginal delivery.119,197,202,205

Oxytocin. The prior use of oxytocin significantly increased the odds of UI by 1.9 times in 

women ≥60 years.59

Epidural analgesia. Evidence does not support that epidural analgesia increases the risk of 

incontinence.98 

Duration of labor. Several studies have examined labor time and the duration of specific 

stages of labor. One study found that labor time, duration of second, passive, and active stages, 

as well as the duration that the fetal head was deeply engaged was not associated with UI.199
101

Another study found that labor beyond 24 hours was not associated with UI.59 In contrast, a 

study found that functional delivery disorders increased the odds of having moderate/severe UI.98 

Episiotomy, lacerations, and perineal suturing. Episiotomy has not been associated with UI, 

either having had one or several episiotomies.59,64,196 Perineal rupture and perineal suturing were 

not significantly associated with UI.59,64,196

Gestational age. Relatively few studies have examined gestational age as a risk factor for UI. 

Studies available do not support an independent association with UI.59,98,197 

Fetal weight and head circumference. There is inconsistent data on the effect of fetal weight 

on UI. Two studies found that heavier babies increased the risk of UI.98,197 In one study, heavier 

babies (birth weight in the top quartile or ≥4,000 grams increased the odds of becoming 

incontinent by 10-56 percent,98 and in another a heavier fetal weight increased the odds of 

developing stress UI but not urge or mixed UI.98 However, most studies do not report a 

significant association between fetal weight and UI.196,199 Relatively few studies have examined 

fetal head circumference as a risk factor. Data from three studies indicate that it is not an 

independent risk factor for UI,98,199 although one study found it to significantly increase the odds 

of urge UI by 80 percent.98

Lactation. Breast feeding as a risk factor for subsequent UI has been examined in a few 

studies with conflicting findings.96,198 Although lactation was associated in bivariate analysis 

with UI, in multivariate analyses, it was not independently associated with UI.96 In another study, 

length of breast-feeding slightly increased the odds of UI by 17 percent.198

 Menstrual cycle and menopause. Because of the presence of estrogen and progesterone 

receptors in the lower urinary tract, female UI is assumed to be associated with a woman’s 

hormonal status and the fluctuations in it (Appendix Table. F19).One study 2,158 premenopausal 

women in Denmark examining the role of hormonal variation found that self-reported UI the day 

before completing a survey questionnaire was strongly associated with a recent decrease in 

bleeding duration (OR 2.2, 95 percent CI 1.3; 3.6).96 

 Because of the increased prevalence of UI in the perimenopausal years, menopause has been 

assumed to be a key risk factor in UI. One study found that perimenopausal status was 

independently associated with UI, increasing the odds by 127 percent (OR 1.3, 95 percent CI 1.1; 

1.5).93 The large Women's Health in the Lund Area study found an increase in adjusted odds of 

UI by 144 percent among premenopausal women (OR 1.4, 95 percent CI 1.1; 1.8) and by 1.5 

percent in depressed premenopausal women (OR 1.5, 95 percent CI 1.1; 2.0).191 Studies 

examining menopause assessed by self report have not found it to be an independent risk factor 

for stress UI.70,95 Although menopause was not found to be significantly associated with UI, the 

number of years past menopause did increase the odds of UI by 15 percent, suggesting the aging 

process may have a greater role in the development of UI than hormonal status.90 

 Gynecological or abdominal surgery. There is mixed evidence related to prior 

gynecological surgery as a risk factor (Appendix Table F20). Five55,83,108,124,138 studies of 

eight55,62,72,83,108,124,138,144,191 that examined this association reported significantly higher adjusted 

rates of total UI among women after hysterectomy. The increase was 160 percent (OR 1.6, 95 

percent CI 1.1; 2.1) for UI in the past month,108 130 percent for at least monthly UI (OR 1.3, 95 

percent CI 1.1; 1.6),124 140 percent for daily UI (OR 1.4, 95 percent CI 1.1, 1.6),55 and 160 

percent for severe UI (OR 1.6; 95 percent 1.5; 1.7).138 In contrast, rates of stress UI were either 

the same after hysterectomy in four studies87,108,118,135 or were less in the Women's Health 

Australia study (OR 0.8, 95percent CI 0.7; 0.9).68 Women after hysterectomy also had the same 

prevalence of urge UI in three studies.70,74,108 Only one European cross-sectional study reported 
102

higher adjusted odds of bothersome urge UI among women after hysterectomy (OR 2.6, 95 

percent CI 1.4; 4.4).87 Depressed women after hysterectomy had UI 1.3 times more often (OR 

1.3, 95 percent CI 1.0;1.7).191 Diabetics after hysterectomy also had increased adjusted rates of 

weekly UI (OR 2.3, 95 percent CI 1.0; 5.2).140

 Evidence on the relationship between UI and other gynecological conditions and procedures 

is conflicting (Appendix Table F21). Women with previous gynecological surgery had stress UI 

twice as often (OR 2, 95 percent CI 1.1; 3.7).95 Women with prolapse (OR 4.11, 95 percent CI 

2.15; 7.86)92 and after prolapse surgery had increased odds of UI.62,68 In another study, pelvic 

organ prolapse surgery was not significantly associated with UI.135 Women who had both a 

hysterectomy and prolapse repair were 1.8 to 2.3 times more likely to have UI compared to 

women without these surgeries.68 

 Other surgeries on the uterus, excluding hysterectomies, led to conflicting findings, 

depending on the measurement of UI, when UI was confirmed by objective measures, they did 

raise the odds of having UI by 2.2 times, but when self report was used as the UI measure, there 

was no association.62 In another study of premenopausal women, having had abdominal or 

gynecological surgery was associated with a 170 percent higher risk when compared to women 

without this surgery;96 and in another study involving both premenopausal and postmenopausal 

women, prior gynecological surgery doubled the odds of having UI.95

 Pelvic floor muscle contraction strength. Two studies examined the role of pelvic floor 

muscle contraction or exercises on either the prevalence or incidence of UI. In one crosssectional study involving 507 women who completed a clinical evaluation, poor ability to 

contract pelvic floor muscles was strongly associated with UI (adjusted odds ratio of 3.5 for 

objectively confirmed according to the ICS definition UI and 4.5 for self-reported UI) depending 

on the definition of UI.62 In a study of primiparous women, inability to interrupt urine flow 

doubled the odds of being incontinent.636 

 Other factors. One clinical study found that abnormal findings on a gynecological 

examination were significantly associated with having UI in women ages 50-74.62 Vaginal 

symptoms (dryness, discharge, itching, dyspareunia) in postmenopausal women are significantly 

associated with any UI and severe UI.144 In this same study, atrophic vaginitis was significantly 

associated with any UI but not severe UI. Vaginal colonization with E. coli was not 

independently associated with any or severe UI.144 

 In a study of 665 primiparous women, perceived discomfort in the lower abdomen increased 

the odds of UI by 3.6 times.636 One large survey of middle-aged American women found that 

fibroids were associated with prevalent UI but not incident UI.149 

Urological Factors 

 Childhood voiding dysfunction. There is limited evidence available on the role of 

childhood voiding dysfunctions as a risk factor for UI in adulthood. Evidence available suggests 

that childhood nocturnal enuresis is associated with the development of UI in adulthood, 

particularly urge UI. In one study, the odds of having UI were increased by 2.4 times among 

premenopausal women.96 In two other studies, childhood nocturnal enuresis increased the odds 

of urge UI by 2.7 times.70,637 but was not associated with stress UI.70 It was also associated with 

increasing the risk of severe UI almost 3-fold.(Kuh, 1999, #1578). Childhood daytime 

incontinence has also shown to be associated with adult urge UI (OR 2.6, 95 percent CI 1.1; 

5.9).637
103

 Lower urinary tract symptoms. Few epidemiological studies have examined the 

association of lower urinary tract symptoms (urgency, frequency, nocturia, dysuria, difficulty 

with bladder emptying) as independent risk factors for either prevalent or incident UI. Findings 

are inconsistent across studies (Appendix Table F22). Urinary frequency was independently 

associated with UI in women ≥60 years,42 whereas it was not associated with UI risk in women 

ages 20-84 years.139 Urgency increased the odds of UI by 9.3 times in women ages 60-84 years, 

but was not found to be associated in those ≥85 years.42 However, in another study with women 

ages 20-84 years, urgency did not predict UI risk.139 Nocturia increased the odds of UI in women 

≥85 years but not in those ages 60-84.42 Stinging or burning urine was significantly associated 

with UI in three age cohorts (ages 18-23, 45-50, and 70-75 years).68 

 In a study of postpartum women, frequency of urination increased the odds of having UI one 

year after delivery.198

 Urinary tract infections. There is inconsistent data on the role of urinary tract infections as 

a risk factor for UI (Appendix Table 23). Women with urinary tract infections had higher rates of 

UI in 11 studies66,72,74,90,92,97,108,116,121,127,144 of 1566,70,72,74,90,92,96,97,106,108,116,121,127,144,187 that 

examined the association. Women with recurrent urinary tract infection had the highest increase 

in UI by 230 percent for weekly UI (OR 2.3, 95 percent CI 1.3; 3.9)127 and for monthly UI (OR 

2.3, 95 percent CI 1.6; 3.1),108 220 percent for UI in the past year (OR 2.2, 95 percent CI 1.4; 

3.4),72 and by 470 percent for ever having UI (OR 4.7, 95 percent CI 4.7; 8.9).116

 Several studies reported that menopausal status can influence the association between urinary 

tract infections and UI. One study in premenopausal women,96 one study in postmenopausal 

women,106 and one study that included both premenopausal and postmenopausal women did not 

find a significant increase in odds of UI among women with urinary tract infection.139 In 

contrast, one survey in postmenopausal women found that the lifetime number of urinary tract 

infections (six or more) increased the risk of UI by 1.9 times for any UI and 2.0 times for severe 

UI.144 Two studies found urinary tract infection increased the odds of UI by 4.8 times in women 

who were perimenopausal and by 3.4 in women who were menopausal.90,152 

 Urinary tract infections have been associated with UI type; in one survey two or more urinary 

tract infections in the past year doubled the odds of having urge UI.66 In another study, cystitis 

was significantly associated with stress UI at baseline and 1 year later, increasing the odds of 

stress UI by 50 to 90 percent.132 

 Postvoid residual bladder volume. One study found that postvoid residual bladder volume 

was not associated with UI in postmenopausal women.128

 Bladder or urinary surgery. Several studies have examined whether prior bladder or 

urinary surgery is a risk factor for UI. Some studies have not found significant associations,144

whereas another study found that UI surgery doubled the odds of having UI in perimenopausal 

women.135

Medical Conditions 

 Arthritis and musculoskeletal disorders. Evidence from three studies,7,86,118 suggested that 

women with arthritis had higher rates of UI (Figure 14). Two studies found that arthritis was 

associated with increased odds of UI by 80-88 percent.7,86 Arthritis was also an independent risk 

factor for UI type. In a study involving women ages 70-79 years, arthritis was significantly 

associated with both urge and stress UI.118 
104

 Joint pain was significantly associated with stress UI in a 1-year followup study, increasing 

the odds of UI by 40 percent.132 A history of hip fracture increased the odds of UI by 38 

percent.81 Osteoporosis was associated with UI in one study,7 but the association can be 

confound by age. 

 Diabetes. There is growing evidence to suggest that diabetes mellitus increases the odds of 

having UI (Appendix Table F24).Two studies134,149 of three134,149,186 reported that women with 

diabetes develop UI more often. Incidence of weekly UI was higher by 147 percent (OR 1.5; 95 

percent CI 1.2; 1.9) in women with duration of diabetes more than 10 years.134 The same Nurses' 

Health Study cohort showed that incidence of severe UI was increased by 175 percent (OR 1.8, 

95 percent CI 1.3, 2.3) and very severe by 126 percent (OR 2.6; 95 percent CI 1.4; 5.0).134 The 

Study of Women's Health Across the Nation found 302 percent increase in developing monthly 

UI in women with diabetes independent on other risk factors (OR 3.0, 95 percent CI 1.1; 8.1).149 

 Prevalence of stress UI was greater in women with diabetes in three studies95,133,149 of 

six66,95,108,133,135,149 that examined the association (Figure 15). Pooled odds ratio of prevalent 

stress UI was not significant (OR 1.4, 95 percent 0.9; 2.1). The result of meta-analysis was 

sensitive to one study, The Heart & Estrogen/Progestin Replacement Study Research Group, 

randomized trial of 2,763 women taking combination hormone therapy to prevent coronary heart 

disease, that did not find a significant association between diabetes and stress UI.66 However, the 

majority of the studies reported a significant increase in adjusted odds of total UI among women 

with diabetes (Figure 16)55,66,72,86,93,97,108,116,124,127,128,133,134,138,149,186 Pooled analysis of 16 studies 

resulted in an odds ratio of 1.4 (95 percent CI 1.2; 1.5) of having prevalent UI in women with 

diabetes. Four of five studies found a significant increase in adjusted odds of urge UI among 

women with diabetes (Figure 17).66,108,118,133,149 Pooled analysis of five studies estimated that 

diabetic women had urge UI 1.7 times more frequently than nondiabetics (95 percent CI 1.2; 

2.2). 

 Diabetic complications such as macroalbuminuria, retinopathy, and/or peripheral neuropathy 

significantly increased the odds of having UI in two studies.128,140 Diabetic neuropathy was 

associated with an adjusted odds ratio of 2.4 and macroalbuminuria increasing the odds by 3.8.140

However, in another study, a BMI adjustment decreased the strength of these associations.128

This same study also found that neither diabetes treatment (diet, pill, or insulin) nor duration of 

treatment was associated with UI after adjustment for BMI. Blood glucose control as measured 

by HbA1c was also not associated with UI.128Women who have insulin-dependent diabetes were 

found to have a 3.5 times higher risk of urge UI when compared to women without diabetes.128 

 Stroke. One prospective cohort , the Canadian Study of Health and Aging, found that elderly 

community dwelling women had higher risk of developing UI after stroke (OR 1.6, 95 percent 

CI 1.1; 2.2).207 Prevalence of UI was significantly higher among women after stroke in 

five55,86,97,133,186of six55,67,86,97,133,186 studies that examined this association (Figure 18) Pooled 

analysis of six studies estimated an increase by 167 percent of UI in women with history of 

stroke (OR 1.7 95 percent CI 1.4; 2.1). Severe UI was more prevalent in women with history of 

stroke in one study (OR 1.9, 95 percent CI 1.4; 2.8).67 Paraplegia was also associated with UI 

(OR 1.6, 95 percent CI 1.1; 2.6).133

 Neurological disorders. There is conflicting evidence on neurological diseases and 

prevalent UI (Appendix Table F25). Women with any neurological diseases had greater rates of 

ever having UI (OR 3.8, 95 percent CI 1.7; 8.6).116 Parkinson’s disease was associated with 

increased odds of having UI in one study (OR 2.3, 95 percent CI 1.1; 4.5)81 while two other 

studies97,133 did not find a significant association. 
105

 Pulmonary disorders. Asthma and chronic obstructive pulmonary disease (COPD) have 

been studied as potential risk factors for UI in several studies with conflicting findings 

(Appendix Table F26). Although most studies find COPD to predict UI risk,81,124,133 in a large 

study involving 29,520 women,86 COPD was not associated with UI. In a smaller survey 

involving 1,531 women ≥65 years, COPD increased the odds of UI by 53 percent.81 In other 

studies, COPD was associated with the type of UI. In women ages 55-75 years, the odds of 

having stress UI were increased five-fold, although it was not associated with urge UI risk.118

Asthma was not associated with UI risk in one study,86 whereas in another study it increased the 

odds of stress UI by 50 percent at baseline but was not significantly associated 1 year later.132

Several studies indicated that frequent or prolonged coughing increases the odds of UI by 33 to 

60 percent114,638

Comorbidity and poor health. Some studies have examined the role of comorbidity in 

relation to UI (Appendix Table F26). Elderly community dwelling women with kidney problems 

(OR 1.7, 95 percent CI 1.2; 2.3) and foot diseases (OR1.4, 95 percent CI 1.0; 1.8) were at risk of 

developing UI.186 Women with two or more comorbid diseases had higher adjusted rates of UI 

(OR 5.9, 95 percent CI 3.7; 9.6).92 Increased comorbidity index was associated with higher 

adjusted odds of UI in three studies.121,124,189

 In studies involving community dwelling females, poor self-rated health increased the odds 

of having daily UI by 60 percent55 and was weakly associated with stress UI.118 In another study, 

poor health was not associated with stress or urge UI in post-menopausal women; however, it did 

increase the odds of having mixed UI by 143 percent (OR 1.4, 95 percent CI 1.1; 1.8).66 In a 

large survey of women ages 40-55 years, poor health was associated with increased odds of urge 

UI but not mixed or stress UI.149 Women with poor or fair health experienced UI 2.6187 to 2.984

times more often. 

 Cardiovascular disorders. There is limited evidence on the role of cardiovascular disorders 

such as heart problems and hypertension on UI (Appendix Table F26). Hypertension was 

strongly associated with UI in two studies,83,127 whereas two studies did not find a significant 

association with any UI639 or with stress UI.95 In large surveys, heart problems,639 including 

congestive heart failure,55,97 were not associated with UI. 

 Gastrointestinal diseases and procedures. 

Constipation. A limited number of studies have explored the role of constipation as a UI risk 

factor (Appendix Table F27).68,144,152 Three studies68,121,144 reported a significant increase in 

adjusted odds of UI in women with constipation among six studies that examined this 

association.68,74,97,121,144 One study found that constipation increased the odds of having severe UI 

by 50 percent, whereas it was weakly associated with having any UI.144 In another study 

involving different multivariate analyses in three age cohorts (ages 18-23, 45-50, and 70-75 

years), constipation nearly tripled the odds of having UI.68 However, two studies did not find a 

significant association between constipation and UI; one study in homecare patients97 and the 

other with women ages 45 years and over.143 Bowel straining significantly increased the odds of 

stress UI at baseline by 150 percent; however, the effect was not present 1 year later.132

Constipation was not associated with urge UI.74 Constipation 4-6 weeks after childbirth was 

independently associated with UI at 1-year postpartum in all women (primiparae and multiparae 

women combined), and in primiparae alone but not in multiparae women.119 Women with bowel 

symptoms had higher adjusted rates of UI in one study68with random findings in another.185 One 

study96 of seven reported a significant increase in prevalence of UI after abdominal 

surgery.72,96,108,135,144,185
106

Other surgical procedures. One study found that varicose veins and hemorrhoids were 

independently associated with UI at 1-year post-partum in primiparous women by 50 percent.640

Previous surgery for UI was associated with increased odds of weekly UI (OR 1.4, 95 percent CI 

1.2; 1.8)83 and stress UI (OR 1.3, 95 percent CI 1.3; 4).135 In one study, urological surgeries were 

not associated with prevalent UI in women.72

Medications 

 Relatively few studies have investigated the independent effect of medications on prevalent 

or incident UI (Appendix Table F28). 

Incident UI. Only one study reported incident UI in women with diabetes treated with 

pharmacological agents and found that insulin administration but not oral medications were 

association with a 350 percent increase in developing of UI (OR 3.5, 95 percent CI 1.6; 7.9).123

Diuretics. The evidence on the role of diuretics on UI risk is conflicting. Earlier studies that 

examined bivariate associations indicated that diuretics were associated with UI in older 

adults.641 However, large studies involving multivariate analyses did not find that diuretics 

including nonthiazide diuretics increased the odds of having UI.55,86 Diuretics is a strong 

predictor of UI type, particularly urge UI.133 One study found that diuretics significantly 

increased the odds for stress and urge UI in women ages 40-60 years by two to four times.78

Estrogen. Several epidemiological studies have examined estrogen therapy as a risk factor 

for UI (Appendix Table F29).55,59,105,118,144,191 The risk of UI is elevated among women taking 

postmenopausal hormones (oral and transdermal estrogen with and without progestin) as 

compared to those who have never taken them.153 Women taking transdermal estrogen with and 

without progestin (RR 1.7, 95 percent CI 1.4; 2.06 and RR 1.5, 95 percent CI 1.2; 1.8, 

respectively) had a slightly higher risk of UI than those who took the oral forms (RR 1.5, 95 

percent CI 1.4; 1.6 and RR 1.3, 95 percent CI 1.2; 1.4). This same study also found there was 

little risk after cessation of hormones and a decreasing risk of incontinence with increasing time 

since last hormone use.105 Ten years after stopping hormone use, the risk was identical in women 

who had and had not taken hormone therapy. Two studies found that oral hormone replacement 

therapy increased the odds of having UI by 1.9 times.55,59 Vaginal estrogen cream use was 

significantly associated with any UI in women ages 55-75 years, although this same association 

was not found with severe UI.144 Systemic hormone replacement therapy is strongly associated 

with urge and stress UI. In a study of 1,584 women ages 70-79 years, current oral estrogen use 

increased the odds of urge UI by 70 percent and stress UI by 98 percent, respectively.118

Hormone use for menstrual disorders was also an independent risk factor for UI.96 Former use of 

oral contraceptives increases the odds of UI by 18-20 percent, although current use was not 

associated.138

Psychotropic medications. A few studies have examined whether antidepressants in general 

or specific types of antidepressants are a risk factor for UI. In a large survey, antidepressant use 

was associated with increased odds of having UI by 75 percent.86 In a study involving 6,642 

women, the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin norephinephrine 

reuptake inhibitors (SNRIs) was not associated with UI in multivariate models that included all 

women, depressed women only, and nondepressed women who reported depressive 

symptoms.191 However, in a subanalysis of depressed women on SSRI/SNRIs, there was a 

significant association between drug use and UI.191 Tranquilizers have been shown to increase 

the risk of UI by 65 percent.86 The contribution of psychotropic medications, independent from 
107

baseline disease on UI, has not been examined in prospective observational studies. The results 

from RCTs showed that serotonin-noradrenaline reuptake inhibitor, duloxetine improved stress 

UI,642 suggesting that depression rather than the antidepressant could be considered as a risk 

factor for UI. 

Other medications. In a large survey of 29,520 women, pain, narcotics, asthma, 

hypertensive, and heart medications were not associated with an increased risk of UI.86 In this 

same survey, antibiotics were significantly associated with UI, increasing the odds by 64 percent, 

laxatives by 67 percent, and hypnotics by 52 percent. However, another study did not find an 

association between sleeping medications and UI risk.106 Polypharmacy (e.g., three drugs or 

more) was not associated with UI risk in women ages 70 years and over.106

Summary. Limited evidence, Level IIA from prospective cohort studies suggested that 

increased BMI, diabetes, comorbidities, cognitive decline, and hormone therapy were associated 

with developing UI in community dwelling females. Prevalence of UI was higher in aging and 

depressed women, after stroke, vaginal trauma, and in women with physical dependency. The 

strength of the association depends on definitions of UI by time, type, and severity. Differences 

in assessment of associated factors may also contribute to the effects on UI. Hormone status of 

women modified the effects of other associated factors. Comparisons across the studies were 

difficult to make due to methodological heterogeneity in adjustment and statistical models. 

Risk Factors for UI in Community Dwelling Men 

 The prevalence of UI in elderly males with different risk factors was examined in one 

population based survey (Appendix Table F30).607 Men with arthritis had the highest prevalence 

of mixed (51 percent), urge (43 percent), and stress UI (46 percent) compared to other internal 

diseases. Mixed UI was reported in 29-39 percent of males with hearing and vision problems; 35 

percent reported urge UI. Diabetics experienced stress UI more often than men with other 

diseases (36 percent). Urge UI was prevalent in men with pulmonary diseases (27 percent). The 

prevalence of UI was 36 percent in men who used diuretics, 38 percent in men treated for 

prostate problems, and 60 percent in those taking antispasmodic agents 181 After prostate surgery 

(47 percent) and bladder surgery (58 percent of men) had a higher prevalence of UI.181 However, 

one European survey of 840 men reported lower compared to other studies prevalence of UI after 

transvesical prostatectomy for benign prostatic hyperplasia.643 

 The prevalence of UI in men with prostate cancer varied from less than 1 percent173 to 30 

percent180 and 44 percent181 being lower than 10 percent in the majority of the studies167-174

(Appendix Table F31). The rates of UI in men treated for prostate cancer varied substantially 

depending on the treatment use, time of followup, population characteristics, and definitions of 

UI (Appendix Table F32). The largest case series reported that 8 percent of men experienced UI 

after radical prostatectomy (Appendix Table F33).644 A retrospective analysis of a national 

random sample of 12,079 Medicare beneficiaries showed that the incontinence rate after radical 

prostatectomy decreased from 20 percent in 1991 to 4 percent in 1995, being the highest in older 

patients.175 One prospective population-based cohort, the Prostate Cancer Outcomes Study, 

found differences in the rates of occasional and frequent UI after radical prostatectomy.172 The 

rates of UI after radiation therapy differed across the published case series. The largest (1,192 

males followed for 52 months after external beam radiotherapy) reported 5 percent with Grade 1 

UI using the modified Radiation Therapy Oncology Group/Subjective, Objective, Management, 
108

and Analytic scale (Grade I - Occasional [less frequent than weekly] use of incontinence 

pads).170

 Associations between UI and risk factors were reported in several studies (Table 

20).72,74,81,83,84,86,92,97,170,174,175,180-182,644 Age was an independent risk factor for UI in two 

studies.58,97 One study reported crude significant association,81 not confirmed in the largest 

retrospective cohort study of Medicare beneficiaries.175 Limited evidence suggested that age was 

significantly associated with urge UI (OR 5.34, 95 percent CI 2.26; 12.62) among those older 

than 70 years compared to younger men,74 with random association with stress UI.645 Non-White 

men had the same rates of UI compared to Whites.175 Marital status84 and education in men72,83,92

were not associated with lower odds of UI. Two studies showed that a sedentary lifestyle was 

associated with UI in males.83,92 

 Alcohol intake (Figure 19)72,83,84,92 did not show an association with male UI. Only one study 

of 748 men 61-70 years old showed that 15-21 alcoholic drinks weekly were associated with 

lower adjusted odds of urine loss during the last year).72 Three studies examined crude and 

adjusted odds of UI among smokers and none found a significant association (Figure 20).72,83,92

 BMI in relation to UI was examined in two studies with univariate79,92 and three studies with 

multivariate72,83,84 analysis (Figure 21). Only one study of 232 males reported an increase in 

adjusted odds of total UI by 320 percent among obese males.84 Males with diabetes had 

significantly higher adjusted rates of UI in two97,176 studies of five58,72,86,97,176 with pooled odds 

ratio of 1.4 (95 percent CI 1.1;1.6) (Figure 22). 

 Comorbidities and poor general health were associated with UI in several studies (Table 

21).81,84,92,97 The presence of FI was associated with an increased odds of urge UI in one study of 

2,198 males (OR 17, 95 percent CI 7.5; 40)176 but with random changes in another.106 Males with 

arthritis had higher adjusted odds of total86 (OR1.6, 95 percent CI 1.1; 2.4) or urge UI (OR 1.8, 

95 percent CI 1.4; 2.4).176

 Dementia was associated with an increase adjusted odds of UI in nursing home male 

residents4 but not in community dwelling older men in Japan.58 The National Population Health 

Survey in Canada reported that use of narcotics, laxatives, and diuretics were associated with 

greater odds of UI independent of other risk factors.86 Memory problems, epilepsy, and 

neurological diseases were associated with higher rates of UI (Figure 23).4,58,72,86,97,176-178 Stroke 

was shown as a strong and independent risk factor for UI (Figure 24) in nursing home residents4

and in community dwelling males58,86,97,176,177 with a pooled odds ratio of 2.12 (95 percent CI 

1.36; 3.29). Restrictions in activities of daily living were associated with higher crude and 

adjusted odds of UI in males in all studies that examined the relationship (Figure 

25).4,81,92,97,106,114

 Males with urinary tract infections had higher adjusted rates of UI (Figure 26) with a pooled 

odds ratio of 3.5 (95 percent CI 2.3; 5.2).72,74,92,97,106 Acute genitourinary toxicity, enuresis, 

incomplete urination, and other urological conditions were associated with higher adjusted odds 

of UI in all studies that examined the relationship (Figure 27).72,170,174,179

 Men with prostate diseases had higher rates of UI after adjustment for confounding factors in 

the majority of the studies (Figure 28).72,83,92,170,176,180-183 Prostate cancer (RR 2 95 percent, CI 

1.5; 2.8), radical prostatectomy (RR 4.3, 95 percent CI 2.6; 7.3), and radiotherapy for prostate 

cancer (RR 2.3, 95 percent CI 1.3; 4.1) were associated with increased adjusted relative risk of 

UI.180
109

 Summary. Consistent published evidence, Level IIb-III suggested that poor general health, 

limitation in daily activities, stroke, diabetes, and treatments for prostate cancer were associated 

with higher risk of UI in men. 

Association between Stroke and UI in Community Dwelling Adults 

 Acute stroke was associated with a 280-520 percent higher prevalence of UI compared to 

age-matched adults without stroke.177 The prevalence of UI among patients with acute stroke 

varied from 7 percent646 to more than 30 percent220,647-649 (Table 22).The prevalence varied 

depending on definitions of UI from 11 percent for partial to 36 percent for complete UI.220 One 

study reported the incidence of UI in patients with stroke as 2 percent for women and 4 percent 

for men.650 The prevalence decreased with the time of followup after an acute stroke (11 to 36 

percent) to 8 to 11 percent at 6 months.220 Elderly patients experienced UI more often, from 35 

percent in younger patients to 57 percent among those older than 80 years (Table 23).647 The 

adjusted odds of UI remained higher 4 years after stroke.177 Age was associated with increased 

risk of UI among patients with stroke by 72 percent per 10 years.220 The results, however, were 

not consistent across the studies, with 16 times greater odds of UI after 75 years of age in one 

study651 but an association in the opposite direction in another.652 Functional impairment after 

stroke including dysphasia, dysphagia, visual field defect, motor weakness, and cognitive 

impairment was associated with significant increase in UI.177,651-653

Risk Factors for UI in LTC Settings 

Association between risk factors and UI in LTC settings. The prevalence of UI increased 

with the length of stay in nursing homes from 39 percent at 2 weeks to 44 percent at 1 year after 

admission.28 It is not clear if this is an effect of prolonged exposure or a difference in case mix 

(Table 24). The majority of residents with cognitive impairment experienced UI (72 to 84 

percent).1 The proportion of incontinent patients increased responding to severity of impairment, 

from 60 percent in mild to 93 percent in severely demented.34 Physical dependency was 

associated with a higher prevalence of UI, from 26 percent in independent residents to 81 percent 

immobile.34 The prevalence of UI among dependent residents was more than 70 percent in seven 

countries and varied from 87 percent in Iceland to 72 percent in the United States.1

 The 

prevalence of UI among residents with diabetes ranged from 55 percent29 to 65 percent.34 Almost 

all (93 percent) residents with FI also experienced UI.29 One study of 9,013 patients with 

multiple sclerosis reported 21 percent UI and 9 percent of frequent UI.654 The estimations were 

not consistent; however, the prevalence of UI among patients with urinary tract infection in Italy 

was 63 percent in one study1

 and 81 percent in another.29 Few studies examined adjusted odds 

ratios of UI among residents in LTC independent of other confounding factors. Aging was 

associated with increased odds of UI by 3 percent per year to 24 percent per 5 years of age 

(Table 25).4,165 In contrast with higher incidence of UI in males,166 prevalence of UI was lower in 

males than females in two studies29,165 of three 29 ,165,655 that examined this association. Race, 

BMI, diabetes, arthritis, and cardiovascular diseases did not show significant association with UI, 

but the evidence was limited to one state survey of nursing homes.4,165 

 Stroke increased the adjusted odds of UI by 20 to 40 percent.4,165 Physical dependency was a 

strong and independent risk factor for UI in several studies (Table 26).4,29,164,165 Impairment of 

ADLs was associated with three to four times larger odds of UI.4,164 Residents with dependency 
110

in toilet use experienced UI six times more often.165 The odds of UI were seven times higher 

among wheelchair users and bedridden residents.29 Mental impairment was associated with 192 

to 361 percent higher prevalence of UI.29

 FI was associated with ten29 to 20165 times larger odds of UI. The conditions that assume 

intensive bowel control and frequent checking of wet condition of residents, including tube 

feeding and diarrhea, were associated with lower UI. In conclusion, consistent evidence suggests 

that restrictions in ADL, physical dependency, and cognitive impairment are risk factors for UI 

in LTC. Factors that induce UI also seem to affect FI. 
111

Figure 3. Association between incident UI in women of different races compared to Caucasian women 

(results from two studies)123,149

Odds ratio of incident UI

 Favors other races Favors Caucasians

 .070000 1 14.2857

Race (Type)

 Odds ratio of incident UI

(95% CI) At least weekly

White vs. other (Total) 3.10 (2.00, 4.80)

UI >weekly/daily

African American (Total) 1.66 (0.67, 4.14)

Chinese (Total) 1.28 (0.31, 5.22)

Japanese (Total) 2.15 (0.62, 7.48)

Hispanic (Total) 2.96 (1.06, 8.18)

UI at least monthly

African American (Total) 1.33 (0.89, 1.99)

Chinese (Total) 0.81 (0.50, 1.30)

Japanese (Total) 0.64 (0.36, 1.13)

Hispanic (Total) 0.63 (0.36, 1.13)

African American (Stress) 0.44 (0.28, 0.68)

Chinese (Stress) 0.68 (0.39, 1.17)

Japanese (Stress) 0.88 (0.52, 1.48)

Hispanic (Stress) 0.45 (0.25, 0.81)

African American (Urge) 1.91 (1.22, 2.99)

Chinese (Urge) 0.22 (0.07, 0.72)

 Japanese (Urge) 0.37 (0.14, 0.97)

Hispanic (Urge) 0.33 (0.11, 0.95)
112

Figure 4. Prevalent UI in African American women compared to Caucasian women 

Figure 5. Prevalent UI in Hispanic women compared to Caucasian women 

.1 1

Author (Sample)

 Odds Ratio

(95% CI)

Mild

Grodstein (27,936) 0.54 (0.43, 0.67)

Danforth (83,355) 0.60 (0.50, 0.70)

Moderate

Sampselle (3,302) 0.31 (0.23, 0.40)

Nygaard (5,701) 0.42 (0.31, 0.56)

Nygaard (5,701) 0.30 (0.19, 0.46)

Grodstein (27,936) 0.39 (0.31, 0.50)

Thom (2,109) 0.61 (0.45, 0.83)

Danforth (83,355) 0.60 (0.50, 0.70)

Waetjen (3,302) 0.36 0.27, 0.48)

Severe

Danforth (83,355) 0.50 (0.40, 0.60)

Waetjen (3,302) 0.31 (0.21, 0.46)

Odds Ratio

 Odds Ratio

 .1 1

Author (Sample)

 Odds Ratio

 (95% CI)

Mild

Grodstein (27,936) 0.67 (0.49, 0.91)

Danforth (83,355) 1.09 (0.90, 1.30)

Moderate

Sampselle (3,302) 0.44 (0.27, 0.71)

Nygaard (5,701) 0.50 (0.34, 0.74)

Nygaard (5,701) 0.29 (0.15, 0.53)

Grodstein (27,936) 0.75 (0.56, 1.00)

Danforth (83,355) 1.00 (0.90, 1.20)

Waetjen (3,302) 0.18 (0.11, 0.30)

Severe

Danforth (83,355) 1.10 (0.90, 1.30)

Waetjen (3,302) 0.16 (0.11, 0.35)
113

Figure 6. Association between prevalent UI and BMI in women depending on time of having UI 

Figure 7. Association between prevalent UI and BMI in women who reported involuntary urine loss in the 

past year 

Odds Ratio

.5 1 20

BMI category

Odds Ratio

(95% CI)

Ever UI

BMI <20 vs. 20-25 0.69 (0.52, 0.92)

BMI <20 vs. 20-25 0.90 (0.58, 1.41)

BMI >25 vs. 20-25 1.41 (1.24, 1.60)

BMI >25 vs. 20-25 1.24 (1.03, 1.51)

BMI 25 vs. <25 12.50 (6.70, 24.40)

UI in the past month

BMI 20-25 vs.>25 1.50 (0.90, 2.50)

BMI 21.6-23.8 vs.<21.6 1.15 (0.81, 1.63)

BMI 23.9-27.2 vs. <21.6 1.38 (0.98, 1.94)

BMI 25-/30 vs. <25 1.46 (1.27, 1.67)

BMI: 50th- 75th percentile: 1.30 (0.80, 2.20)

BMI 25-30 vs. 20-25 1.53 (1.10, 2.14)

BMI 25-30 vs. 20-25 1.42 (0.98, 2.05)

BMI >30 2.00 (1.20, 3.50)

BMI <27.3 vs. <21.6 1.90 (1.35, 2.67)

BMI >30 vs. <25 1.92 (1.52, 2.43)

 UI in the past week

BMI per 1 unit increase 1.15 (1.07, 1.25)

BMI per 1 unit increase 1.17 (1.07, 1.27)

BMI per 5 unit increase 1.26 (1.15, 1.38)

BMI <20 vs. 20-25 0.74 (0.42, 1.31)

BMI <20 vs. 20-25 0.53 (0.28, 1.01)

BMI < 22 vs. 22-24 0.80 (0.70, 0.90)

BMI >30 vs. <30 2.90 (1.60, 5.50)

 Odds Ratio

.5 1 20

BMI category

 Odds Ratio

(95% CI)

BMI per 1 unit increase 1.07 (1.04, 1.10)

BMI per 1 unit increase 1.10 (1.00, 1.10)

BMI 21.6-23.8 vs. <21.6 1.50 (0.80, 2.70)

BMI 20-25 vs. <20 1.08 (0.94, 1.23)

BMI 20-25 vs. <20 1.31 (1.10, 1.55)

BMI 20-25 vs. <20 1.19 (1.00, 1.40)

BMI 22.1-24.8 vs. <22.1 1.12 (0.62, 2.00)

BMI 23.9-27.2 vs. <21.6 1.80 (1.00, 3.20)

BMI 24.8-28.1 vs. <22.1 1.63 (0.91, 2.95)

BMI 25 vs. <19 1.40 (0.90, 2.20)

BMI 25-29 vs. <25 0.90 (0.70, 1.20)

BMI 25<30 vs. <20 1.34 (1.13, 1.60)

BMI 25<30 vs. <20 1.47 (1.23, 1.75)

BMI 25<30 vs. <20 1.39 (1.16, 1.65)

BMI >29 vs. <19 2.00 (1.30, 3.20)

BMI >28.1 vs. <22.1 2.98 (1.78, 5.01)

BMI >28.1 vs. <22.1 2.67 (1.37, 5.20)

BMI >30 vs. <19 2.60 (1.60, 4.30)

BMI > 27.3 vs. <21.6 2.50 (1.40, 4.30)

BMI >29 vs. <25 1.00 0.70, 1.40)

BMI 30-40 vs. <20 2.09 (1.67, 2.61)

BMI 30-40 vs. <20 2.05 (1.70, 2.46)

BMI 30-40 vs. <20 1.82 (1.49, 2.23)

BMI >40 vs. <20 1.82 (1.07, 3.09)

BMI >40 vs. <20 2.49 (1.84, 3.35)

BMI >40 vs. <20 3.29 (2.05, 5.29)
114

Figure 8. Association between severity of prevalent UI and BMI in women 

Figure 9. Association between severity of prevalent stress UI and BMI in women 

Odds ratio

.7 1 7

BMI cagegory 

 Odds ratio (95% CI)

Daily

BMI per 1 unit increase 1.44 (1.26, 1.64)

BMI per 1 unit increase 1.02 (0.96, 1.04)

BMI per 5 unit increase 1.60 (1.40, 1.70)

BMI per 5 unit increase 1.30 (1.10, 1.60)

BMI >28.1 vs. <22.1 1.65 (1.31, 2.10)

UI at least monthly

BMI per 1 unit increase 1.02 (0.97, 1.07)

BMI per 1 unit increase 1.04 (0.97, 1.11)

BMI <20 vs. 20-25 2.39 (0.69, 8.30)

BMI 25-29 vs. <25 1.20 (1.00, 1.50)

BMI 25-29 vs. 22-24 1.30 (1.20, 1.30)

BMI >25 kg/m2 1.87 (1.07, 3.24)

BMI 25-<30 vs. 20-<25 2.24 (1.39, 3.61)

BMI >29 1.70 (1.40, 2.10)

BMI >28.1 vs. <22.1 0.99 (0.78, 1.24)

BMI >30 vs. <25 2.40 (2.00, 2.90)

BMI >30 vs <30 1.80 (1.30, 2.30)

BMI >30 vs. 20-<25 2.16 (1.38, 3.39)

BMI >30 vs. <30 1.60 (1.20, 2.10)

UI at least weekly

BMI < 22 vs. 22-24 0.80 (0.70, 0.80)

BMI 25-29 vs. 22-24 1.40 (1.30, 1.40)

BMI >28.1 vs. <22.1 2.37 (1.48, 3.80)

BMI > 30 vs. 20-25 1.53 (1.00, 2.36)

BMI >30 vs. 22-24 1.80 (1.70, 1.90)

BMI >30 vs. 22-24 2.40 (2.30, 2.60)

BMI >30 vs. <30 3.70 (2.00, 6.70)

 Odds Ratio

 .07 1 14.31

 BMI category Odds Ratio

(95% CI)

Daily

BMI per 5 unit increase 1.20 (1.00, 1.40)

 BMI 25-30 vs. <25 1.40 (1.10, 1.80)

BMI 25-30 vs. <25 1.30 (1.00, 1.70)

BMI 25-30 vs. <25 1.30 (1.00, 1.70)

BMI >30 vs. <25 2.60 (1.90, 3.60)

BMI >30 vs. <25 2.50 (1.80, 3.50)

BMI >30 vs. <25 2.50 (1.80, 3.50)

UI at least monthly

 BMI per 1 unit increase 0.99 (0.95, 1.04)

Underweight vs. acceptable 0.70 (0.20, 2.40)

25-30 vs. <25 1.45 (1.25, 1.68)

Overweight vs. acceptable 1.40 (0.90, 1.90)

Obese vs. acceptable 2.30 (1.60, 3.30)

>30 vs. <25 1.78 (1.40, 2.27)

UI in the last year BMI per 1 unit increase 1.07 (1.04, 1.10)

BMI per 5 unit increase 1.10 (1.00, 1.20)

 UI in the past week

BMI per 1 unit increase 1.33 (1.10, 1.60)

BMI per 5 unit increase 1.13 (1.01, 1.27)

BMI 25 kg/m2 or greater in Asian women 5.10 (1.82, 14.31)

BMI 25 kg/m2 or greater in White women 1.84 (1.21, 2.78)
115 

Table 18. Association between parity and UI in females

Author Incontinence Parity OR (95% CI) 

Brown, 199655 Daily UI Number of live births >2 vs. 1 1.2 (1.0; 1.6) 

Parity 2 1.4 (0.5; 2.1) 

Parity 3 1.5 (0.7; 2.9) 

Thom199759 UI 

Parity 4 1.5 (0.9; 2.7) 

Once vs. never 2.82 (2.37; 3.35) 

Twice vs. never 2.59 (1.86; 3.61) 

Chiarelli, 199968 UI 

Three or more vs. never 4.84 (2.54; 9.20) 

Kuh, 199970 Severe incontinence Number of children 1.2 (0.99, 1.5)( 

Parity 0 1 (1; 1) 

Parity 1 1.3 (0.7; 2.4) 

Parity 2 1.9 (1; 3.3) 

Total UI 

Parity >3 2.2 (1.2; 4) 

Parity 0 1 

Parity 1 3.9 (1.6; 9.5) 

Parity 2 3.9 (1.7; 9) 

Stress UI 

Parity >3 3.7 (1.5; 9.1) 

Parity 0 1 

Parity 1 0.2 (0.2; 3.1) 

Parity 2 0.8 (0.4; 5) 

Urge UI 

Parity >3 1.5 (0.4; 5.3) 

Parity 0 1 

Parity 1 0.2 (0.1; 0.8) 

Parity 2 0.8 (0.3; 1.9) 

Bortolotti, 200072

Mixed 

Parity >3 1.5 (0.6; 3.3) 

Parity 0 1 

Parity 1 1.6 (1.5; 1.8) 

Parity 2 1.8 (1.6; 1.9) 

Parity 3 2 (1.8; 2.2) 

Total UI 

Parity >4 2.3 (2.1; 2.5) 

Parity 0 1 

Parity 1 1.9 (1.6; 2.2) 

Parity 2 2.3 (2.0; 2.6) 

Parity 3 2.4 (2.1; 2.7) 

Stress UI 

Parity >4 2.3 (2.0; 2.7) 

Parity 0 1 

Parity 1 1.2 (0.9; 1.6) 

Parity 2 1 (0.8; 1.3) 

Parity 3 1.1 (0.9; 1.5) 

Urge UI 

Parity >4 1.5 (1.2; 1.9) 

Parity 0 1 

Parity 1 1.5 (1.2; 1.8) 

Parity 2 1.7 (1.4; 1.9) 

Parity 3 2.1 (1.8; 2.5) 

Mixed UI 

Parity >4 2.8 (2.4; 3.3) 

20-34 years old Parity 0 1 

20-34 years old Parity 1 2.2 (1.8; 2.6) 

20-34 years old Parity 2 2.4 (2.0; 2.8) 

20-34 years old Parity 3 2.4 (2.0; 3.0) 

UI 

20-34 years old Parity >4 3.3 (2.4; 4.4) 

20-34 years old Parity 0 1 

20-34 years old Parity 1 2.7 (2.0; 3.5) 

20-34 years old Parity 2 3.4 (2.7; 4.4) 

20-34 years old Parity 3 3.6 (2.7; 4.8) 

Stress 

20-34 years old Parity >4 4 (2.5; 6.4) 

20-34 years old Parity 0 1 

Rortveit 2001195

Urge 

20-34 years old Parity 1 1.7 (1.1; 2.8) 
Table 18. Association between parity and UI in females (continued)

116

Author Incontinence Parity OR (95% CI) 

20-34 years old Parity 2 1 (0.6; 1.7) 

20-34 years old Parity 3 1.2 (0.6; 2.3) 

20-34 years old Parity >4 1 (0.2; 4.1) 

20-34 years old Parity 0 1 

20-34 years old Parity 1 1.9 (1.4; 2.7) 

20-34 years old Parity 2 2.3 (1.7; 3.1) 

20-34 years old Parity 3 1.7 (1.1; 2.6) 

Mixed 

20-34 years old Parity >4 4 (2.3; 7.0) 

35-44 years old Parity 0 1 

35-44 years old Parity 1 1.4 (1.1; 1.9) 

35-44 years old Parity 2 1.5 (1.2; 1.9) 

35-44 years old Parity 3 1.6 (1.3; 2.1) 

UI 

35-44 years old Parity >4 1.6 (1.2; 2.2) 

35-44 years old Parity 0 1 

35-44 years old Parity 1 1.9 (1.2; 2.9) 

35-44 years old Parity 2 2.2 (1.5; 3.2) 

35-44 years old Parity3 2.4 (1.6; 3.6) 

Stress 

35-44 years old Parity >4 2.1 (1.4; 3.2) 

35-44 years old Parity 0 1 

35-44 years old Parity 1 1.3 (0.5; 3.5) 

35-44 years old Parity 2 1.1 (0.5; 2.5) 

35-44 years old Parity 3 1.1 (0.5; 2.6) 

Urge 

35-44 years old Parity >4 1.8 (0.7; 4.6) 

35-44 years old Parity 0 1 

35-44 years old Parity 1 1 (0.6; 1.7) 

35-44 years old Parity 2 1 (0.6; 1.5) 

35-44 years old Parity 3 1.1 (0.7; 1.7) 

Mixed 

35-44 years old Parity >4 1.2 (0.8; 2.0) 

45-54 years old Parity 0 1 

45-54 years old Parity 1 1.7 (1.3; 2.2) 

45-54 years old Parity 2 1.6 (1.3; 2.1) 

45-54 years old Parity 3 1.7 (1.3; 2.2) 

UI 

45-54 years old Parity >4 2 (1.5; 2.6) 

45-54 years old Parity 0 1 

45-54 years old Parity 1 1.5 (1.0; 2.2) 

45-54 years old Parity 2 1.7 (1.2; 2.3) 

45-54 years old Parity 3 1.5 (1.1; 2.1) 

Stress 

45-54 years old Parity >4 2 (1.4; 2.8) 

45-54 years old Parity 0 1 

45-54 years old Parity 1 1.5 (0.6; 3.8) 

45-54 years old Parity 2 1.1 (0.5; 2.5) 

45-54 years old Parity 3 1.1 (0.5; 2.5) 

Urge 

45-54 years old Parity >4 0.8 (0.3; 2.2) 

45-54 years old Parity 0 1 

45-54 years old Parity 1 2 (1.1; 3.5) 

45-54 years old Parity 2 1.5 0.9; 2.6) 

45-54 years old Parity 3 2.3 (1.4; 3.8) 

Mixed 

45-54 years old Parity >4 2.4 (1.4; 4.1) 

55-64 years old Parity 0 1 

55-64 years old Parity 1 1.9 (1.4; 2.7) 

55-64 years old Parity 2 1.6 (1.2; 2.1) 

55-64 years old Parity 3 1.8 (1.3; 2.4) 

UI 

55-64 years old Parity >4 1.9 (1.4; 2.6) 

55-64 years old Parity0 1 

55-64 years old Parity 1 1.9 (1.2; 3.1) 

55-64 years old Parity 2 1.2 (0.8; 1.9) 

55-64 years old Parity 3 1.5 (1.0; 2.2) 

Stress 

55-64 years old Parity >4 1.3 (0.9; 2.0) 

Urge 55-64 years old Parity 0 1 
Table 18. Association between parity and UI in females (continued)

117

Author Incontinence Parity OR (95% CI) 

55-64 years old Parity 1 0.7 (0.2; 2.5) 

55-64 years old Parity 2 1.1 (0.4; 2.6) 

55-64 years old Parity 3 1.2 (0.5; 2.8) 

55-64 years old Parity >4 1.2 (0.5; 2.7) 

55-64 years old Parity 0 1 

55-64 years old Parity 1 2.8 (1.3; 6.2) 

55-64 years old Parity 2 3.1 (1.5; 6.3) 

55-64 years old Parity 3 3.4 (1.7; 6.8) 

Mixed 

55-64 years old Parity >4 4.6 (2.3; 9.2) 

65-74 years old Parity 0 1 

65-74 years old Parity 1 0.9 (0.7; 1.2) 

65-74 years old Parity 2 0.9 (0.8; 1.2) 

65-74 years old Parity 3 1.1 (0.9; 1.3) 

UI 

65-74 years old Parity >4 1.1 (0.9; 1.3) 

65-74 years old Parity 0 1 

65-74 years old Parity 1 0.8 (0.5; 1.3) 

65-74 years old Parity 2 0.8 (0.6; 1.2) 

65-74 years old Parity 3 0.8 (0.6; 1.2) 

Stress 

65-74 years old Parity >4 1.1 (0.8; 1.5) 

65-74 years old Parity 0 1 

65-74 years old Parity 1 0.8 (0.4; 1.7) 

65-74 years old Parity 2 1.3 (0.7; 2.2) 

65-74 years old Parity 3 1.1 (0.6; 2.0) 

Urge 

65-74 years old Parity >4 1 (0.5; 1.7) 

65-74 years old Parity 0 1 

65-74 years old Parity 1 1 (0.7; 1.5) 

65-74 years old Parity 2 1 (0.7; 1.4) 

65-74 years old Parity 3 1.3 (0.9; 1.8) 

Mixed 

65-74 years old Parity >4 1.2 (0.9; 1.6) 

>75 years old Parity 0 1 

>75 years old Parity 1 0.9 (0.7; 1.1) 

>75 years old Parity 2 1.1 (0.9; 1.3) 

>75 years old Parity 3 1.1 (0.9; 1.3) 

UI 

>75 years old Parity >4 1.2 (1.0; 1.4) 

>75 years old Parity 0 1 

>75 years old Parity 1 0.8 (0.5; 1.4) 

>75 years old Parity 2 1.1 (0.8; 1.6) 

>75 years old Parity 3 1.1 (0.8; 1.6) 

Stress 

>75 years old Parity >4 1 (0.7; 1.5) 

>75 years old Parity 0 1 

>75 years old Parity 1 1.1 (0.6; 1.8) 

>75 years old Parity 2 0.8 (0.5; 1.2) 

>75 years old Parity 3 0.8 (0.5; 1.3) 

Urge 

>75 years old Parity >4 0.9 (0.6; 1.5) 

>75 years old Parity 0 1 

>75 years old Parity 1 0.8 (0.5; 1.3) 

>75 years old Parity 2 1.2 (0.9; 1.7) 

>75 years old Parity 3 1.3 (0.9; 1.8) 

Mixed 

>75 years old Parity >4 1.5 (1.1; 2.0) 

Parity 0 1 

Parity 1 1.36 (1.0; 1.83) 

Schmidbauer200183 UI 

Parity 2 1.38 (1.05; 1.82) 

Sampselle, 200293 UI Parous 1.62 (1.31; 2.01) 

UI Number of children vs.0 1 

 Number of children 1 vs.0 2.24 (0.95; 5.27) 

 Number of children 2 vs.0 1.8 (0.75; 4.32) 

 Number of children 3 vs.0 1.12 (0.36; 3.45) 

Van Oyen, 200292

 Number of children 4 vs.0 1.99 (0.64; 6.12) 
Table 18. Association between parity and UI in females (continued)

118

Author Incontinence Parity OR (95% CI) 

Parity 0 1 

Parity 1 1.14 (1.02; 1.28) 

Parity 2 1.26 (1.14; 1.38) 

Parity 3 1.31 (1.19; 1.44) 

Parity 4 1.39 (1.26; 1.53) 

Occasional leaking 

urine 

Parity 5+ 1.43 (1.29; 1.58) 

Parity 0 1 (1) 

Parity 1 1.14 (0.99; 1.32) 

Parity 2 1.23 (1.09; 1.39) 

Parity 3 1.33 (1.18; 1.50) 

Parity 4 1.44 (1.27; 1.64) 

At least enough to wet 

underwear 

Parity 5+ 1.56 (1.38; 1.78) 

Parity 0 1 (1) 

Parity 1 1.22 (1.08; 1.36) 

Parity 2 1.37 (1.25; 1.51) 

Parity 3 1.47 (1.33; 1.61) 

Parity 4 1.58 (1.43; 1.74) 

Frequent leaking urine 

Parity 5+ 1.72 (1.55; 1.90) 

Parity 0 1 (1) 

Parity 1 1.3 (1.13; 1.48) 

Parity 2 1.41 (1.26; 1.58) 

Parity 3 1.54 (1.37; 1.72) 

Parity 4 1.62 (1.44; 1.82) 

Grodstein2003105

At least enough to wet 

underwear 

Parity 5+ 1.83 (1.62; 2.05) 

Hvidman, 2003 Vaginal childbirths >1 3.1 (1.7; 5.8) 96 UI 

OR per vaginal birth 1.53 (1.23; 1.90) 

Uustal Fornell, 2004185 UI Children 2 (vs. 1-2) 1.8 (1.2; 3.0) 

Melville, 2005124 Any UI Number of deliveries 1.2 (1.1; 1.2) 

Nulliparity (yes) 0.72 (0.58; 0.90) 

Nulliparity (yes) 0.81 (0.61; 1.10) 

Moghaddas, 2005191 Any UI 

Nulliparity (yes) 0.6 (0.42; 0.87) 

No. of deliveries 0 1 

1 or 2 1.07 (0.90; 1.28) 

Any UI 

3+ 1.2 (1.00; 1.44) 

No. of deliveries 0 1 

1 or 2 1.13 (0.93; 1.37) 

Stress 

3+ 1.27 (1.04; 1.55) 

No. of deliveries 0 1 

1 or 2 1.02 (0.83; 1.25) 

Rohr, 2005133

Urge 

3+ 1.04 (0.84; 1.28) 

1 birth 1.4 (1.3; 1.5) 

2 births 1.6 (1.5; 1.7) 

Danforth, 2006138 UI 

≥3 births 1.6 (1.5; 1.7) 

Prevalent incontinence Nulliparous Referent 

Any (at least monthly) Parous 1.43 (1.00; 2.03) 

Prevalent incontinence Nulliparous Referent 

Frequent 

(>weekly/daily) 

Parous 1.7 (1.05; 2.73) 

Incident incontinence Nulliparous Referent 

Any (at least monthly) Parous 1.31 (0.88; 1.96) 

Incident incontinence Nulliparous Referent 

Frequent 

(>weekly/daily) 

Parous 2.57 (0.58; 11.48) 

Prevalent stress Nulliparous Referent 

Parous 1.91 (1.31; 2.79) 

Prevalent mixed Nulliparous Referent 

Parous 2.16 (1.26; 3.71) 

Nulliparous Referent 

Waetjen, 2007149

Incident stress 

Parous 1.44 (0.87; 2.40) 
Table 18. Association between parity and UI in females (continued)

119

Author Incontinence Parity OR (95% CI) 

Incident urge Nulliparous Referent 

Parous 0.92 (0.51; 1.68) 

Foldspang, 199964 UI Number of vaginal deliveries 1.2 (1; 1.3) 

Chen, 200395 Stress UI Parities >2 2 (1.1; 3.8) 

0 1 

1 1.6 (1.5; 1.8) 

2 1.8 (1.6; 1.9) 

3 2 (1.8; 2.2) 

UI 

>4 2.3 (2.1; 2.5) 

0 1 

1 1.9 (1.6; 2.2) 

2 2.3 (2.0; 2.6) 

3 2.4 (2.1; 2.7) 

Stress 

>4 2.3 (2.0; 2.7) 

0 1 

1 1.2 (0.9; 1.6) 

2 1 (0.8; 1.3) 

3 1.1 (0.9; 1.5) 

Urge 

>4 1.5 (1.2; 1.9) 

0 1 

1 1.5 (1.2; 1.8) 

2 1.7 (1.4; 1.9) 

3 2.1 (1.8; 2.5) 

Mixed 

>4 2.8 (2.4; 3.3) 

20–34 years 0 1 

20–34 years 1 2.4 (1.9; 2.9) 

20–34 years ≥2 2.8 (2.3; 3.3) 

35–64 years 0 1 

35–64 years 1 1.8 (1.5; 2.2) 

35–64 years ≥2 2 (1.6; 2.3) 

>65 years 0 1 

>65 years 1 0.8 (0.7; 1.1) 

Rortveit, 2001195

UI 

>65 years ≥2 1.1 (0.9; 1.3) 

0 0.5 (0.3; 0.8) 

1 1 

2 1.2 (1.0; 1.6) 

Fritel, 2005135 Severe stress UI 

3+ 1.2 (0.8; 1.7) 

0 (baseline) 

1 2.4 (1.2; 4.3) 

2 1.7 (0.8; 1.9) 

Stress 

3–4 1.9 (0.8; 3.1) 

0 (baseline) 1 

1 2.5 (0.4; 6.2) 

2 3.1 (0.5; 9.7) 

Altman, 2006196

Urge 

3–4 2.2 (0.7; 9.2) 

Burgio, 1996194 UI Number of births 1.218 (0.970, 1.529) 

3 months after delivery, parity 2 1.3 (1; 1.8) 

3 months after delivery, parity 3 1.4 (1; 2) 

3 months after delivery, parity 4 1.1 (0.6; 2) 

3 months after delivery, parity 5+ 2.2 (1; 4.9) 

3 months after delivery, parity 2, 

continent before pregnancy 

1.5 (1; 2.4) 

3 months after delivery, parity 3, 

continent before pregnancy 

1 (0.6; 1.9) 

3 months after delivery, parity 4, 

continent before pregnancy 

1 (0.4; 2.9) 

Wilson, 1996193 UI 

3 months after delivery, parity 

5+, continent before pregnancy 

0.9 (0.1; 8.2) 
120

Figure 10. Odds ratios of UI in females with different numbers of births 

 Odds ratio of UI

 .9 1 9 

Author Odds ratio of UI

(95% CI) Parity==2 Thom 1.40 (0.50, 2.10) Chiarelli 2.59 (1.86, 3.61) Bortolotti 1.90 (1.00, 3.30) Rortveit 1.80 (1.60, 1.90) Schmidbauer 1.38 (1.05, 1.82) Van Oyen 1.80 (0.75, 4.32) Grodstein 1.26 (1.14, 1.38) Hvidman 3.10 (1.70, 5.80) Rohr 1.07 (0.90, 1.28) Danforth 1.60 (1.50, 1.70) Waetjen 1.43 (1.00, 2.03) Wilson 1.30 (1.00, 1.80) Schytt 1.40 (1.10, 1.80) Subtotal 1.53 (1.34, 1.74)

Parity==3

 Thom 1.50 (0.70, 2.90) Chiarelli 4.84 (2.54, 9.20) Rortveit 2.00 (1.80, 2.20) Sampselle 1.62 (1.31, 2.01) Van Oyen 1.12 (0.36, 3.45) Grodstein 1.31 (1.19, 1.44) Fornell 1.80 (1.20, 3.00) Wilson 1.40 (1.00, 2.00) Subtotal 1.72 (1.37, 2.16)

Parity==4

 Thom 1.50 (0.90, 2.70) Bortolotti 2.20 (1.20, 4.00) Grodstein 1.39 (1.26, 1.53) Rohr 1.20 (1.00, 1.44) Danforth 1.60 (1.50, 1.70) Wilson 1.10 (0.60, 2.00) Subtotal 1.43 (1.25, 1.63)

Parity==5

 Rortveit 2.30 (2.10, 2.50)

Parity==6

 Grodstein 1.43 (1.29, 1.58) Wilson 2.20 (1.00, 4.90)

 Subtotal 1.47 (1.20, 1.81)
121

Figure 11 . Odds ratios of stress UI in females with different numbers of births 

 .9 1 9

Author

 Odds ratio of UI 

 (95% CI)

Parity==2 

Bortolotti 3.90 (1.70, 9.00) 

Rortveit 2.30 (2.00, 2.60) 

Rohr 1.13 (0.90, 1.37) 

Waetjen 1.91 (1.30, 2.79) 

Altman 1.70 (0.80, 1.90) 

Parity==3 

Rortveit 2.40 (2.10, 2.70) 

Chen 2.00 (1.10, 3.80) 

Parity==4 

Bortolotti 3.70 (1.50, 9.10) 

Rohr 1.27 (1.00, 1.55) 

Altman 1.90 (0.80, 3.10) 

Parity==5 

Rortveit 2.30 (2.00, 2.70) 

 Odds ratio of UI
122 

Table 19. Odds ratio of UI according to delivery 

Author Urinary 

Incontinence Delivery Odds Ratio 

(95% CI) 

Cesarean 

Rortveit, 2003 Any UI Cesarean vs. nulliparous 1.5 (1.2; 1.9) 206

Moderate/severe UI Cesarean vs. nulliparous 1.4 (1.0; 2.1) 

MacLennan, 2000 Cesarean only vs. nulliparous 2.5 (1.5; 4.3) 7 Mixed 

Both vaginal and Cesarean vs. nulliparous 4.7 (2.3; 9.3) 

Fritel, 2005135 Severe stress UI Caesarean vs. vaginal 0.8 (0.5; 1.3) 

Chaliha, 1999 Stress Cesarean vs. vaginal 1 (0.8; 1.2) 205

Urge Cesarean vs. vaginal 0.5 (0.2; 1.1) 

Hojberg, 1999204 UI Caesarean at 1 pregnancy vs. nulliparous 1.3 (0.4; 4.3) 

UI 6 weeks after labored Cesarean vs. elective 

Cesarean 

2.3 (0.3; 17.6) 

 6 weeks after Cesarean in second stage vs. 

elective Cesarean 

1.2 (0.1; 12.2) 

 6 weeks after Cesarean in labor vs. vaginal 0.4 (0.2; 0.8) 

 Labored Cesarean vs. elective Cesarean 2.5 (0.3; 18.5) 

 Cesarean in second stage vs. elective Cesarean 0.6 (0.04; 9.1) 

Farrel, 2001199

 Cesarean in labor vs. vaginal 0.6 (0.3; 1.0) 

UI 8 weeks after Cesarean vs. vaginal 0.25 (0.14; 0.44) 

 16 weeks after Cesarean vs. vaginal 0.59 (0.35; 0.99) 

Thompson, 2002200 

 24 weeks after Cesarean vs. vaginal 0.55 (0.31; 0.98) 

Hvidman, 2003201 UI Cesarean vs. vaginal 0.2 (0.06; 0.9) 

Schytt, 2004119 UI Cesarean vs. vaginal 0.5 (0.3; 0.9) 

Casey, 2005202 UI Cesarean vs. vaginal 0.5 (0.3; 0.8) 

Glazener, 2006197 UI Caesarean vs. vaginal 0.28 (0.19; 0.41) 

Lukacz, 2006141 UI Cesarean vs. nulliparous 1.3 (0.82; 1.9) 

Burgio, 2007203 UI Cesarean vs. vaginal 0.5 (0.3; 0.9) 

Altman, 2006 Stress Episiotomy vs. noninstrumental 0.9 (0.3; 2.6) 196

Urge Episiotomy vs. noninstrumental 1.7 (0.5; 4.1) 

Forceps 

Any UI Forceps vs. no forceps 0.9 (0.7; 1.1) 

Mixed Forceps vs. no forceps 1 (0.7; 1.3) 

Moderate severe UI Forceps vs. no forceps 0.9 (0.7; 1.2) 

Stress UI Forceps vs. no forceps 0.9 (0.7; 1.1) 

Rortveit, 2003206

Urge Forceps vs. no forceps 0.8 (0.4; 1.5) 

MacLennan, 20007 Mixed At least one forceps vs. nulliparous 4.3 (2.8; 6.6) 

Fritel, 2005135 Severe stress UI Forceps vs. vaginal 0.8 (0.6; 1.1) 

6 weeks after forceps 1.3 (0.6; 2.5) 

6 weeks after forceps vs. vaginal 1.5 (1.1; 2.2) 

6 weeks after forceps vs. Cesarean 4.3 (2.2; 8.2) 

6 months after forceps vs. vaginal 1.5 (1.0; 2.3) 

Farrel, 2001199 UI 

Forceps vs. Cesarean 3.1 (1.7; 5.9) 

Burgio, 2003198 UI Forceps vs. vaginal 1.87 (1.1; 3.22) 

Casey, 2005202 UI Forceps vs. vaginal 1.5 (0.8; 2.6) 

Glazener, 2006197 UI Forceps/breech vs. vaginal 1.18 (0.92; 1.51) 

Vacuum Delivery 

Mixed Vacuum vs. no vacuum 0.8 (0.5; 1.1) 

Moderate severe UI Vacuum vs. no vacuum 0.8 (0.6; 1.1) 

Stress UI Vacuum vs. no vacuum 0.8 (0.6; 1.0) 

Any UI Vacuum vs. no vacuum 0.8 (0.7; 1.0) 

Rortveit, 2003206

Urge Vacuum vs. no vacuum 1.2 (0.7; 2.2) 

Altman, 2006 Stress Vacuum extraction vs. noninstrumental 1.8 (0.3; 2.7) 196

Urge Vacuum extraction vs. noninstrumental 1.5 (0.4; 5.5) 

Hvidman, 2003201 UI Vacuum extraction or forceps vs. vaginal 0.2 (0.03; 0.8) 

Glazener, 2006197 UI Vacuum vs. vaginal 1.16 (0.83; 1.63) 
Table 19. Odds ratio of UI according to delivery (continued) 

123

Author Urinary 

Incontinence Delivery Odds Ratio 

(95% CI) 

Schytt, 2004119 UI Vacuum extraction or forceps vs. vaginal 1.1 (0.7; 1.8) 

Vaginal Delivery 

MacLennan, 20007 Mixed Vaginal only vs. nulliparous 3.4 (2.4; 4.9) 

Rortveit, 2003 Moderate/severe UI Vaginal vs. nulliparous 2.6 (2.1; 3.1) 206

Any UI Vaginal vs. nulliparous 2.3 (2.0; 2.6) 

Chen, 200395 Stress UI Vaginal 1.3 (0.9; 2.1) 

UI First, vaginal vs. nulliparous 5.7 (3.9; 8.3) 

 Parity >3; only vaginal vs. nulliparous 4.8 (3.0; 7.9) 

Hojberg, 1999204 

 Parity 3; only vaginal vs. nulliparous 7.7 (3.9; 15.3) 

Farrel, 2001 UI 6 weeks after vaginal vs. Cesarean 2.8 (1.5; 5.3) 199 

 6 months after vaginal vs. Cesarean 2.1 (1.1; 3.7) 

Burgio, 2003198 UI 12 months after vaginal vs. baseline 2.36 (1.36; 4.1) 

UI Vaginal parous vs. nulliparous 2.3 (1.7; 3.0) 

 Vaginal parous vs. Cesarean 1.8 (1.3; 2.6) 

 Vaginal parous vs. unlabored Cesarean 3.9 (1.5; 9.2) 

Lukacz, 2006141 

 Vaginal parous vs. labored Cesarean 1.6 (1.0; 2.6) 

Borcello-France, 

2006231

UI Vaginal vs. Cesarean 1.3 (0.8; 2.3) 

Bold - significant association at 95% confidence level 
124 

Figure 12. Odds ratio of UI after vaginal delivery compared to Cesarean section 

Figure 13. Odds ratio of UI after forceps delivery compared to vaginal or no forceps 

 Odds ratio 

 Favors Vaginal Favors Cesarean

 1 9

 Author Odds ratio 

 (95% CI) Severe stress UI 

 Fritel 1.25 (0.77, 2.00) 

 Stress 

 Chaliha 1.00 (0.83, 1.25) 

 UI 

 Farrel 2.10 (1.10, 3.70) 

 Lukacz 1.80 (1.30, 2.60) 

 Borcello-France 1.30 (0.80, 2.30) 

 Farrel 1.67 (1.00, 3.33) 

 Thompson 1.82 (1.02, 3.23) 

 Hvidman 5.00 (1.11, 16.67) 

 Schytt 2.00 (1.11, 3.33) 

 Casey 2.00 (1.25, 3.33) 

 Glazener 3.57 (2.44, 5.26) 

 Burgio 2.00 (1.11, 3.33) 

 Urge 

 Chaliha 2.00 (0.91, 5.00) 

 Odds ratio

 Favors forceps Favors vaginal

 0.3 1 3.2

 Author Odds ratio

 (95% CI) Mixed 

 Rortveit 1.00 (0.70, 1.30) 

 Moderate severe UI 

 Rortveit 0.90 (0.70, 1.20) 

 Severe stress UI 

 Fritel 0.80 (0.60, 1.10) 

 Stress UI 

 Rortveit 0.90 (0.70, 1.10) 

 UI 

 Rortveit 0.90 (0.70, 1.10) 

 Farrel 1.50 (1.00, 2.30) 

 Burgio 1.87 (1.10, 3.22) 

 Casey 1.50 (0.80, 2.60) 

 Glazener 1.18 (0.92, 1.51) 

 Urge 

 Rortveit 0.80 (0.40, 1.50) 
125 

Figure 14. Association between arthritis and UI in women 

Figure 15. Association between prevalent stress UI and diabetes in females 

Odds Ratio

.9 1 3

Author (sample)

Odds Ratio

(95% CI)

Incident UI

Jackson (1,584) 1.70 (1.10, 2.60)

Prevalent Stress UI

Jackson (1,584) 1.55 (1.00, 2.39)

Prevalent UI

Maclennan (3,010) 1.80 (1.30, 2.50)

Finkelstein (29,520) 1.87 (1.38, 2.54)

Prevalent Urge UI

Jackson (1,584) 1.71 (1.12, 2.60)

Odds Ratio

.13 1 7.60

Author (sample)

Odds Ratio

(95% CI)

Brown (2,763) 0.82 (0.58, 1.14)

Chen (1,247) 3.30 (1.40, 7.60)

Parazzini (2,205) 0.90 (0.60, 1.50)

Rohr (5,795) 1.67 (1.29, 2.16)

Fritel (2,625) 1.60 (0.90, 2.80)

Waetjen (3,302) 2.11 (1.09, 4.09)

Overall 1.43 (0.98, 2.09)
126

Figure 16. Association between prevalent UI and diabetes in women 

Figure 17. Association between prevalent urge UI and diabetes in women 

.9 1 9

Author (sample)

Odds Ratio

 (95% CI)

Brown (2,763) 1.32 (1.04, 1.67)

Parazzini (2205) 1.20 (0.80, 1.60)

Brown (7949) 1.70 (1.20, 2.40)

Bortolotti (2,767) 1.80 (0.80, 4.10)

Ozerdogan (625) 3.60 (1.40, 8.70)

Melville (3,596) 1.80 (1.20, 2.90)

Ostbye (5,322) 1.06 (0.78, 1.43)

Kocak (1,012) 1.20 (0.49, 2.95)

Jackson (1,017) 1.50 (0.80, 2.50)

Rohr (5,795) 1.46 (1.13, 1.89)

Lifford (81,845) 1.30 (1.20, 1.40)

Danforth (83,355) 1.10 (1.00, 1.20)

Waetjen (3,302) 2.34 (1.21, 4.55)

Finkelstein (29,520) 1.97 (1.27, 3.05)

Sampselle (3,302) 1.53 (1.12, 2.10)

Landi (3,194) 1.27 (1.02, 1.58)

Overall 1.37 (1.24, 1.52)

Odds Ratio

Odds Ratio

.9 1 9

Author (sample)

Odds Ratio

(95% CI)

Brown (2,763) 1.49 (1.11, 2.00)

Parazzini (2,205) 1.30 (0.80, 2.00)

Jackson (1,584) 3.50 (1.55, 7.91)

Rohr (5,795) 1.37 (1.03, 1.83)

Waetjen (3,302) 3.62 (1.45, 9.01)

Overall 1.66 (1.23, 2.23)
127 

Figure 18. Association between stroke and prevalent UI in women 

Effect size

 .5 1 5

Author (sample)

Effect size

(95% CI)

Brown (7,949) 1.90 (1.30, 2.70)

Fultz (3,991) 1.54 (0.73, 3.25)

Finkelstein (29,520) 2.73 (1.60, 4.66)

Landi (3,194) 1.31 (1.06, 1.61)

Ostbye (5,322) 1.61 (1.07, 2.43)

Rohr (5,795) 1.74 (1.14, 2.64)

Overall 1.67 (1.36, 2.06)
128 

Table 20. Association between age, race, and behavioral risk factors with male UI 

Author Sample Level of Risk Factors Relative Measure of the 

Association (95% CI) 

Age (total) 

Maggi, 200181 867 Age >70 years 2.49 (1.45; 4.28)

Landi, 2003 2,178 75–84 vs. 65-74 0.97 (0.66; 1.44) 97

2,178 >85 vs. 65-74 1.99 (1.39; 2.84)

Hu, 2003 12,079 Age 70–74 vs. 65–69 0.97 (0.84; 1.12) 175

12,079 Age >74 vs. 65–69 0.99 (0.83; 1.17) 

Nakanishi, 199758 1,405 Age >75 4.99 (2.63; 9.44)

Nelson, 20054

 2,559 Age (per year) 1.03 (1.02; 1.04) 

Burkhard, 2006183 536 Age 0.96 (0.90; 1.02) 

Age (stress) 

1,000 Age 45-54 vs. 35-44 1.40 (0.14; 13.98) 

1,000 Age 55-64 vs. 35-44 4.54 (0.60; 39.61) 

Maral, 2001645

1,000 Age >65 vs. 35-44 6.03 (0.80; 52.90) 

Age (urge) 

Ueda, 2000 968 Age 60-69 2.16 (0.90; 5.17) 74

968 Age 70-79 5.34 (2.26; 12.62)

Nuotio, 2002578 171 Age (Per year) 1.01 (0.95; 1.08) 

Race (total) 

Hu, 2003175 12,079 Nonwhite vs. white 0.88 (0.72; 1.07) 

Coffee (total) 

748 Coffee cups/day 1 vs. 0 0.30 (0.10; 1.00) 

683 Coffee cups/day 2 vs. 0 0.30 (0.10; 0.70)

Bortolotti, 200072

1,198 Coffee cups/day 3+ vs. 0 0.70 (0.20; 2.00) 

Education (total)

Bortolotti, 200072 748 Education secondary vs. 

primary education 

0.90 (0.40; 1.80) 

Schmidbauer, 200183 1,236 Secondary or higher 

education vs. primary 

1.57* (0.92; 2.68) 

Van Oyen, 200292 3,462 Higher education vs. 

primary 

0.76 (0.42; 1.35) 

Physical activity (total) 

Schmidbauer, 200183 1,236 Physical activity 1+/week 

vs. none 

0.49* (0.25; 0.96)

3,462 <4hours/week of physical 

activity vs. training 

Van Oyen, 2002 1.85 (0.76; 4.46) 92

3,462 Sedentary life vs. training 2.70 (1.12; 6.48)

Marital status (total) 

Muscatello, 2001 232 Single vs. married 1.90 (0.90; 4.20) 84

232 Never married vs. 

married 

1.50 (0.70; 3.60) 

Bold - adjusted odds ratios; * relative risk; underlined - significant association at 95% confidence level 
129

Figure 19. Association between alcohol intake and male UI 

Figure 20. Association between smoking and male UI 

 Odds ratio

 .4 1 4

Alcohol intake (sample) 

Odds ratio

(95% CI)

Adjusted 

1-6 beverages/day vs. 0 (1,236) 1.82 (0.94, 3.53) 

Drinks/week 1-7 vs. 0 (683) 0.70 (0.20, 2.30) 

Drinks/week 15-21 vs. 0 (748) 0.30 (0.10, 0.90) 

Drinks/week 22+ vs. 0 (683) 0.50 (0.20, 1.30) 

Drinks/week 8-14 vs. 0 (1,128) 0.80 (0.30, 2.30) 

Current regular drinker (232) 1.00 (0.40, 3.00) 

Daily alcohol vs. never (1,236) 0.63 (0.19, 2.11) 

Occasional alcohol drinker vs. non drinker (232) 0.90 (0.40, 2.40) 

Crude 

1-7 glasses/week vs. 0 (3,462) 1.01 (0.61, 1.67) 

15-22 glasses/week vs. 0 (3,462) 0.52 (0.18, 1.48) 

8 -14 glasses/week vs. 0 (3,462) 0.47 (0.20, 1.07) 

>22 glasses/week vs. 0 (3,462) 0.58 (0.22, 1.51) 

Odds ratio

 .109999 1 9.09090

 Smoking (sample)

 Odds ratio

 (95% CI)

 Adjusted

 Current smokers vs. Nonsmokers (748) 1.50 (0.60, 4.00)

 Ex smokers vs. nonsmokers (683) 1.60 (0.70, 3.50)

 Cigarettes/day 5-10 vs. 0 (748) 1.00 (0.70, 1.70)

 Cigarettes/day 10-20 vs. 0 (683) 1.10 (0.40, 3.00)

 Cigarettes/day 20+ vs. 0 (1,198) 2.20 (0.90, 5.20)

 Ex smoker vs. Nonsmoker (1,236) 1.07 (0.56, 2.06)

 Current smoker vs. Nonsmoker (1,236) 0.59 (0.27, 1.31)

 1-20 cigarettes/day vs. 0 (1,236) 0.36 (0.11, 1.16)

 >21 cigarettes/day vs. 0 (1,236) 0.77 (0.24, 2.51)

 Crude

 Past smoker vs. never smoker (3,462) 1.39 (0.79, 2.44)

 <20cigarettes/day vs. 0 (3,462) 0.96 (0.46, 2.00)

 >20 cigarettes/day vs. 0 (3,462) 1.12 (0.43, 2.96)
130 

Figure 21. Association between BMI and male UI 

Figure 22. Association between diabetes and male UI (random effects model) 

Odds ratio

.204081 1 4.90000

Author (sample)

Odds ratio

(95% CI)

Bortolotti (683) 1.60 ( 0.50, 4.90)

Finkelstein (25400) 0.94 ( 0.53, 1.67)

Landi (2178) 1.37 ( 1.05, 1.78)

 Nakanishi (1405) 1.75 ( 0.73, 4.20)

Koskimäki (2198) 2.00 ( 1.40, 3.10)

Overall 1.47 ( 1.15, 1.89)

 Odds ratio

0 .1 1 9.0

 BMI categories (sample) 

Odds ratio

 (95% CI)

 Adjusted 

 BMI 23.3-25.8 vs. < 23.3 (1,198) 1.20 (0.50, 2.90) 

 BMI 25.9-28.3 vs. < 23.3 (748) 0.90 (0.30, 2.40) 

 BMI 28.4 +vs. < 23.3 (683) 0.50 (0.20, 1.30) 

 BMI23.5-25.8 vs. <23.3 (1,236) 1.15 (0.57, 2.33) 

 BMI25.9-28.3 vs. <23.3 (1,236) 1.12 (0.53, 2.38) 

 BMI28.4 vs. <23.5 (1,236) 0.91 (0.38, 2.17) 

 BMI<20 vs. 20-25 (3,462) 1.70 (0.61, 4.75) 

 BMI 25-30 vs. <21 (3,462) 1.45 (0.83, 2.52) 

 BMI >30 vs. <22 (3,462) 2.04 (1.00, 4.14) 

 Overweight (232) 1.40 (0.70, 2.60) 

 Obese (232) 3.20 (1.20, 9.00) 

 Crude 

 BMI<20 vs. 20-25 (3,462) 2.75 (1.10, 6.91) 

 BMI 25-30 vs. <21 (3,462) 1.47 (0.88, 2.46) 

 BMI >30 vs. <22 (3,462) 2.27 (1.20, 4.29) 

 Overweight (248) 2.90 (1.20, 6.70) 
131 

Table 21. Association between risk factors and male UI 

Author Sample Risk Factor Relative Measure of 

Association (95% CI) 

Muscatello, 200184 232 Self reported poor health 4.70 (1.90; 11.40)

Maggi, 200181 867 Self-rated health 1.69 (1.00; 2.88) 

Nakanishi, 199758 1,405 Poor general health 3.18 (1.72; 5.89)

Schmidbauer, 2001 Systolic blood pressure >146 vs. <145 0.81 (0.44; 1.49) 83 1,236 

Diastolic blood pressure >90 vs. <90 1.23 (0.67; 2.27) 

Finkelstein, 2002 Hypertension 1.88 (0.81; 4.36) 86 25,400 

Heart problems 1.01 (0.58; 1.76) 

Landi, 2003 Heart failure 1.06 (0.79; 1.41) 97 2,178 

Atrial fibrillation 1.11 (0.82; 1.52) 

Ueda, 200074 968 Angina 2.76 

Koskimaki, 2001 Hypertension 1.2* (0.90; 1.60) 176 2,198 

Heart disease 1.2* (0.90; 1.70) 

Comorbidity 1.67 (0.80; 3.49) 

Comorbidities 3.85 (1.98; 7.51) 

Comorbidity 1.33 (0.60; 2.94) 

Van Oyen, 200292 3,462 

Comorbidities 2.65 (1.28; 5.52)

Constipation 0.76 (0.35; 1.70) 

Diarrhea 6.92 (2.22; 21.50)

Maggi, 2001 867 

Comorbidity 1.52 (0.89; 2.61) 

Finkelstein, 200286 25,400 Back problems 2.10 (1.50; 2.93)

Landi, 2003 Hip fracture 1.06 (0.74; 1.51) 97 2,178 

Constipation 1.10 (0.86; 1.41) 

Ueda, 200074 968 Constipation 0.762* (0.35; 1.66) 

Nuotio, 2003106 171 Comorbidity 1.40 (0.66; 2.93) 

Edema in legs 1.32 (1.11; 1.58)

Diarrhea 0.66 (0.50; 0.88)

Dizziness 1.26 (1.07; 1.50)

Stenzelius, 2004114 1,642 

Fatigue 1.21 (1.02; 1.44)

Lower back pain 1.6* (1.00; 2.30) 

Constipation 1.3* (0.80; 2.20) 

Koskimaki, 2001176 2,198 

Inguinal hernia 1.9* (0.90; 4.00) 

Landi, 2003 CPS score 2-4 vs. 0-1 2.04 (1.61; 2.58) 97 2,178 

CPS score >5 vs. 0-1 5.37 (3.90; 7.38)

Nuotio, 2003106 171 Fecal incontinence 3.50 (0.24; 50.37) 

Koskimaki, 2001176 2,198 FI 17* (7.50; 40.00)

Finkelstein, 200286 25,400 Arthritis 1.59 (1.07; 2.38)

Nelson, 20054 2,559 Arthritis 0.80 (0.70; 1.00) 

Koskimaki, 2001 Arthritis 1.8* (1.40; 2.40) 176 2,198 

Rheumatoid arthritis 1* (0.40; 2.70) 

Nakanishi, 199758 1,405 Dementia 2.71 (0.41; 17.96) 

Nelson, 20054 2,559 Dementia 1.50 (1.20; 1.70)

Schmidbauer, 200183 1,236 Feeling stressed 0.86 (0.45; 1.63) 

Muscatello, 200184 232 High stress 1.80 (0.70; 4.40) 

Nuotio, 2003 Low social activity 1.29 (0.61; 2.75) 106 171 

Depressive mood 2.69 (1.14; 6.34)

No participation in social activity 1.10 (0.55; 2.21) 

No life worth living 1.29 (0.66; 2.53) 

Nakanishi, 199758 1,405 

Anxiety 1.55 (0.78; 3.05) 

Bortolotti, 200072 748 BPCO 1.70 (0.70; 4.00) 

Finkelstein, 2002 Asthma 1.30 (0.73; 2.32) 86 25,400 

COPD 1.33 (0.74; 2.40) 

Stenzelius, 2004114 1,642 Protracted coughing 1.33 (1.04; 1.69)

Koskimaki, 2001176 2,198 Pulmonary disease 1.3* (0.90; 1.90) 

Smoger, 2000 Use of antispasmodic agents 3.11 (1.00; 9.96) 181 840 

diuretics 1.20 (0.84; 1.69) 
Table 21. Association between risk factors and male UI (continued) 

132

Author Sample Risk Factor Relative Measure of 

Association (95% CI) 

Van Oyen, 200292 3462 Diuretics 2.24 (1.07; 4.67)

Pain medication 0.77 (0.52; 1.15) 

Tranquilizers 1.16 (0.58; 2.35) 

Antidepressants 1.79 (1.00; 3.23) 

Hypnotics 1.09 (0.65; 1.84) 

Narcotics 2.03 (1.28; 3.20)

Laxatives 2.34 (1.46; 3.75)

Asthma medication 1.55 (0.84; 2.87) 

BP medication 0.45 (0.20; 1.00) 

Heart medication 1.38 (0.81; 2.35) 

Diuretics 2.11 (1.28; 3.47)

Finkelstein, 200286 25,400 

Antibiotics 1.11 (0.74; 1.66) 

Nuotio, 2003 Polypharmacy 1.55 (0.68; 3.50) 106 171 

Sleeping medication 0.70 (0.30; 1.62) 

* urge UI; italic - relative risk; bold - adjusted odds ratios; underlined - significant association at 95% confidence level 
133

Figure 23. Association between neurological diseases and male UI 

Figure 24. Association between stroke and male U 

Odds ratio

 .99 1 20

Author (sample)

 Odds ratio

 (95% CI)

Stroke

Finkelstein (25,400) 8.26 (3.63, 18.80)

Landi (2,178) 1.23 (0.98, 1.54)

 Jorgensen (123) 2.80 (1.50, 5.20)

 Nakanishi (1,405) 2.63 (0.93, 7.42)

 Nelson (2,559) 1.20 (1.00, 1.50)

 Koskimaki (2,198) 2.30 (0.90, 5.20)

 Overall 2.12 (1.36, 3.29)

 Odds ratio

 .99 20

 Author (sample)

 Odds ratio

 (95% CI)

 Delirium

 Landi (2,178) 1.18 (0.90, 1.53)

 Depression

 Landi (2,178) 1.15 (0.93, 1.41)

 Epilepsy

 Tellez-Zentano (49,026) 4.80 (3.60, 6.30)

 Tellez-Zentano (130,822) 3.40 (2.50, 4.50)

 Memory problems

Stenzelius (1,642) 1.70 (1.42, 2.03)

 Neurological disease

 Bortolotti (5,488) 6.00 (1.60, 22.50)

Koskimaki (2,198) 2.60 (1.30, 5.00)

 Parkinson’s disease

 Landi (2,178) 1.27 (0.87, 1.85)

 Transient ischemic attack

 Koskimaki (2,198) 1.40 (0.70, 2.60)
134

Figure 25. Association between ADL and male UI 

Figure 26. Association between urinary tract infections and symptoms and male UI 

 .017452 1 57.3000

Author (sample)

 Relative measure of the association

 (95% CI)

 Lower UT symptoms

 Schmidbauer (1,236) 0.58 (0.27, 1.23)

 Nuotio (171) 3.49 (1.42, 8.57)

 Stenzelius (1,642) 1.67 (1.10, 1.71)

 Subtotal 1.48 (0.67, 3.27)

 Urinary tract infection

 Bortolotti (1,198) 12.50 (2.70, 57.30)

 Ueda (968) 3.07 (1.11, 8.48)

 Ueda (845) 3.07 (1.10, 8.50)

 Van Oyen (3,462) 5.32 (2.29, 12.30)

 Landi (2,178) 3.20 (2.20, 4.66)

 Nuotio (171) 1.06 (0.25, 4.55)

 Subtotal 3.49 (2.33, 5.23)

Odds ratio

 0.13 1 7.57

 Risk factor (sample)

 Odds ratio

 (95% CI) Adjusted

 ADL score 2–4 vs. 0-1 (2,178) 1.91 (1.29, 2.83)

 ADL score >5 vs. 0-1 (2,178) 4.42 (3.25, 6.01)

 ADL Disability (171) 2.59 (1.14, 5.89)

 Moderate physical limitations (3,462) 1.91 (1.00, 3.64)

 Severe physical limitations (3,462) 3.34 (1.52, 7.34)

 Difficulty talking (1,642) 1.25 (1.04, 1.54)

 Difficulty walking (1,642) 1.63 (1.37, 1.95)

 Mobility limitation (1,642) 1.23 (1.02, 1.48)

 Trunk restraints (2,559) 2.90 (2.00, 4.10)

 Crude

 ADL disability (867) 2.31 (1.23, 4.32)

 Moderate physical limitations (3,462) 2.08 (1.14, 3.80)

 Severe physical limitations (3,462) 3.39 (1.52, 7.57)

 Sensorial limitations (3,462) 1.76 (1.07, 2.89)

 Mobility disability (867) 2.11 (1.16, 3.85)

 Relative measure of the association
135

Figure 27. Association between urinary tract conditions and male UI 

 Odds Ratio

 .154083 1 6.48999

Risk factor

 Odds Ratio

 (95% CI)

Acute GU toxicity 1.58 (1.19, 2.09)

Enuresis 1.40 (0.50, 4.10)

Frequency 3.06 (2.42, 3.87)

Incomplete urination 4.12 (2.92, 5.80)

 Nocturia 2.88 (1.66, 5.01)

Acute GU toxicity 4.80 (3.70, 5.00)

Weak stream 3.35 (2.52, 4.44)

Stop/start 2.73 (2.06, 3.63)

Straining 3.75 (2.38, 5.91)

AUA symptom index >7 4.35 (3.41, 5.54)

Urgency 4.96 (3.80, 6.49)
136

Figure 28. Association between prostate diseases, treatments for prostate disease, and male UI 

PC - prostate cancer; RP - radical prostatectomy, TURP - transurethral resection of prostate; PSA - prostate specific 

antigen; NVB - neurovascular bundle resection 

 Odds ratio

 0.09 1 10.6 

 Risk factor (sample) 

 Odds ratio 

 (95% CI) 

 Adjusted 

 Attempted nerve sparing during RP (536) 4.77 (2.18, 10.44)

 Endocrine treatment after RP vs. no PC (312) 1.50 (0.70, 3.10)

 Endocrine treatment for PC vs. no PC (314) 1.60 (1.00, 2.50)

 External radiation for PC vs. no PC (314) 2.30 (1.30, 4.10)

 Gleason score (536) 1.01 (0.50, 2.05)

 History of TURP then RP (123) 1.19 (0.71, 2.01)

 History of TURP then RP (314.) 1.80 (1.07, 3.04)

 Neoadjuvant hormone therapy for PC (123) 0.74 (0.43, 1.27)

 No treatment for PC vs. no PC (314) 1.90 (1.20, 2.80)

 Pathological lymph node status (536) 0.66 (0.25, 1.72)

 Pathological tumor stage (536) 1.41 (0.59, 3.37)

 Preoperative PSA (536) 1.00 (0.98, 1.01)

 Preservation of NVB (123) 1.49 (0.96, 2.33)

 Previous prostate surgery (840) 2.05 (1.15, 3.66)

 Previous prostate surgery (1,236) 1.94 (0.84, 4.47)

 Prostate Cancer vs. no PC (314.) 2.00 (1.50, 2.80)

 Prostate Cancer vs. no PC (2,198) 1.30 (0.70, 2.30)

 Prostate diseases (3,462) 6.15 (3.57, 10.60)

 RP(314) 1.90 (0.70, 5.30)

 RP vs. no PC (314) 4.30 (2.60, 7.30)

 Urological surgery (683) 2.60 (0.60, 10.50)

 Crude 

 Prostate Cancer vs. no PC (840) 1.63 (0.65, 4.03)

 Prostate active agents (840) 1.30 (0.74, 2.29)

 Prostate diseases (3,462) 5.26 (3.12, 8.85)
137

Table 22. Prevalence of UI in patients with stroke 

Author Patient Population UI Sample Size Prevalence 

(% CI) 

Acute stroke patients from The 

Copenhagen Stroke Study 

Full UI 935 36 

Acute stroke patients from The 

Copenhagen Stroke Study 

Partial UI 935 11 

At discharge Full UI 935 15 

Partial UI 935 13 

At 6-Month Followup Full UI 935 8 

Partial UI 935 11 

Full UI at 

discharge 

935 30 

Partial UI at 

discharge 

935 10 

Full UI 6 at 

month followup 

935 14 

Nakayama, 

1997220

Full UI on Admission 

Partial UI at 6 

month followup 

935 10 

UI in <80 years 3,141 34.9 

UI in >80 years 1,358 57.4 

Di Carlo,1999647 Acute first-in-a-lifetime stroke 

(European Union Concerted Action) 

UI 4,499 41.7 

Hankey, 2000648 Acute cerebrovascular disease in the 

Perth Community Stroke Study 

UI 492 43.6 

Acute first-in-a-lifetime in the South 

London Stroke Register 

UI 1,259 48.2 

Total anterior circulation infarcts UI 189 87 (82; 92) 

Partial anterior circulation infarcts UI 250 37 (31; 43) 

Posterior circulation infarcts UI 142 38 (30; 45) 

Lacunar infarcts UI 283 25 (20; 30) 

Primary intracerebral hemorrhage UI 170 70 (63; 78) 

Lawrence, 

2001649

Subarachnoid hemorrhage UI 77 71 (57; 85) 

Survivors after the first stroke. UI 178 15.7 

UNILATERAL SPATIAL NEGLECT UI 178 44.9 

Survivors after the first stroke. UI at discharge 178 4.9 

Paolucci, 2001656

UNILATERAL SPATIAL NEGLECT UI at discharge 178 20.5 

Acute first-in-a-lifetime in the South 

London Stroke Register 

UI 235 40 

3 month followup UI 235 19 

1 year followup UI 235 15 

Patel, 2011651

2 year followup UI 235 10 

Incident UI 143 2.9 (1.8; 4.8) 

Incident UI in 

Women 

143 1.7 (0.6; 45) 

Incident UI Men 143 3.9 (2.2; 6.9) 

van Kuijk. 2001651 Survivors after first-time, unilateral 

hemispheric stroke 

Regained 

continence rate 

143 14.6 (7.3; 29.2) 

Subarachnoid haemorrhage UI 322 3.1 

Intracerebral haemorrhage UI 322 5.2 

Ischemic stroke UI 322 6.7 

Lee, 2003646

transient ischemic attack UI 322 2 
138

Table 23. Association between stroke and UI in community dwelling adults 

Author 

Sample Age Risk Factors Odds Ratio 

(95% CI) 

Age for 10-year increments 1.72 (1.32; 2.25) 

Lesion size for a 10-mm increase in diameter 1.22 (1.1; 1.36) 

DM 3.38 (1.75; 6.51) 

Hypertension 0.5 (0.29; 0.87) 

Other disabling disease 2.4 (1.28; 4.52) 

Nakayama, 1997220 

N = 935; 60% female 

74.6 

Initial Scandinavian Stroke Scale score - 10-point 

increase in SSS score 

0.39 (0.3; 0.45) 

<50 1 

50–75 6.14 (0.97; 38.89) 

>75 15.9 (2.18; 116.17) 

Female sex 0.84 (0.39; 1.8) 

Total Anterior Circulatory Infarction 1 

Partial Anterior Circulatory Infarction 0.36 (0.09; 1.48) 

Posterior Circulatory Infarction 0.45 (0.09; 2.4) 

Lacunar Infarction 0.12 (0.02; 0.62) 

Primary Intracerebral hemorrhage 1.31 (0.24; 7.12) 

Subarachnoid hemorrhage 15.4 (1.32; 179.8) 

Unknown 0.83 (0.12; 5.85) 

Hypertension 0.76 (0.35; 1.65) 

Diabetes mellitus 0.93 (0.31; 2.8) 

Atrial fibrillation 1.4 (0.53; 3.68) 

Dysphasia 2.04 (0.76; 5.47) 

Dysphagia 4.03 (1.85; 8.73) 

Visual field defect 4.78 (1.78; 12.9) 

Patel, 2001651 

N = 235; 50% female 

73.3 

Motor weakness 5.41 (1.38; 21.1) 

>75 0.38 (0.17; 0.83) 

Female sex 0.71 (0.34; 1.47) 

Total anterior circulation infarcts 1 

Partial anterior circulation infarcts 2.22 (0.78; 6.37) 

Posterior circulation infarcts 2.24 (0.43; 11.6) 

Lacunar infarcts 3.66 (1.1; 12.2) 

Primary intracerebral hemorrhage 1.42 (0.5; 4.03) 

Subarachnoid hemorrhage 0.6 (0.09; 4.13) 

Unknown 3.78 (0.48; 29.7) 

Hypertension 0.64 (0.31; 1.3) 

Diabetes mellitus 1.23 (0.47; 3.22) 

Atrial fibrillation 1.03 (0.45; 2.33) 

Motor weakness 1.23 (0.27; 5.56) 

Dysphasia 1.45 (0.65; 3.22) 

Dysphagia 0.77 (0.35; 1.71) 

Barthel index 0-14 1 

Patel, 2001652 

N = 207; 42% female 

73.1 

Barthel index 15-18 21.8 (5.95; 79.7) 

Tang, 2004653 

N = 280; 45% female 

70.9 Poststroke dementia 6.7 (3.5; 12.8) 

Stroke 2.8 (1.5; 5.2) 

Acute stroke (<1 year) 5.2 (1.6; 17.2) 

1–4 Years after stroke 5.3 (2.3; 12.6) 

5–10 Years after stroke 2.2 (1; 5) 

> 10 years after stroke 1.4 (0.5; 4.1) 

Weakness of a leg (SSS score, <5), or depressive 

symptoms (MADRS score, >7), or lower cognitive 

function (MMSE score<24) 

3.5 (1.5; 8.2) 

Jorgensen, 2005177

N = 213/242 

noninstitutionalized 

stroke survivors and 

healthy control 

2–3 of weakness of a leg (SSS score, <5), or 

depressive symptoms (MADRS score, >7), or 

lower cognitive function (MMSE score<24) 

7.2 (2.1; 24.6) 

Bold - significant at 95% confidence level 
139 

Table 24. Prevalence of UI among residents in LTC with risk factors 

Author Country Risk Factor Sample Prevalence (%) 

Cognitive Impairment

No mental impairment 140 27 

Mild mental impairment 96 60 

Moderate mental impairment 78 86 

Severe mental impairment 123 93 

Borrie, 199234 UK 

Dementia 139 78 

Denmark, impaired cognitive status 1,799 72.4 

France, impaired cognitive status 167 81.4 

Iceland, impaired cognitive status 377 78.9 

Italy, impaired cognitive status 586 79 

Japan, impaired cognitive status 539 84 

Sweden, impaired cognitive status 436 83.9 

Sgadari, 19971

USA, impaired cognitive status 126,070 78.3 

Dependency

Independent 110 26 

Supervised 33 52 

Assistance required 59 69 

Borrie, 199234 UK 

Immobile 233 81 

Denmark, dependent 1,799 81.2 

Denmark, bedfast 1,799 69.3 

France, dependent 167 83.5 

France, bedfast 167 82.5 

Iceland, dependent 377 79.1 

Iceland, bedfast 377 86.6 

Italy, dependent 586 82.7 

Italy, bedfast 586 82.5 

Japan, dependent 539 80.8 

Japan, bedfast 539 79.5 

Sweden, dependent 436 87 

Sweden, bedfast 436 57.9 

USA, dependent 126,070 71.5 

Sgadari, 19971

USA, bedfast 126,070 61.9 

Internal Diseases

Diabetes 51 65 

Malignant neoplasm 34 44 

Cerebrovascular diseases 113 70 

Parkinson's disease 40 78 

Multiple sclerosis 25 60 

COPD 52 42 

Prostate disease 28 79 

Ischemic heart disease 58 64 

Borrie, 199234 UK 

Hypertension 40 65 

Diabetes 121 55.4 

Constipation 253 72.7 

Fecal incontinence 196 93.4 

Neurological disease 322 71 

Bone fracture 21 52.4 

Urinary tract infection 79 81 

Psychiatric disease 89 29 

Hypertension 330 58 

Aggazzotti, 200029 Italy 

Cardiovascular diseases 82 46 

Multiple sclerosis 9,013 21.3 

Multiple sclerosis, occasional UI 9,013 5.6 

Buchanan, 2001654 USA 

Multiple sclerosis, frequent UI 9,013 9 

Sgadari, 1997 Denmark, urinary tract infection 1,799 68.4 1

France, urinary tract infection 167 77.8 
Table 24. Prevalence of UI among residents in LTC with risk factors (continued) 

140

Author Country Risk Factor Sample Prevalence (%) 

Iceland, urinary tract infection 377 56.4 

Italy, urinary tract infection 586 62.7 

Japan, urinary tract infection 539 54 

Sweden, urinary tract infection 436 80.9 

USA, urinary tract infection 126,070 50.9 

LOS

2 weeks after admission 434 39 

2 months after admission 317 47 

Palmer, 199128 USA 

1 year after admission 196 44 
141 

Table 25. Association between UI and risk factors (adjusted odds ratios) in LTC settings 

Author Age Sample Gender 

% Female 

Odds Ratio 

(95% CI) 

Age 

Nelson, 20054 85.9 3,850 71 1.03 (1.02; 1.04) 

Nelson, 2001 0.99 (0.98; 0.99) 165 85.9 10,328 71 

0.98 (0.98; 0.99) 

Aggazzotti, 200029 82 839 59.8 1.24 every 5 years 

(1.02; 1.51) 

0.43 - Age 65 to 74 vs. >95 

(0.19; 0.95) 

0.62 - 75 to 84 vs. >95 

(0.32; 1.21) 

Saxer, 2005655 2,722 67 

0.64 - 85 to 94 vs. >95 

(0.34; 1.23) 

Male Gender

Nelson, 20054 85.9 3,850 71 0.8 (0.7; 1) 

Nelson, 2001 0.8 (0.7; 0.9) 165 85.9 10,328 71 

0.8 (0.7; 0.8) 

Aggazzotti, 200029 82 839 59.8 0.51 (0.81; 0.33) 

Saxer, 2005655 2,722 67 1.69 (1.36; 2.09) 

Race (NW = 1, W = 0)

Nelson, 20054 85.9 3,850 71 1 (1; 1) 

Nelson, 2001 1 (1; 1) 165 85.9 10,328 71 

1 (1; 1) 

BMI

Nelson, 20054 85.9 3,850 71 1 (1; 1) 

Nelson, 2001 85.9 10,328 71 1 (1; 1) 165

85.9 10,328 71 1 (1; 1) 

Diabetes

Nelson, 20054 85.9 3,850 71 1 (1; 1) 

Nelson, 2001 1 (1; 1) 165 85.9 10,328 71 

1 (1; 1) 

CVD

Nelson, 20054 85.9 3,850 71 1 (1; 1) 

Nelson, 2001 1 (1; 1) 165 85.9 10,328 71 

1 (1; 1) 

Stroke

Nelson, 20054 85.9 3850 71 1.2 (1; 1.5) 

Nelson, 2001 1.3 (1.2; 1.4) 165 85.9 10,328 71 

1.4 (1.2; 1.5) 

Arthritis

Nelson, 20054 85.9 3850 71 0.8 (0.7; 1) 

Nelson, 2001 1 (1; 1) 165 85.9 10,328 71 

1 (1; 1) 

Bold - significant association at 95% confidence level. 
142 

Table 26. Association between dependency, mental, gastrointestinal diseases, and UI (adjusted odds ratios) 

in LTC settings 

Author Age Sample % Female Risk Factor OR 

(95% CI) 

Dependency 

Trunk restraints 2.9 (2; 4.1) 

Impaired vision 1 (1; 1) 

Pressure ulcer 1 (1; 1) 

Tube feeding 1 (1; 1) 

3,50 71 

Loss of ADL 3.1 (2.6; 3.8) 

Toilet use 1 (1; 1) 

Eating 1.3 (1.1; 1.6) 

Hygiene 1.7 (1.3; 2.1) 

Dressing 1.8 (1.5; 2.3) 

Bed mobility 1 (1; 1) 

Locomotion 1.3 (1.1; 1.5) 

Nelson, 20054 85.9 

951 

Transferring 1 (1; 1) 

Impairment of ADL 4.2 (3.2; 5.6) 

Restraints: Trunk 1.7 (1.5; 2) 

Restraints: Chair 1.4 (1.2; 1.6) 

Brandeis, 

1997164

60-

105 

2,14 75.5 

Restraints: Bedrails 1.3 (1.1; 1.5) 

Trunk restraints 2.5 (2.3; 2.8) 

Impaired vision 1.4 (1.3; 1.5) 

Pressure ulcer 1 (1; 1) 

Tube feeding 0.6 (0.4; 0.7) 

Trunk restraints 2.4 (2.1; 2.7) 

Impaired vision 1.4 (1.3; 1.6) 

Pressure ulcer 1 (1; 1) 

Tube feeding 0.7 (0.5; 0.9) 

Dependency in toilet use, 1992 5.6 (4.9; 6.6) 

Dependency in eating, 1992 3 (2.8; 3.3) 

Dependency in hygiene, 1992 2 (1.7; 2.5) 

Dependency in dressing, 1992 1 (1; 1) 

Dependency in bed mobility, 1992 1.8 (1.6; 1.9) 

Nelson, 2001165 85.9 10,328 71 

Dependency in locomotion, 1992 1.2 (1.1; 1.3) 

Dependency in transferring, 1992 1 (1; 1) 

Dependency in toilet use, 1993 6.3 (5.3; 7.4) 

Dependency in eating, 1993 2.9 (2.7; 3.2) 

Dependency in hygiene, 1993 1.8 (1.5; 2.3) 

Dependency in dressing, 1993 1 (1; 1) 

Dependency in bed mobility, 1993 1.9 (1.7; 2.1) 

Dependency in locomotion, 1993 1.2 (1.1; 1.3) 

Nelson, 2001165 85.9 10,328 71 

Dependency in transferring, 1993 1 (1; 1) 

Mobility With support 1.8 (1.5; 3.0)8 

Mobility with care providers 5.63 (2.92; 10.8) 

Aggazzotti, 

200029

82 839 59.8 

Wheelchair/bedridden 7.38 (4.86; 11.2) 

67 No loss in long-term memory 0.7 (0.54; 0.9) 

 Cognitive abilities 0.64 (0.49; 0.83) 

 No problem moving in bed 0.51 (0.36; 0.73) 

 No problem moving around 

among 65-74 years 

0.33 (0.07; 1.57) 

 No problem moving around 

among-84 

0.28 (0.11; 0.75) 

 No problem moving around 

among 85-94 

0.63 (0.25; 1.61) 

 Minor problem moving around 

among 65-74 

0.74 (0.15; 3.68) 

Saxer, 2005655 2722 

 Minor problem moving around 1.02 (0.37; 2.83) 
Table 26. Association between dependency, mental, gastrointestinal diseases, and UI (adjusted odds ratios) 

(continued) 

143

Author Age Sample % Female Risk Factor OR 

(95% CI) 

among 75-84 

 Minor problem moving around 

among 85-94 

1.1 (0.41; 2.93) 

No loss in long-term memory 0.19 (0.08; 0.46) 

No problem moving in bed 0.17 (0.06; 0.48) 

No problem moving about in own 

corridor 

0.15 (0.03; 0.67) 

At 12 months 

no problem moving in bed 0.13 (0.03; 0.55) 

At 12 months No loss in long-term memory 0.53 (0.36; 0.78) 

adjusted for 

baseline 

condition 

No problem walking in room 0.34 (0.18; 0.63) 

Gastrointestinal Diseases

Constipation 1 (1; 1) 

Fecal impaction 1 (1; 1) 

Nelson, 20054 85.9 3850 71 

Diarrhea 1 (1; 1) 

Fecal incontinence 20.5 (18.6; 22.6) 

Constipation 1.3 (1.2; 1.4) 

Fecal impaction 1 (1; 1) 

Diarrhea 0.7 (0.5; 0.8) 

Fecal incontinence 17.8 (16.1; 19.7) 

Constipation 1.3 (1.2; 1.4) 

Fecal impaction 1 (1; 1) 

Nelson, 2001165 85.9 10,328 71 

Diarrhea 0.7 (0.6; 0.9) 

Aggazzotti, 

2000165

82 839 59.8 Fecal incontinence 10.4 (1.4; 20.2) 

Mental Diseases

Nelson, 2005165 85.9 3850 71 Depression 1 (1; 1) 

Brandeis, 

1997165

60-

105 

2014 75.5 Use of anti anxiety/hypnotics 0.7 (0.5; 1) 

Nelson, 2001 85.9 10,328 71 Depression, 1992 1 (1; 1) 165

 Depression, 1993 1 (1; 1) 

Aggazzotti, 82 839 59.8 Alternating mental orientation 1.92 (1.08; 3.44) 

2000165 82 839 59.8 No mental orientation 3.61 (2.42; 5.39) 

Bold – significant associations at 95% confidence level. 
144

Overview of Risk Factors for FI 

Age. In the past decade, a large body of evidence has suggested an association between FI 

and patient age . Age was a strong predictor of FI and combined UI and FI in the majority of the 

studies (79 percent or 22/28) (Table 27). The association between age and FI was examined 

among women only.187,208-213 Adjusted odds of AI increased by 87 percent for every additional 

10 years of age in Asian women and by 36 percent in White women.187 The frequent comorbidity 

of FI and UI may be attributable to the common cause of both disorders, such as pelvic floor 

sphincter injuries.4,58,162,186 Women over age 42 reported combined UI and FI 16 times more 

often than younger females after adjustment for other risk factors.186 Japanese adults over age 75 

had 319 percent higher odds of combined UI and FI compared to those 65-74 years old.58 The 

association between age and FI was not linear.657 However, one study reported a 30 percent 

increase in the adjusted odds of FI corresponding to a 10 year increment in age in women.225 The 

threshold age for women was related to menopausal age; no significant increase in FI was shown 

when women older than 30 or 35 years were compared to women younger than 29 years of 

age.230 The results became significant when 30-49 year old women were compared to those 50-

69 years old (211 percent increase in FI) or those 70-90 years old (222 percent increase in FI).163

No studies reported adjusted odds ratios of FI in men, with an inconsistent increase in the crude 

odds of FI after 35,658 44,659 or 65 years of age.221 Studies with women and men analyzed 

together reported a 2 percent increase in FI in adults older than 40 years222 and a 271 percent 

increase in FI after age 7558 after adjustment for other risk factors. 

 Age not only increases the risk of FI, it likely modifies the effects of other risk factors, 

including birth related anal trauma. Maternal age older than 25 years was associated with greater 

odds of FI214 and persistent FI.215 Women 20-24 years old at the time of delivery did not 

experience a larger risk of FI compared to younger pregnant women.218 Less expected was the 

fact that pregnant women below age 20 experienced FI more often than women over 30.218 

 The interaction between age and other risk factors requires future research. Pooled analysis 

indicated that studies with older adults reported higher crude rates of FI, but the estimation had 

low validity due to significant statistical heterogeneity between studies.518Age, but not study 

quality, contributed to differences in rates of FI.518 The authors used different age categories 

which made pooling more questionable. Pooled analysis of patients’ individual data should give 

better information of the curve-linear association and meaningful cut-points for men and women 

independent of other risk factors. 

Gender. This line of research shows mixed results (Table 28). Traditionally, FI is believed to 

be more prevalent in women.6,622 Two recent studies confirmed this finding by reporting a 

greater prevalence of FI in women.7,508 One study reported greater prevalence of combined 

incontinence (FI + UI) in community-living elderly women than men.660 However, three 

different groups of researchers found no differences in the prevalence of FI in women and 

men.4,216,217 Four other studies showed that male gender is an independent risk factor for 

FI3,58,222,224 and combined incontinence.58 One study indicated that men ages 75-79 or 85-89 are 

more likely to have FI, combined incontinence, and less severe FI than women in the same 

group.

114 The majority of these studies involved a large sample (more than 4,000) elderly people 

(>65 years) and adjusted for at least one risk factor. However, a definite association between 

gender and FI cannot be drawn given varying study designs, sampling and statistical methods, FI 

definitions, and varying control for potential risk factors. Valid synthesis of different studies 
145

would be possible when relative risk of incident incontinence, adjusted for age and genderspecific confounding factors, was examined in prospective cohorts. 

Race. Limited evidence from one study suggested that Asian women had a higher prevalence 

of birth related FI compared to other ethnic groups after adjustment for mode of delivery, 

maternal age, perineal trauma, BMI, and total number of births (Appendix Table F34).215 The 

prevalence of combined UI and FI was two times higher in non-White than White residents of 

nursing homes in Wisconsin, independent of other risk factors identified in the Health Care 

Financing Administration Minimum Data Set.4 Younger Taiwanese women living in the 

community (mean age of 43 years) had a prevalence of FI of 2.5 percent,213 a rate similar or less 

than that reported in non-Asian women of a similar age group.218,232 The association between 

race and severity of FI and quality of life related to FI in men and women from the community 

and in LTC facilities requires future investigation. 

Diet, BMI, and diabetes. The highest prevalence of FI (44 percent) was reported among 

women with morbid obesity undergoing laparoscopic weight loss surgery (Appendix Table F35). 

The prevalence of FI among patients with diabetes mellitus varied from 1 percent in women163,211

to 13 percent in a study of both genders;626 3 percent of men and women with diabetes 

experienced incontinence of solid feces and 13 percent solid or liquid feces.626 

 Adults with decreased serum levels of vitamin B12 (300pg/ml or less) had a significantly 

higher prevalence of combined UI and FI (Table 29).661 No other dietary intakes have been 

shown to increase the risk of FI. Increased BMI and the presence of diabetes in residents of 

nursing homes were not associated with higher rates of combined UI and FI.3,4 Higher BMI in 

women did not increase the risk of FI208,210-213 but was associated with higher prevalence of 

flatus662 and liquid feces incontinence.185 One study of 8,774 women reported a 70 percent 

increase in risk of persistent postnatal FI in obese women (Appendix Table F36).218

 Inconsistent evidence suggested that men and women with diabetes had FI more frequently 

than nondiabetics with rates higher by 70 percent216 to 300 percent58 in older adults and by 207 

percent in younger adults217 after adjustment for other risk factors. 

Physical activity. Physically active adults had a 70 percent lower risk of fecal urgency after 

adjustment for other risk factors (Appendix Table F37).125 Distance runners had a FI prevalence 

of 12 percent in one study with no formal control comparison.663 The association between 

physical activity and incidence of FI and quality of life related to FI in adults in community and 

LTC requires future investigation. 

Smoking and pulmonary diseases. The association between smoking and FI is inconsistent 

in direction and effect size (Table 30).125,185,186,208,218,226,227 White women with obstructive 

pulmonary diseases had a 208 percent higher rate of FI after adjustment for possible confounding 

factors.187 Women with chronic bronchitis had liquid incontinence 3.5 times more often in a 

bivariate analysis.185 Older men and women with protracted coughing experienced increased risk 

of combined UI and FI by 65 percent.114

Muscle-skeletal disorders. The crude prevalence of FI was 71 percent higher among older 

men with arthritis with attenuation of the association in multivariate analysis (Table 31).186 Foot 

and ankle problems in elderly adults were associated with a two-fold increase in prevalence but 

not incidence of FI.186 Arthritis in older men and women increased the risk of liquid FI by 80 

percent in bivariate analysis of 1,352 adults over 75 years old.158

Neoplasm. Older patients with rectal cancer had the highest prevalence of FI (55 percent),664

but other studies showed lower prevalence of FI among patients with rectal cancer665,666
146

(Appendix Table F38). Patients after proctocolectomy with J-pouch anastomosis reported 25 

percent prevalence of FI with lower rates after W-pouch anastomosis.667 

Comorbidities. High rates of medical comorbidities in women were associated with a 2.6 

times higher adjusted risk of FI (Table 32).163 Incremental increases in the Charlson Comorbidity 

Scale scores in women were associated with 76 percent higher adjusted odds of FI.219 The 

presence of kidney diseases in older adults was associated with a significant risk of incident FI 

by 48 percent in women and 94 percent in men.186 Men suffering from transient ischemic attack 

had a three times higher prevalence of FI.219 Women with arterial hypertension reported FI 2.4 

times more often compared to normotensive females after adjustment for other risk factors.213

Heart disease in nursing home residents did not increase the risk of FI.3,4

Stroke and other neurological disorders. The prevalence of FI was 30 percent221 to 34 

percent220 after acute stroke (Appendix Table F39). The absolute risk of FI was less than 10 

percent several months after stroke in most studies.220-222,668 Stroke was associated with a 

significant increase in adjusted odds of FI in the majority of the studies (Table 33). Combined UI 

and FI was five times more frequent in community dwelling adults after stoke58 but not in 

residents of nursing homes.4

 Incident FI occurred twice as frequently in women but not in men 

after a stroke.186 Adjusted prevalence of FI was three216 to five58 times higher in stroke survivors 

compared to adults without a stroke. Incremental 10-year increase in age at the time of a stroke 

was associated with a 45 percent higher probability of FI 6 months after the stroke.220 Diabetics 

experienced FI 2.2 times more often after stroke compared to non diabetics after adjustment for 

confounding factors.220 Severity of stroke was positively associated with FI.220,221 Functional 

dependency and need for assistance with toilet access 3 months after stroke in men and women 

was associated with a 349 percent increase in FI. Residents of nursing homes after stroke 

suffered from FI 1.2-1.3 times more often.4 Adjustment for other risk factors of FI attenuated the 

strength of association, but a higher odds ratio was still highly significant (4.9, 95 percent CI 14; 

16).58

 Several studies examined the prevalence of FI in patients with neurological diseases 

(Appendix Table F40). The prevalence of FI was 10 percent in men and 5 percent in women with 

Parkinson’s Disease.669 Two studies of patients with multiple sclerosis reported that 21 percent524

to 51 percent670 experienced FI. Among patients with spinal cord injury, subjects with tetraplegia 

had the highest prevalence of FI (14 percent)671 compared to 4 percent in cases with paraplegia, 

and 2 percent in patients with incomplete injury.671 

Functional impairments and dependency status in association to FI in residents of 

nursing homes were examined in one study using Wisconsin annual nursing home surveys 

(Table 34).3,4 Tube feeding was associated with an 8-9 percent increase in the odds of FI,3

dependence in daily activities with 6-7.3 higher odds of FI, and dependency in eating with four 

times higher odds of FI after adjustment for all risk factors in the model.3

 Nursing home 

institutionalization was examined in one study of 430 residents.166 Increased length of stay from 

2 weeks to 1 year was associated with a seven times higher prevalence of FI.166 Residents with 

pressure ulcers experienced FI 2.3 to 2.6 times more often; this increase was independent of 

other FI risk factors. (Appendix Table F41)3

Functional status and mental health in association with FI in community dwelling 

adults. Poor general health and dementia increased the risk of combined UI and FI in adults after 

adjustment for confounding factors (Table 35).58 Crude rates of combined incontinence were 

significantly higher in older adults with memory problems, edema in legs, and slow healing 

wounds.114 The odds ratios of FI were significantly higher by 188 percent in women and by 218 
147

percent in men with poor general health,219 by 400 percent in adults with functional 

limitations,222 and by 80 percent in adults with decreased mobility and severe/mild physical 

activity impairment.223 Major depression in women was associated with 273 percent higher rates 

of FI independent of other risk factors.163 Geriatric depression in men was associated with a 283 

percent higher risk of FI.219 Adults with dementia had FI twice as often in two studies after 

adjustment for other risk factors of FI.223,224 Impaired cognitive status in men was associated 

with a five-fold increase in the adjusted odds ratio of FI.186 Older men and women with MiniMental State Examination (MMSE) score <15 had a 250 percent increase in the adjusted rates of 

FI.223 

Chronic gastrointestinal conditions. Constipation, chronic diarrhea, and fecal impaction 

increased the adjusted relative odds of FI, but not combined incontinence, in residents of nursing 

homes (Appendix Table F42).3,4 Constipation increased the risk of FI by 209-211 percent in 

women (Table 36).187,212 Women with irritable bowel syndrome experienced FI 2.7 to 6.3 times 

more often after adjustment for other risk factors.187,211,212 Crude rates of combined incontinence 

were significantly higher in men and women with chronic gastrointestinal disorders.114 The 

adjusted rates of FI were 240 percent225 to 450 percent219 higher in women with diarrhea, 190 

percent higher in irritable bowel syndrome patients, 250 percent higher in females with anal 

fistula, and 140 percent higher after cholecystectomy.225 Adults with incomplete bowel 

evacuation had four times higher odds of FI.217 Frequent diarrhea and water stools were 

associated with higher rates of liquid FI (Appendix Table F43).224 One study reported increased 

crude rates of severe FI in association with chronic gastrointestinal problems in adults.158 

Surgical procedures. The majority of women (97 percent) after surgery for rectal prolapse 

experienced FI (Appendix Table F44).672 Hemorrhoid surgery in women was associated with a 

270 percent increase in the odds of FI.211 Patients with inflammatory bowel disease after ileal 

pouch-anal anastomosis and pouchitis had a 43 percent prevalence of occasional and 11 percent 

of frequent FI.673 Perianal surgery of the skin outside of the anal canal was associated with a five 

times higher adjusted odds ratio of FI.217 The odds of FI were not significantly different among 

women after anorectal surgery after adjustment for parity and delivery.225 Isolated flatus 

incontinence at least once a week occurred 1.5 times more often after previous lower abdominal 

or urological surgery.227 The association was not consistent across different surgeries and studies. 

Gynecological surgery increased the adjusted odds ratio of AI by 180 percent (Appendix Table 

F45).213 

Drug administration. Crude rates of combined UI and FI were higher after diuretic and 

laxative use (Appendix Table F46).661 One large study of 6,099 adults over 65 years old reported 

a significant increase in the adjusted odds of FI after anticonvulsants, antidepressants, anti 

Parkinson medications, antipsychotic, narcotics, and hypnotics.216 Hormone replacement therapy 

in morbidly obese women before laparoscopic weight loss surgery208 and contraceptive use225 did 

not show a significant association with FI. 

Prostate diseases. The prevalence of FI was less than 10 percent in all studies among men 

with prostate diseases (Appendix Table F47).180,674,675 Prostate diseases, including prostate 

cancer, were associated with an increased adjusted odds ratio of FI (Table 37).180,219 Both 

baseline prostate diseases and treatments have been associated with an increased risk of FI. 

Baseline FI before perineal prostatectomy for localized prostate cancer was associated with 600 

percent higher adjusted rates of FI and 400 percent higher rates of severe FI after surgery.676

Patients with positive surgical margins experienced severe FI seven times more often after 

surgery.676 Radical prostatectomy was associated with a significant increase in the adjusted odds 
148

ratio of FI by 530 percent compared to healthy controls.180 External beam radiation was 

associated with higher rates of bowel symptoms than radical prostatectomy independent of other 

confounding factors.677,678

Anal trauma. Consistent evidence suggests that anal trauma was associated with significant 

risk of FI independent of other risk factors (Table 38). The adjusted odds of FI were 4.4 times 

higher in women with anal sphincter tear.232 Women with anal injury not related to childbirth had 

240 percent increases in FI.225 The adjusted odds ratio of bothersome FI was 16 times higher in 

women with anal sphincter defect.679 A combination of anal injury and pelvic organ prolapse 

increased the odds of bothersome FI by seven times. Women with anal injury, pelvic organ 

prolapse, and UI had an adjusted odds ratio of 55 to experience bothersome FI.679 Perianal injury 

increased risk of FI by 262 percent in men and women in one study.217 The independent 

contribution of anal injuries in males and females by age and race categories requires future 

investigation. Abortions were not associated with FI in one study (Appendix Table F48).227

Menopause did not increase the adjusted odds of FI210,213 but was associated with a higher 

prevalence of FI in another study226 (Appendix Table F49). 

FI in association with UI. The prevalence of FI was 25 percent210 to 28 percent680 in women 

with stress UI and 41 percent in women with overactive bladder.210 UI was associated with 11-12 

times higher odds of FI in residents of nursing homes in one study (Appendix Table F50).3

Several studies reported an increase in the crude odds of FI in patients with UI187,208,210-213,681 but 

only one study211 found a significant (1.9 times) increase in the adjusted odds ratio of FI in 881 

women with UI (Table 39). Urinary symptoms other than UI in men and women were associated 

with a significant increase in crude odds of combined UI and FI in one study.114 UI in men and 

women was associated with 2.9223 to eight times greater odds of FI.222 The adjusted odds of FI in 

women with UI were two to six times higher compared to continent females.162,163,219,226 The 

presence of stage II pelvic organ prolapse and/or urinary incontinence compared to stage 0 or I 

pelvic organ prolapse and no UI increased the adjusted odds of bothersome FI by 4.9 times.679

Prolapse. Most studies reported a prevalence of FI of more than 10 percent in women with 

genital prolapse (Appendix Table F51). The adjusted odds of FI were 1.9 times in patients with 

rectal prolapse211 and 3.2213 to five times in women with utero-vaginal prolapse (Appendix Table 

F52). One study reported a significant increase in the crude odds of flatus, liquid, and solid FI in 

women with genital prolapse.185 More than a third of men and women with rectal prolapse 

reported FI.682 Burch colposuspension was associated with greater adjusted odds of flatus and 

liquid FI compared to healthy controls 14 years after surgery.683 Women after Burch 

colposuspension also experienced more severe flatus and liquid incontinence with greater impact 

on their quality of life (Appendix Table F53).683 

FI related to pregnancy and birth. Consistent evidence suggested a significant dose 

response increase in the absolute risk of FI after vaginal trauma. The prevalence of FI was 7 

percent at 3 months and 5 percent at 12 months postpartum (Appendix Table F54).684 Women 

with sphincter tears experienced higher rates of FI, from 15 percent among nullipara to 30 

percent after more than two deliveries.685 The highest prevalence (40 percent) was reported in 

nullipara with fourth degree sphincter tear after index delivery.686 Less than 1 percent of women 

experienced FI after vacuum delivery.211 The prevalence was 2 percent211 to 5 percent687 after 

forceps delivery and 13 percent211 after episiotomy or vaginal delivery.210 The prevalence of 

combined UI and FI was 6 percent at 10 months688 and 2 percent at 24 months postpartum.684

Pregnant women657 and women after episiotomy628 reported 13 percent FI. The prevalence of FI 

was lower by 1 percent in nulliparous and 3 percent after spontaneous vaginal delivery.163 The 
149

prevalence of FI was lowest (0.3 percent) after Cesarean sections.163 The prevalence of flatus 

was 4 percent in pregnant women with one previous delivery,227 6 percent at 3 months after 

delivery,684 8 percent after instrumental delivery,689 and 25 percent after previous multiple 

pregnancies689 and among multiparous women.658 One small study reported the highest 

prevalence of flatus 30 years postpartum in women with anal disruption (59 to 76 percent) and 

episiotomy (70 percent).690 The prevalence of liquid incontinence was less than 6 percent227,658

and solid incontinence less than 5 percent227,658,684,688 in pregnant women and after different 

modes of delivery. Women with obstetric sphincter tears experienced higher rates of incident FI 

and severe FI (Appendix Table F55). More than 5 percent of women with complete third-degree 

tears after the first pregnancy and more than two deliveries after that experienced severe FI.685

Almost 7 percent of women 12 months after instrumental delivery and/or a high birth weight 

infant reported solid and liquid FI.658 Complete FI with liquid and solid incontinence was 

reported by 12 percent of women 13 years after an obstetrical anal sphincter tear.691 More than 2 

percent of young women 3 months postpartum complained about weekly solid or liquid 

incontinence.228

 The relative effects of different risk factors were less consistent across the studies and 

depended on the definitions of FI and adjustment for confounding factors (Table 40). The 

adjusted odds of FI were significantly increased after delivery of heavy babies,202 among women 

with narrow subpubic arch angle,692 and with FI during pregnancy,209 after increased number of 

births,215,226 and a high degree of perineal injury.187,209,228-231 No independent significant risk 

factors were reported for solid FI.185,693,694 Caesarean section was associated with a reduced risk 

of frequent FI214 in contrast with forceps delivery followed by frequent and persistent FI214,215,218

(Table 41). The number of births215 and anal injury218,227 were associated with higher adjusted 

odds of severe FI. 

 Fetal characteristics were examined in association to FI in 11 studies (Appendix Table 

F56).202,205,218,226-228,232,662,689,692,695 Fetal weight was associated with random changes in 

AI205,228,232,692 and FI,662,689 but with a significant increase in the adjusted odds of FI by 240 

percent in one study of 3,887 women.202 Head circumference of the baby did not show a 

significant relationship with FI205,692 or fecal urgency.205 

 Women with FI during pregnancy experienced higher rates of FI after delivery (Table 

42).209,662 Women with narrow subpubic arch angle experienced FI almost nine times more often 

independent of other risk factors.692 The number of births associated with FI was examined in 18 

studies,163,185,186,208,212,218,227,229,230,657,658,695,696 but only five found a significant increase in odds of 

FI independent on other risk factors.209,213,215,226,232 Women giving birth had FI three times more 

often compared to childless females.232 Four studies reported dose response associations between 

FI and the number of births.209,213,215,226 Adjusted odds of persistent FI were 3.2 times greater 

among women after four or more deliveries.215

 The association between FI and delivery management was examined in several studies 

(Appendix Table F57). Mediolateral episiotomy after the first pregnancy was associated with 

lower odds by 83 percent of FI in one study229 of seven.202,227-229,695,697 Prolonged pushing time 

was associated with 22 percent higher odds of solid FI.218 Cesarean surgery was shown to reduce 

the risk of FI by 42 percent and frequent FI by 64 percent in one study214 of 14.163,185,202,205,208,214, 

215,218,225,226,228,692,695,698 Forceps delivery was associated with increased adjusted odds of FI in one 

multicenter study215 with random results in others.202,214,215,218,226-228,692,699-701 An inconsistent 

increase in FI was shown after instrumental delivery in one study.230 The operative delivery in 

women with stage II pelvic organ prolapse and/or UI was associated with a 4.5 times greater 
150

adjusted odds of bothersome FI.679 Vacuum extraction did not show a significant association 

with postpartum FI.214,215,218,227,694,701 Vaginal delivery was not shown as a significant risk factor 

for FI.7,163,185,210,212,213,225,229,231,695

 Birth related perianal trauma was associated with a large increase in adjusted rates of FI in 

eight of 24 studies (Table 43)187,209,218,228-232 Women with sphincter tears had 230 percent209 to 

280 percent231,232 higher rates of FI. The degree of perineal damage showed dose response 

association with FI.229,230 Women with stage IV perineal damage experienced FI more often 

compared to damage of grades I-II.228,229 Full thickness of the internal anal sphincter defect was 

associated with 510 percent higher rates of FI after adjustment for other risk factors.230

Summary. In conclusion, aging and dependency in daily activities were strongly associated 

with the development of FI in LTC facilities. Neurological disorders, perineal trauma, and rectal 

diseases, including neoplasm, are among the independent risk factors of FI in community 

dwelling adults. Women are at risk of FI related to pregnancy and birth. The strength of the 

association varied depending on the definitions of FI. Primary prevention of diseases associated 

with increased risk of FI could reduce the incidence and severity of incontinence in adults. 

Strategies to reduce the risk of FI related to pregnancy and birth are not well documented and 

require future research. 
151 

Table 27. Association between age and FI 

Author 

Sample Definition of FI Gender Age as a Risk Factor 

(strata with cut offs) Odds Ratio (95% CI) 

Richter, 2005208

N = 180 

AI Women only Age 1.02 (0.98; 1.05) 

Pollack, 2004209

N = 349 

AI Women only Age 1.10 (1.00; 1.20) 

Ng, 2002210

N = 320 

AI Women only >65 1.77 (0.33; 9.41) 

Meschia, 2002211

N = 881 

AI Women only Age 1.30 (0.80; 2.00) 

Boreham, 2005212

N = 457 

AI Women only Age (per year) 1.05 (1.03; 1.07) 

Chen, 2003213

N = 1,253 

AI Women only > 65 0.8 (0.4; 1.8) 

Huang, 2006 Asian women only Age (per decade) 1.87 (1.26; 2.79) 187 AI 

White women only Age (per decade) 1.36 (1.14; 1.61) 

Men only 85+ vs. 75-84 3.273 (1.02; 10.52) 

Men only 85+ vs. 75-84 1.213 (0.36; 4.11) 

Women only 85+ vs. 75-84 2.37 (0.92; 6.09) 

Women only 85+ vs. 75-84 1.646 (0.68; 4.0) 

Men only 85+ vs. 65-74 4.409 (1.20; 16.14) 

Men only 85+ vs. 65-74 2.064 (0.50; 8.49) 

Women only 85+ vs. 65-74 4.235 (1.35; 13.26) 

Ostbye, 2004186

N = 8,949 

FI+ UI 

Women only 85+ vs. 65-74 3.907 (1.24; 12.32) 

Nelson, 20054

N = 8,170 

FI + UI Combined Age 1.02 (1.00; 1.03) 

Ballester, 2005162

N = 103 

FI + UI Women only >42 16.7 (1.9; 141.1) 

Nakanishi, 199758

N = 1,405i 

FI + UI Combined >75 3.19 (1.69; 6.04) 

Quslander, 2005 Combined >85 vs.65-74 3.28 (1.32; 8.16) 216

N = 6,099 

FI 

Combined >85 vs.75-84 2.00 (0.90; 4.42) 

Women only 75-84 vs. <65-74 1.55 (1.06; 2.26) 

Women only 85+ vs. <65-74 1.91 (1.14; 3.17) 

Women only 75-84 vs. <65-74 1.16 (0.89; 1.51) 

Women only 85+ vs. <65-74 1.34 (0.87; 2.08) 

Men only 75-84 vs. <65-74 2.97 (1.64; 5.39) 

Men only 85+ vs. <65-74 3.41 (1.44; 8.11) 

Men only 75-84 vs. <65-74 1.25 (0.86; 1.83) 

Men only 85+ vs. <65-74 2.51 (1.26; 5.01) 

Men only 85+ vs. 75-84 2.37 (0.86; 6.5) 

Men only 85+ vs. 75-84 2.25 (0.99; 5.09) 

Women only 85+ vs. 75-84 1.99 (0.76; 5.21) 

Women only 85+ vs. 75-84 1.43 (0.62; 3.28) 

Men only 85+ vs. 65-74 3.59 (1.13; 11.41) 

Men only 85+ vs. 65-74 4.75 (1.71; 13.23) 

Women only 85+ vs. 65-74 2.84 (0.97; 8.29) 

Ostbye, 2004186

N = 8,949 

FI 

Women only 85+ vs. 65-74 2.35 (0.91; 6.03) 

Nelson, 20054

N = 8,170 

FI Combined Age 1.02 (1.00; 1.03) 

Nelson, 1998 Combined Age in 1992 1.00 (1.00; 1.01) 3

N = 18,224 

FI 

Combined Age in 1993 1.00 (1.00; 1.01) 

Nakanishi1997 Combined 75+ vs. 65-74 4.1 (2.66; 6.3) 58

N = 1,405 

FI 

Combined >75 2.71 (1.23; 5.94) 

Melville, 2005 Women only 50-69 vs. 30-49 2.11 (1.47; 3.03) 163

N = 6,888 

FI 

Women only 70-90 vs. 30-49 2.22 (1.47; 3.36)
Table 27. Association between age and FI (continued) 

152

Author 

Sample Definition of FI Gender Age as a Risk Factor (strata with cut offs) Odds Ratio (95% CI) 

McKinnie, 2005 Women only Age (per year) 1.05 (1.03; 1.07) 657

N = 1,004 

FI 

Women only Age (per year) 1.05 (1.03; 1.07) 

Mahony, 2007 Women only 30-34 vs. ≤29 1.20 (0.30; 4.70) 230

N = 500 

FI 

Women only >35 vs. ≤29 2.70 (0.70; 11.30)

Women only Maternal age 25-29 vs. <25 1.22 (0.88; 1.69)

Women only Maternal age 30-34 vs. <25 1.71 (1.21; 2.42)

MacArthur, 2001214

N = 7,879r 

FI 

Women only Maternal age > 35 vs. <25 1.75 (1.04; 2.94)

Women only Maternal age 25-29 vs. <25 1.09 (0.84; 1.41)

Women only Maternal age 30-34 vs. <25 1.60 (1.18; 2.16)

Macarthur, 2005215

N = 4,046 

FI 

Women only Maternal age >35 vs. <25 1.72 (1.06; 2.79

Longstreth, 1993 Women only >65 vs.<44 3.60 (2.20; 4.00) 659

N = 1,264 

FI 

Men only >65 vs.<44 2.00 (0.90; 2.20) 

Abramov, 2005226

N = 542 

FI Women only ≥40 2.82 (1.21; 6.6)

Ballester, 2005162

N = 103 

FI Women only >42 4.6 (0.9; 22.7) 

Bharucha, 2006225

N = 2,800 

FI Women only Age (per decade) 1.3 (1.2; 1.4)

Brittain, 2006222

N = 2,800 

FI Combined >40 1.02 (1.01; 1.03) 

Chassagne, 1999223 FI Combined ≥70 1.7 (1; 2.8) 

Chiarelli, 2003658

N = 568 

FI Men only >35 4.33 (1.56; 12.01) 

Harari, 2003221

N = 1,069 

FI Combined ≥65 2.16 (1; 4.8)

Maternal age 25-29 vs. <25 2.61 (1.07; 6.37)

Maternal age 30-34 vs. <25 6.00 (2.42; 14.79)

Maternal age >35 vs. <25 6.00 (1.85; 19.45)

Maternal age 25-29 vs. <25 1.12 (0.72; 1.74

Maternal age 30-34 vs. <25 1.95 (1.19; 3.19)

Macarthur, 2005215

N = 1,793 

N = 3,813 

Persistent FI Women only 

Maternal age >35 vs. <25 2.65 (1.25; 5.63)

Age at followup 45-50 vs. 

<45 

Faltin, 2006 1.23 (0.65; 2.3) 695

N = 540 

Symptoms ≥2 

once/week or 3 

symptoms 

(incontinence to 

flatus, liquid or solid 

stool; need to wear 

a pad; lifestyle 

alteration) 

Women only 

Age at followup >50 vs. <45 2.21 (1.19; 4.1) 

Age at this delivery 20-24.9 

vs. <20 

0.78 (0.54; 1.11)

Age at this delivery 25-29.9 

vs. <20 

0.78 (0.55; 1.11)

Age at this delivery ≥30 vs. 

<20 

0.61 (0.43; 0.86)

Age at 1st delivery 20-24.9 

vs. <20 

0.79 (0.62; 1)

Age at 1st delivery 25-29.9 

vs. <20 

0.74 (0.58; 0.95)

Guise, 2007218

N = 8,774 

Severe 

incontinence, 

incontinence of 

stool 

Women only 

Age at 1st delivery ≥30 vs. 

<20 

0.6 (0.46; 0.77)

15-24 vs. 25-29 0.9 (0.6; 1.3)

Age 30-34 vs. 25-29 1.3 (1; 1.8)

Hojberg, 2000227 Isolated flatus 

incontinence at 

least once a week 

Combined 

Age > 35 vs. 25-29 1.6 (1.1; 2.4)

Abramov, 2005226

N = 542 

Flatus Women only Age ≥40 years 1.9 (1.11; 3.24)

Bold - multivariate odds ratios 
153

Table 28. Association between gender and FI (women as a reference gender) 

Author 

Sample Definition of FI Age Odds Ratio 

(95% CI) 

 0.70 (0.53; 0.93) 

75-79 1.18 (0.84; 1.65) 

80-84 0.91 (0.66; 1.25) 

85-89 1.28 (0.89; 1.83) 

Stenzelius, 

2004114

N = 4,277 

FI + UI 

>90 0.93 (0.58; 1.47) 

Nelson, 20054

N = 8,170 

FI + UI 1.00 (1.00; 1.00) 

Nakanishi, 199758

N = 1,405 

Fecal I + UI 1.61 (0.88; 2.94) 

75-79 1.11 0.81; 1.52) 

80-84 0.85 (0.63; 1.14) 

85-89 1.20 (0.85; 1.70) 

Stenzelius, 2004114

N = 4,277 

FI 

>90 0.90 (0.58; 1.40) 

Quander, 2005216

N = 6,099 

FI 1.00 (1.00; 1.00) 

Nelson, 20054

N = 8<170 

FI 1.00 (1.00; 1.00) 

Nelson, 1998 1.20 (1.10; 1.30) 3

N = 18,244 

FI 

1.30 (1.10; 1.40) 

Nakanishi, 1997 1.33 (0.89; 1.99) 58

N = 1,405 

FI 

1.58 (0.73; 3.41) 

Brittain, 2006222

N = 38,633 

FI 1.27 (1.05; 1.52) 

Johanson, 1997224

N = 388 

FI 1.5 (1.1; 1.9) 

FI; a little 75-79 1.23 (0.87; 1.73) 

FI, very much 75-79 0.78 (0.40; 1.54) 

FI; a little 80-84 0.92 (0.66; 1.28) 

FI; very much 80-84 0.73 (0.40; 1.33) 

FI; a little 85-89 1.17 (0.79; 1.72)) 

FI; very much 85-89 1.32 (0.70; 2.46) 

FI; a little >90 0.87 (0.53; 1.44) 

Stenzelius, 2004114

N = 4,277 

FI; very much >90 1.01 (0.48; 2.12) 

Bliss, 2004158 

N = 1,352 

Mucus 4.5 (1.5; 16.7) 

Johanson, 1997224

N = 388 

Solid 1.6 (1.2; 2.1) 

Bold - multivariate odds ratios 
154 

Table 29. Association between FI and diet, BMI, and diabetes 

Author 

Sample Age Level of Risk Factors in Population 

Groups 

Odds Ratio 

95% CI 

BMI 

AI in Women 

Meschia, 2002211

N = 881 

58.6 Incremental increase by 1 unit 1.50 (0.90; 2.30) 

Richter, 2005208

N = 180 

16-55 Incremental increase by 1 unit in women 

with morbid obesity before laparoscopic 

weight loss surgery 

0.96 (0.92; 1.00) 

Ng, 2002210

N = 320 

 >20, women 0.93 (0.34; 2.56) 

Boreham, 2005212

N = 457 

18-64 Incremental increase by 1 unit 1.04 (1.01; 1.08)* 

1st vs. 4th (≤25 percentile) 0.80 (0.40; 1.40) 

2nd vs. 4th (> 5-50 percentile) 0.90 (0.50; 1.50) 

Chen, 2003213

N = 1,253 

≥20 

3rd vs. 4th (> 0-75 percentile) 0.70 (0.40; 1.30) 

Combined Incontinence in Men and Women

Nelson, 20054

N = 8,170 

84 Incremental increase by 1 unit in men and 

women in nursing homes 

0.98 (0.96; 1.00) 

FI 

Melville, 2005 Obese women (BMI >29) vs. BMI<25 1.38 (0.99; 1.93) 163

N = 6,888 

30 – 90 

Overweight women (BMI 25-29) vs. BMI <25 0.95 (0.64; 1.40) 

Chiarelli, 2003658

N = 568 

15-44 >25 vs. <25 women 12 months postpartum 0.82 (0.33; 2.02) 

Ballester, 2005162

N = 103 

20-64 Women with BMI ≥25 vs. <25 2.30 (0.60; 8.30) 

2nd quartile vs. lowest quartile in women 3 

months postpartum 

0.79 (0.52; 1.21) 

3rd quartile vs. lowest quartile in women 3 

months postpartum 

1.00 (0.68; 1.47) 

MacArthur, 2001214

N = 7,879 

42.9 

4th quartile vs. lowest quartile in women 3 

months postpartum 

0.72 (0.48; 1.09) 

Abramov, 2005 ≥30 vs. 25 1.35 (0.72; 2.54) 226

N = 542 

26-86 

25–30 vs. <25 1.28 (0.67; 2.44) 

Nelson, 20054

N = 8,170 

84 Incremental increase by 1 unit in men and 

women in nursing homes 

0.98 (0.96; 1.00) 

Incremental increase by 1 unit in men and 

women in nursing homes,1992 

Nelson, 1998 1.00 (1.00; 1.30) 3

N = 18,244 

84 

Incremental increase by 1 unit in men and 

women in nursing homes,1993 

1.00 (1.00; 1.04) 

Incremental increase by 1 unit in women13 

months instrumental delivery 

1.00 (1.00; 1.00) 

Obese women 1.20 (0.75; 1.92) 

Obese women 1.10 (0.70; 1.77) 

Overweight women 1.08 (0.65; 1.79) 

Mazouni, 2005689

N = 159 

29.4 

Overweight women 0.99 (0.60; 1.64) 

Flatus Incontinence in Women 

van Brummen, 2006 23.7, 1 year postpartum 1.00 (1.00; 1.00) 662

N = 487 

30 

24.8, 1 year postpartum 1.08 (1.02; 1.13)* 

Abramov, 2005 ≥30 1.06 (0.65; 1.72) 226

N = 542 

26-86 

25–30 1.40 (0.91; 2.16) 

Uustal Fornell, 2004 Obese BMI >30 1.80 (1.00; 3.10) 185

N = 930 Obese 

1,304 Overweight 

>40 

Overweight >25 BMI 1.70 (1.20; 2.40)* 
Table 29. Association between FI and diet, BMI, and diabetes (continued) 

155

Author 

Sample Age Level of Risk Factors in Population 

Groups 

Odds Ratio 

95% CI 

Liquid Feces Incontinence in Women

Uustal Fornell, 2004 Obese BMI >30 2.50 (1.40; 4.20)* 185

N = 930 Obese 

1,304 Overweight 

>40 

Overweight >25 BMI 1.40 (0.90; 2.00) 

Solid Feces Incontinence in Women

Uustal Fornell, 2004 Obese BMI >30 1.30 (0.50; 3.80) 185

N = 930 Obese 

1,304 Overweight 

>40 

Overweight >25 BMI 1.20 (0.60; 2.40) 

Diabetes Mellitus

AI in Women

Richter, 2005208

N = 180 

16-55 Diabetes and morbid obesity before 

laparoscopic weight loss surgery 

0.59 (0.27; 1.31) 

Boreham, 2005212

N = 457 

18-64 Diabetes 1.54 (0.49; 4.80) 

Chen, 2003213

N = 1,253 

≥20 Diabetes mellitus 1.90 (0.90; 4.10) 

Combined Incontinence in Men and Women

Nelson, 20054

N = 8,170 

84 Diabetes, nursing homes, men and women 1.00 (1.00; 1.00) 

Nakanishi, 199758

N = 1,405 

>65 Men and women with diabetes 0.26 (0.05; 1.23) 

FI 

Quander, 2005216

N = 6,099 

>65 Men and women with diabetes 1.70 (1.40; 2.10)* 

Prevalence in women with diabetes 1.09 (0.63; 1.87) 

Incidence in women with diabetes 1.30 (0.91; 1.87) 

Prevalence in men with diabetes 2.49 (1.32; 4.69)* 

Ostbye, 2004186

N = 8,949 

>65 

Incidence in men with diabetes 1.32 (0.81; 2.15) 

Nelson, 20054

N = 8,170 

84 Men and women with diabetes, nursing 

homes 

1.00 (1.00; 1.00) 

Men and women with diabetes, nursing 

homes 1992 

Nelson, 1998 1.00 (1.00; 1.00) 3

N = 18,224 

84 

Men and women with diabetes, nursing 

homes 1993 

1.00 (1.00; 1.00) 

Nakanishi, 1997 Men and women with diabetes 1.00 (0.47; 2.12) 58

N = 1,405 

>65 

Men and women with diabetes 3.08 (1.16; 8.17)* 

Kalantar, 2002217

N = 642 

>18 Men and women with diabetes 2.07 (0.68; 6.32)* 

Diet

Combined Incontinence

FI 2.23 (1.24; 3.98)* 

FI 

Prevalence in women coffee drinker 1.13 (0.78; 1.62) 

Incidence in women coffee drinker 1.08 (0.82; 1.43) 

Prevalence in men coffee drinker 2.03 (1.05; 3.90)* 

Ostbye, 2004186

N = 8,949 

>65 

Incidence in men coffee drinker 1.06 (0.70; 1.61) 

Bold - multivariate odds ratios 

* Significant difference 
156

Table 30. Association between FI, smoking, and pulmonary diseases 

Author 

Sample Age Definition of Fecal 

Incontinence 

Risk Factor in Population 

Groups 

Odds Ratio 

(95% CI) 

Smoking 

Richter, 2005208

N = 180 

16-55 AI Current smoker women with 

morbid obesity before 

laparoscopic weight loss surgery 

0.58 (0.18; 1.84) 

Abramov, 2005226

N = 542 

26-86 FI Smoking women 1.72 (0.79; 3.73) 

Women smoked <1 pack/day 1.02 (0.75; 1.38) 

Women smoked 1+ pack/day 1.23 (0.83; 1.82) 

Men smoked <1 pack/day 0.33 (0.17; 0.63)* 

Men smoked 1+ pack/day 0.59 (0.32; 1.11) 

Women smoked <1 pack/day 0.85 (0.56; 1.29) 

Women smoked 1+ packs/day 1.33 (0.8; 2.2) 

Men smoked <1 pack/day 0.42 (0.23; 0.78)* 

Ostbye, 2004186

N = 8,949 

>65 Incidence of FI 

Men smoked 1+ pack/day 0.67 (0.37; 1.2) 

Bradley, 2005125

N = 297 

Mean 

age of 

68.2 

Fecal urgency Smoking Women 2.9 (0.7; 11.7) 

Guise, 2007218

N = 8,774 

 Severity, 

incontinence of 

stool 

Current smoking women 1.85 (1.46; 2.35)* 

Hojberg, 2000227

N = 1,726

≥15 Severity, isolated 

flatus incontinence 

at least once a 

week 

Smoking men and women 1 (0.7; 1.3) 

Abramov, 2005226

N = 542 

26-86 Flatus incontinence Smoking women 0.95 (0.55; 1.62) 

>40 Flatus incontinence Smoking women 0.90 (0.60; 1.40) 

Liquid feces 

incontinence 

Smoking women 0.70 (0.40; 1.10) 

Uustal Fornell, 2004185

N = 885 >40 

Solid feces 

incontinence 

Smoking women 0.60 (0.10; 0.80)* 

Pulmonary Diseases 

Richter, 2005208

N = 180 

16-55 AI Sleep apnea in women with 

morbid obesity before 

laparoscopic weight loss surgery 

1.46 (0.75; 2.82) 

Huang, 2006187

N = 345 

 AI Women with chronic obstructive 

pulmonary disease 

2.08 (1.18; 3.69)* 

Stenzelius, 2004114

N = 4,277 

>75 Combined 

incontinence 

Men and women with protracted 

coughing 

1.65 (1.17; 2.32)* 

Uustal Fornell, 2004 Liquid incontinence Women with chronic bronchitis 3.50 (1.30; 9.90)* 185

N = 885 

>40 

Solid incontinence Women with chronic bronchitis 2.20 (0.00; 13.30) 

Bold - multivariate odds ratios 

* Significant difference 
157

Table 31. Association between FI and muscle-skeletal diseases 

Author Age Fecal Incontinence Risk Factors in Population 

Groups 

Odds Ratio 

(95% CI) 

Richter2005208

N = 180 

16-55 AI Arthritis in women with morbid 

obesity before laparoscopic 

weight loss surgery 

1.64 (0.76; 3.55) 

Combined incontinence Arthritis in men and women in 

nursing homes 

Nelson, 2005 0.80 (0.60; 1.00) 4

N = 8,170 

84 

FI Arthritis in men and women in 

nursing homes 

0.80 (0.70; 1.00) 

Nelson19983

N = 18,224 

84 FI Arthritis in men and women in 

nursing homes, 1992 

0.90 (0.80; 1.00) 

Chiarelli, 2003658

N = 568 

15-44 FI Joint hyper mobility at 12 months 

postpartum 

2.75 (1.05; 7.19) 

Prevalence of FI Arthritis in women 1.43 (0.97; 2.1)

Incidence of FI Arthritis in women 1.17 (0.86; 1.59) 

Prevalence of FI Arthritis in men 1.29 (0.76; 2.81) 

Incidence of FI Arthritis in men 0.96 (0.66; 1.39) 

FI Arthritis in men and women in 

nursing homes, 1993 

0.80 (0.70; 0.90)* 

Prevalence of FI Foot and ankle trouble in women 2.01 (1.18; 3.44)* 

Incidence of FI Foot and ankle trouble in women 1.15 (0.79; 1.67) 

Prevalence of FI Foot or ankle trouble in men 2.01 (1.18; 3.44)* 

Ostbye, 2004186

N = 8,949 

>65 

Incidence of FI Foot or ankle trouble in men 1.15 (0.79; 1.67) 

Severity, soils underwear or 

floor 

Lower back pain/sciatica in men 

and women 

Bliss, 2004 1.5 (1.1; 2.1) 158

N = 1,352 

75 

Type, liquid FI Arthritis in men and women 1.8 (1.2; 2.7)* 

Bold - multivariate odds ratios 

* Significant difference 
158

Table 32. Association between FI and comorbidities 

Author 

Sample Age Definition of Fecal 

Incontinence Risk Factors in Population Groups Odds Ratio 

(95% CI) 

Curless, 1994702

N = 31 

25-93 FI Colorectal cancer in men and women 3.4 (1.5; 7.6)* 

Kalantar, 2002217

N = 642 

>18 FI Radiation treatment to lower 

abdomen or pelvis in men and 

women 

2.72 (0.83; 8.89) 

Goode, 2005 FI Swelling in feet and legs in men 3.49 (1.8; 6.76)* 219

N = 501 FI transient ischemic attack/mini-stroke 

in men 

3.11 (1.3; 7.41)* 

Combined incontinence Heart disease in men and women in 

nursing homes 

Nelson, 2005 1.00 (1.00; 1.00) 4

N = 8,170 

84 

FI Heart disease in men and women in 

nursing homes 

1.00 (1.00; 1.00) 

FI Heart disease in men and women in 

nursing homes, 1992 

Nelson, 1998 0.90 (0.80; 1.00) 3

N = 18,224 

84 

FI Heart disease in men and women in 

nursing homes, 1993 

1.00 (1.00; 1.00) 

Richter, 2005208

N = 180 

16-55 AI Hypertension in women with morbid 

obesity before laparoscopic weight 

loss surgery 

1.04 (0.55; 1.98) 

Chen, 2003213

N = 1,253 

≥ 20 AI Hypertension in women 2.4 (1.2; 4.9)* 

Melville, 2005 FI High medical comorbidity in women 2.58 (1.66; 4.01)* 163

N = 6,888 

30 - 90 

FI Moderate medical comorbidity in 

women 

1.76 (1.13; 2.73)* 

Goode, 2005219

N = 499 

 FI Charlson Comorbidity Scale score in 

women 

1.29 (1.07; 1.55)* 

Prevalence of FI Kidney diseases in women 1.46 (0.95; 2.24) 

Incidence of FI Kidney diseases in women 1.48 (1.05; 2.09)* 

Prevalence of FI Kidney diseases in men 1.70 (0.85; 3.87) 

Ostbye, 2004186

N = 8,949 

>65 

Incidence of FI Kidney diseases in men 1.94 (1.15; 3.27)* 

Bold - multivariate odds ratios 

* Significant difference 
159

Table 33. Association between FI and stroke 

Author 

Sample Age Stroke in Population Groups Odds Ratio 

(95% CI) 

Combined Incontinence 

Nelson, 20054

N = 8,170 

84 Men and women after stroke in nursing homes 1.00 (1.00; 1.00) 

Nakanishi, 199758

N = 1,405 

>65 Men and women after stroke 5.39 (2.23; 13.05)* 

FI 

Prevalence of FI in men after stroke 1.44 (0.59; 3.53) 

Incidence of FI in men after stroke 1.14 (0.64; 2.04) 

Prevalence of FI in women after stroke 1.54 (0.78; 3.07) 

Ostbye, 2004186

N = 8,949 

>65 

Incidence of FI in women after stroke 2.07 (1.44; 2.98)* 

Dysphagia 7-10 days after stroke in men and women 2.16 (1.2; 3.8)* 

Glasgow Coma Score ≥15 7-10 days after stroke in 

men and women 

1 (1; 1) 

Glasgow Coma Score <15 7-10 days after stroke in 

men and women 

2.84 (1.6; 5)* 

Harari, 2003221

N = 1,069 

Initial UI 7-10 days after stroke in men and women 17.96 (8.8; 36.8)* 

Brittain, 2006222

N = 38,633 

≥40 Men and women after stroke 1.33 (1.01; 1.76) 

Visual and/or sensory neglect 3 months after stroke 

in men and women 

Harari, 2003 0.98 (0.2; 5.3) 221

N = 846 

N = 1,069 Visual field defect 7-10 days after stroke in men and 

women 

2.69 (1.6; 4.6)* 

10mm increase in lesion size 6 months after stroke in 

men and women 

1.30 (1.17; 1.47)* 

10-year increase in age at stroke in men and women 

(FI was measured 6 months after stroke) 

1.45 (1.09; 1.93)* 

Nakayama, 1997220

N = 935 

75 

Diabetes in men and women 6 month after stroke 2.20 (1.14, 4.28)* 

Harari, 2003 Initial UI 3 months after stroke in men and women 3.34 (0.6; 6.6) 221

N = 846 3 months after 

stroke 

Need for assistance with toilet access 3 months after 

stroke in men and women 

3.49 (1.4; 17.3)* 

Other disabling diseases 6-month after stroke in men 

and women 

Nakayama, 1997 2.07 (1.07; 3.99)* 220

N = 935 

75 

Severity of stroke 6 months after stroke in men and 

women 

0.36 (0.29; 0.45) 

Quander, 2005216

N = 6,099 

>65 Stroke in men and women 2.80 (2.20; 3.50)* 

Stroke in men and women in nursing homes (8,170) 1.00 (1.00; 1.00) 

Stroke in men and women in nursing homes, 1992 

(18,224) 

1.30 (1.20; 1.50)* 

Nelson, 20054

N = 8,170 

N = 18,224 

84 

Stroke in men and women in nursing homes, 1993 

(18,224) 

1.20 (1.10; 1.30)* 

Stroke in men and women 10.58 (5.81; 

19.28)* 

Nakanishi, 199758

N = 1,405 

>65 

Stroke in men and women 4.85 (1.43; 16.41)* 

Bold - multivariate odds ratios 

* Significant difference 
160

Table 34. Association between FI and functional status of residents in nursing homes 

Author 

Sample Risk Factors of Fecal Incontinence Odds Ratio 

(95% CI) 

Combined UI and FI 

Dementia 1.80 (1.40; 2.20)* 

Dependency in dressing 2.00 (1.50; 2.70)* 

Dependency in eating 1.60 (1.30; 2.10)* 

Dependency in hygiene 1.60 (1.20; 2.20)* 

Impaired vision 1.00 (1.00; 1.00) 

Trunk restraints 2.90 (2.00; 4.30)* 

Tube feeding 1.00 (1.00; 1.00) 

Depression 1.00 (1.00; 1.00) 

Nelson, 20054

N = 8,170 

Dementia 1.70 (1.40; 2.00)* 

Nelson, 1998 Dementia, 1992 1.50 (1.40; 1.70)* 3

N = 18,224 Dementia, 1993 1.40 (1.30; 1.50)* 

Dependency in dressing 1.90 (1.50; 2.50)* 

Dependency in eating 1.50 (1.20; 1.90)* 

Dependency in hygiene 1.50 (1.10; 1.90)* 

Impaired vision 1.00 (1.00; 1.00) 

Trunk restraints 2.50 (1.70; 3.60)* 

Nelson, 20054

N = 8,170 

Tube feeding 1.00 (1.00; 1.00) 

Bed mobility, 1993 2.10 (1.90; 2.30)* 

Dependency in dressing, 1992 1.00 (1.00; 1.00) 

Dependency in eating, 1992 4.10 (3.80; 4.40)* 

Dependency in hygiene, 1992 2.50 (2.00; 3.00)* 

Impaired vision, 1992 1.50 (1.40; 1.70)* 

Dependency in locomotion,1992 1.10 (1.00; 1.20) 

Loss of activities of daily living,1992 6.00 (4.70; 7.70)* 

Toilet use, 1992 5.20 (4.40; 6.10)* 

Transferring, 1992 1.00 (1.00; 1.00) 

Trunk restraints, 1992 3.20 (4.70; 7.70)* 

Tube feeding, 1992 7.60 (5.60; 10.40)* 

Bed mobility, 1993 2.20 (2.00; 2.40)* 

Dependency in dressing, 1993 1.50 (1.20; 1.90)* 

Dependency in eating, 1993 4.10 (3.80; 4.40)* 

Dependency in hygiene, 1993 2.20 (1.80; 2.70)* 

Impaired vision, 1993 1.40 (1.30; 1.50)* 

Dependency in locomotion, 1993 1.00 (1.00; 1.00) 

Loss of activities of daily living, 1993 7.30 (5.50; 9.70)* 

Toilet use, 1993 3.90 (3.30; 4.60)* 

Transferring, 1993 1.00 (1.00; 1.00) 

Trunk restraints, 1993 3.00 (2.70; 9.80)* 

Nelson, 19983

N = 18,224 

Tube feeding, 1993 8.80 (6.30; 12.30)* 

Nelson, 20054

N = 8,170 

Depression 1.00 (1.00; 1.00) 

Nelson, 1998 Depression, 1992 1.00 (1.00; 1.00) 3

N = 18,224 Depression, 1993 0.90 (0.80; 1.00) 

Ouslander, 1993 1 year vs. 2 months length of stay in nursing home 5.194 (2.844; 9.483)* 166

N = 430 1 year vs. 2 weeks length of stay in nursing home 7 (3.755; 13.048)* 

Bold - multivariate odds ratios 

* Significant difference 
161

Table 35. Association between FI with functional status and mental health in adults 

Author 

(Sample) Age Risk Factors in Population Groups Odds Ratio 

95% CI 

Combined UI and FI in Men and Women 

Definition of incontinence - difficulty talking 2.13 (1.56; 2.93)* 

Definition of incontinence - difficulty walking 1.37 (0.98; 1.93) 

Memory problems 2.26 (1.48; 3.46)* 

Mobility limitation 1.40 (1.02; 1.92) 

Edema in legs 1.74 (1.30; 2.33)* 

Stenzelius, 2004114

(N = 4,277) 

>75 

Slow-healing wounds 1.94 (1.34; 2.81)* 

Anxiety 1.13 (0.57; 2.23) 

Dementia 15.37 (3.77; 62.67)* 

Poor general health 9.44 (4.41; 20.19)* 

Restricted social activity 2.92 (0.96; 8.91) 

Nakanishi, 199758

(N = 1,405) 

>65 

Life not worth living 1.65 (0.89; 3.03) 

Endo, 2002661 (N = 605) Need help in instrumental activity of daily living 0.821 (0.777; 0.867) 

FI

Anxiety 1.32 (0.83; 2.1) 

Anxiety 1.1 (0.47; 2.58) 

Dementia 22.82 (9.22; 56.45)* 

Nakanishi, 199758

(N = 1,405) 

>65 

Dementia 0.01 (0; 2.48) 

Johanson, 1997224 (N = 

388) 

31-103 Dementia 2.1 (1.6; 2.6)* 

History of dementia 2.1 (1.2; 3.5) 

Mini-Mental Status Examination (MMSE) ≥15 1 (1; 1) 

Mini-Mental Status Examination (MMSE) score <15 2.5 (1.4; 4.4)* 

Chassagne, 1999223

(N = 1,186) 

≥60 

Neurological diseases 1.9 (1; 3.4) 

Cognitive status 3MS <78 in women 1.8 (1.02; 3.2) 

Cognitive status 3MS <78 in men 1.28 (0.65; 2.54) 

Cognitive status3MS <50 in women 2.55 (0.26; 25.27) 

Cognitive status3MS <50 in men 6.29 (0.56; 71.2) 

Cognitive status 3MS <78 in women 0.22 (0.05; 0.89)*

Cognitive status 3MS <78 in men 1.03 (0.42; 2.52)

Cognitive status3MS <50 in women 1.04 (0.12; 8.75)

Ostbye, 2004186 (N = 8,949) >65 

Cognitive status3MS <50 in men 4.57 (2.01; 10.35)*

Stenzelius, 2004114 (N = 

4,277) 

>75 Fatigue 1.77 (1.13; 2.77)* 

Goode, 2005219 (N = 501) Men living alone 2.38 (1.23; 4.62)* 

Chassagne1999223

(N = 1,186) 

≥60 Decreased mobility (severe/mild physical activity 

impairment) 

1.8 (1.1; 3)* 

Johanson1997224 (N = 388) 31-103 Restricted mobility 1.5 (1.2; 1.9)* 

No life worth living 1.74 (0.69; 4.39) 

No participation in social activity 0.84 (0.34; 2.06) 

Poor general health 10.82 (6.8; 17.22)* 

Poor general health 2.34 (0.99; 5.53) 

Nakanishi199758

(N = 1,405) 

>65 

>65 

Social activity 4.75 (2.68; 8.43)* 

Brittain, 2006222 (N = 

38,633) 

≥40 Functional limitations 4.02 (3.27; 4.95)* 

Endo2002661 (N = 533) Modifecal incontinence Cumulative Illness Rating 

Scale (CIRS) 

1.204 (1.056; 

1.373)* 

Kalantar2002217 (N = 642) >18 Fair/poor general health 2.74 (1.18; 6.36)* 

Poor self-perceived health status in women 1.88 (1.01; 3.5)* 

Poor self-perceived health status in men 2.18 (1.13; 4.2)* 

Geriatric depression scale score ≤5 in men 1 (1; 1) 

Goode2005219

(N = 501 men and 499 

men) 

Geriatric depression scale score >5 in men 2.83 (1.27; 6.28)* 

Melville2005163 (N = 6,888) 30-90 Major depression in women 2.73 (1.67; 4.51)* 

Bold - multivariate odds ratios; italic - incidence of incontinence; underlined - prevalence of fecal incontinence 

* Significant difference 
162

Table 36. Association between FI and gastrointestinal conditions in adults 

Author 

Sample Age Risk Factors in Population Groups Odds Ratio 

(95% CI) 

AI in women 

Boreham, 2005212

N = 457 

18-64 Constipation 2.11 (1.22; 3.63)* 

Huang, 2006187

N = 345 

 Frequent constipation 2.09 (1.39; 3.16)* 

Boreham, 2005212

N = 457 

18-64 Hemorrhoid surgery 1.22 (0.36; 4.13) 

Meschia, 2002211

N = 881 

58.6 Hemorrhoid surgery 2.70 (1.10; 7.00)* 

Huang, 2006187 Irritable bowel syndrome, White women 3.21 (2.1; 4.89)* 

Meschia, 2002211

N = 881 

58.6 Irritable bowel syndrome 6.30 (3.50; 11.50)* 

Boreham, 2005212

N = 457 

18-64 Irritable bowel syndrome 3.22 (1.75; 5.93)* 

Combined UI and FI in Men and Women

Constipation 1.44 (1.06; 1.94)* 

Diarrhea 7.72 (5.80; 10.29)* 

Stenzelius, 2004114

N = 4,277 

>75 

Definition of incontinence difficulty 

swallowing 

1.63 (1.18; 2.26)* 

FI in Women 

Constipation 1.1 (0.8; 1.5) 

Diarrhea 2.4 (1.6; 3.6)* 

Diarrhea ± constipation 1.7 (0.98; 3) 

Irritable bowel syndrome 1.9 (1.3; 2.7)* 

Urgency, no diarrhea or constipation 5.1 (3.7; 7.1)* 

Anal abscess 1.1 (0.5; 2.4) 

Anal fissure 1.2 (0.9; 1.8) 

Anal fistula 2.5 (1.2; 5.2)* 

Bharucha, 2006225

N = 2,800 

≥20 

Cholecystectomy 1.4 (1.02; 1.9)* 

Goode, 2005219

N = 499 women and 501 

men 

 Chronic diarrhea 4.55 (2.03; 10.2)* 

Chiarelli, 2003658

N = 568 

15-44 Constipation at twelve months postpartum 2.46 (1.11; 5.46)* 

FI in Men and Women

Stenzelius, 2004 Abdominal pain 1.86 (1.15; 3.01)* 114

N = 4,277 

>75 

Diarrhea 6.77 (4.20; 10.90)* 

Hard or lumpy stool 1.52 (0.8; 2.88) 

Incomplete evacuation 3.72 (1.99; 6.96)* 

Loose or watery stools 4.89 (2.56; 9.33)* 

Straining on defecation 1.63 (0.85; 3.13) 

Kalantar, 2002217

N = 642 

>18 

Urgency 5.57 (2.95; 10.51)* 

Goode, 2005219

N = 501 men 

 Chronic diarrhea in men 6.08 (2.29; 16.16)* 

Johanson, 1997 Frequent diarrhea 2.4 (1.3; 4.6)* 224

N = 388 

31-103 

Watery stool 1.8 (1; 3) 

Bold - multivariate odds ratios 

* Significant difference 
163 

Table 37. Association between FI and prostate diseases 

Author 

Sample Age 

Incontinence 

and Bowel 

Symptoms 

Risk Factors Odds Ratio 

(95% CI) 

Adolfsson, 1998180

N = 359 

50-80 FI Not reporting any treatment for prostate 

diseases 

2.20 (0.40; 11.00)

Goode, 2005219

N = 501 

 FI Prostate diseases 2.29 (1.04; 5.02)* 

Treatment for prostate cancer; endocrine 3.20 (0.80; 12.10)

Treatment for prostate cancer; endocrine 

treatment subsequent to external 

radiation or radical prostatectomy 

1.80 (0.30; 12.40)

Treatment for prostate cancer; external 

radiation 

3.80 (0.90; 15.90)

Treatment for prostate cancer; 

prostatectomy 

5.30 (1.40; 20.20)*

Adolfsson, 1998180

N = 359 

50-80 FI 

Prostate cancer 3.10 (1.30; 8.00)*

Baseline fecal incontinence before 

extrafascial perineal prostatectomy for 

Stage cT1-cT3N0M0 prostate cancer 

FI 6.02 (2.29; 15.80)*

Prostate volume before extrafascial 

perineal prostatectomy for Stage cT1-

cT3N0M0 prostate cancer 

1.02 (1.00; 1.05) 

Baseline FI before extrafascial perineal 

prostatectomy for Stage cT1-cT3N0M0 

prostate cancer 

3.96 (1.27; 12.39)*

KirschnerHermanns, 2005676

N = 132 

63.4 

Severe FI 

Positive surgical margins after 

extrafascial perineal prostatectomy for 

Stage cT1-cT3N0M0 prostate cancer 

7.22 (2.05; 25.44)*

Bleeding with 

bowel 

movements 

5 years radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

Potosky, 2004 0.58 (0.31; 1.06) 678

N = 1,187 

55-82 

Bothered by 

frequent bowel 

movement to 

pain, or urgency 

5 years radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

1.23 (0.52; 2.89) 

Potosky, 2000677

N = 1,591 

55-79 Bothered by 

frequent bowel 

movement, pain, 

or urgency 

2 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.68 (0.31; 1.50) 

Adolfsson, 1998180 50-80 Bowel urgency Not reporting any treatment for prostate 

disease 

1.00 (0.40; 2.40) 

Potosky, 2000677

N = 1,591 

55-76 Bowel urgency 2 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.40 (0.27; 0.59)* 

Potosky, 2004678

N = 1,187 

55-76 Bowel urgency 5 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.56 (0.36; 0.87)* 

Treatment for prostate cancer: endocrine 1.30 (0.50; 3.30) 

Treatment for prostate cancer: endocrine 

treatment subsequent to external 

radiation or radical prostatectomy 

2.50 (0.90; 6.90) 

Treatment for prostate cancer: external 

radiation 

2.40 (0.90; 6.20) 

Treatment for prostate cancer: 

prostatectomy 

0.90 (0.10; 6.00) 

Prostate cancer 1.50 (0.80; 2.70) 

Bowel urgency 

No prostate cancer 1.00 (1.00; 1.00) 

Not reporting any treatment 1.70 (0.70; 4.20) 

Adolfsson, 1998180

N = 359 

50-80 

Constipation 

Treatment for prostate cancer: endocrine 1.00 (0.30; 3.60) 
Table 37. Association between FI and prostate diseases (continued)

164

Author 

Sample Age 

Incontinence 

and Bowel 

Symptoms 

Risk Factors Odds Ratio 

(95% CI) 

Treatment for prostate cancer: endocrine 

treatment subsequent to external 

radiation or radical prostatectomy 

3.90 (1.40; 10.40)*

Treatment for prostate cancer: external 

radiation 

2.00 (0.60; 6.90) 

Treatment for prostate cancer: 

prostatectomy 

2.20 (0.50; 9.40) 

With prostate cancer 1.80 (0.90; 3.80) 

Without prostate cancer 1.00 (1.00; 1.00) 

5 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

Potosky, 2004 0.84 (0.55; 1.26) 678

N = 1,187 

55-74 Diarrhea 

5 years radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.70 (0.41; 1.22) 

Diarrhea 2 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

Potosky, 2000 0.50 (0.34; 0.72)* 677

N = 1,591 

55-74 

Painful bowel 

movements 

2 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

1.00 (0.58; 1.80) 

Potosky, 2004678

N = 1,187 

55-75 Painful bowel 

movements 

5 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

1.31 (0.73; 2.35) 

Potosky, 2000677

1,591N = 

55-78 Painful 

hemorrhoids 

2 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.38 (0.23; 0.64)* 

Painful 

hemorrhoids 

5 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.43 (0.25; 0.74)*

Passing mucus 

from rectum 

5 years radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.36 (0.20; 0.66)*

Potosky, 2004678

N = 1,187 

55-78 

Tenderness 

during bowel 

movements 

5 years radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.85 (0.46; 1.56) 

Potosky, 2000677

N = 1,1591 

55-77 Wetness in rectal 

area 

2 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.63 (0.40; 0.99)* 

Potosky, 2004678

N = 1187 

55-77 Wetness in rectal 

area 

5 years after radical prostatectomy vs. 

external beam radiotherapy for localized 

prostate cancer 

0.75 (0.47; 1.20) 

Bold - multivariate odds ratios 

* Significant difference 
165 

Table 38. Association between FI and anal trauma in females 

Author 

Sample Age Definition of 

Incontinence Risk Factor Odds Ratio 

(95% CI) 

Faltin, 2001232

N = 1,228 

15-93 AI Anal sphincter tear in women 4.4 (2; 9.1)* 

Kalantar, 

2002217

N = 642 

>18 FI Perianal injury in men and 

women 

2.62 (1.11; 6.23)* 

Bharucha, 2006225

N = 2,800 

≥20 FI Non childbirth anal injury in 

women 

2.4 (1.3; 4.5)* 

Faltin, 2006695

N = 540 

 Severity, at least 2 

symptoms at least once 

a week or 3 symptoms 

(symptoms: 

incontinence to flatus, 

liquid or solid stool; 

need to wear a pad; 

lifestyle alteration) 

Anal sphincter tear 18 years 

after rupture of anal sphincter 

during childbirth 

1.7 (1; 2.8) 

Anal sphincter defect in 

women 

16.10 (6.80; 38.20)* 

Anal sphincter defect on 

ultrasonography and pelvic 

floor disorders vs. no defect in 

women 

36.40 (12.00; 114.00)*

Anal sphincter defect on 

ultrasonography and pelvic 

floor disorders vs. no defect in 

women 

5.90 (3.00; 11.00) 

Anal sphincter injury in stage 0 

or I pelvic organ prolapse and 

no UI in women 

7.20 (1.80; 28.10)* 

Nichols, 2005679

N = 190 

53 Bothersome AI 

Anal sphincter injury in stage II 

pelvic organ prolapse and/or 

UI in women 

55.00 (13.00; 230.00)*

Bold - multivariate odds ratios 

* Significant difference 
166 

Table 39. Association between FI and UI 

Author 

Sample Age Risk Factors Odds Ratio 

(95% CI) 

AI

Boreham, 2005212 

N = 457 

18-64 UI 2.66 (1.65; 4.28)* 

Meschia, 2002211 

N = 881 

58.6 Detrusor instability 2.30 (1.20; 4.10)* 

Ng, 2002210 

N = 320 

 Genuine stress incontinence 1.19 (0.42; 3.40) 

Meschia, 2002211 

N = 881 

58.6 Genuine stress incontinence 1.60 (1.10; 2.30)* 

Ng, 2002210 

N = 320 

 Mixed incontinence 1.80 (0.56; 5.77) 

Meschia, 2002211 

N = 881 

58.6 Mixed incontinence 2.30 (1.30; 3.90)* 

Ng, 2002210 

N = 320 

 Overactive bladder 1.10 (0.42; 2.88) 

Chen, 2003213 

N = 1,253 

≥20 Overactive bladder 3.2 (1.6; 6.7)* 

Nichols, 2004681 

N = 100 

57 Pelvic organ prolapse and urinary incontinence 

vs. UI only or pelvic organ prolapse only 

2.72 (1.20; 6.10)* 

Chen, 2003213 

N = 1,253 

≥20 Stress UI 1.5 (0.7; 3) 

Richter, 2005208 

N = 180 

16-55 UI in women with morbid obesity before 

laparoscopic weight loss surgery 

6.34 (2.52; 

15.93)* 

Meschia, 2002211 

N = 881 

58.6 UI 1.90 (1.30; 2.80)* 

Huang, 2006 UI, Asian women 2.22 (1.32; 3.76)* 187 

N = 345 UI, White women 3.38 (2.52; 4.53)* 

Combined UI

Stenzelius, 2004114 

N = 4,277 

>75 Urinary symptoms other than UI in men and 

women 

2.29 (1.69; 3.12)* 

FI

UI 1 year postpartum 0.83 (0.04; 17.05) 

Flow-stopping inability 1 year postpartum 1.22 (0.5; 2.92) 

Chiarelli, 2003658 

N = 568 

15-44 

UI 1 year postpartum 0.26 (0.02; 2.53) 

Brittain, 2006222 

N = 38,633 

≥40 UI in men and women 8.1 (6.62; 9.69)* 

UI 12 months postpartum 6.03 (2.37; 15.33)* 

UI before pregnancy 1.6 (0.58; 4.4) 

Chiarelli, 2003658 

N = 568 

15-44 

UI during pregnancy 0.66 (0.27; 1.61) 

Chassagne, 1999223 

N = 1,186 

≥60 History of UI in men and women 2.9 (1.8; 4.6)* 

Abramov, 2005226 

N = 542 

26-86 Stress UI 2.11 (1.12; 3.98)* 

Melville, 2005163 

N = 6,888 

30-90 UI 2.32 (1.7; 3.15)* 

Ballester, 20051622 

N = 103 

20-64 UI 6 (1.7; 21)* 

Goode, 2005219 

N = 499 

 UI 2.65 (1.34; 5.25)* 
Table 39. Association between FI and UI (continued) 

167

Author 

Sample Age Risk Factors Odds Ratio 

(95% CI) 

Flatus Incontinence 

Kjolhede, 2005683 

N = 508 

 Burch colposuspension for UI vs. healthy 

controls 14 years after surgery 

1.98 (1.17; 3.37)* 

Abramov, 2005226 

N = 542 

26-86 Stress UI 1.72 (1.14; 2.59)* 

Uustal Fornell, 2004185 

N = 885 

>40 UI 4.80 (3.00; 7.80)* 

Liquid Feces Incontinence

Bliss158 

N = 1,352 

Mean age 

of 75±6 

UI in men and women 2.9 (1.9; 4.2)* 

Kjolhede, 2005683 

N = 508 

 Burch colposuspension for UI vs. healthy 

controls 14 years after surgery 

3.67 (1.43; 9.42)* 

Uustal Fornell, 2004185 

N = 885 

>40 UI 4.90 (2.90; 8.70)* 

Mucus Incontinence

Bliss, 2004158 

N = 1,352 

Mean age 

of 75±6 

UI in men and women 3.6 (1.2; 12)* 

Solid Feces Incontinence 

Kjolhede, 2005683 

N = 508 

 Burch colposuspension for UI vs. healthy 

controls 14 years after surgery 

2.96 (0.42; 20.90) 

Uustal Fornell, 2004185 

N = 885 

>40 UI 5.90 (2.40; 14.60)*

Bold - multivariate odds ratios 

* Significant difference 
168 

Table 40. Association between FI and pregnancy related risk factors 

Author 

Sample Age Risk Factors Time from Exposure to 

Outcome 

Odds Ratio 

(95% CI) 

AI 

3rd or 4th degree laceration vs. no 

laceration 

1 (0.5; 2) 

Birth weight >4,000g vs. <4,000g 2.4 (1.3; 4.4)* 

Cesarean delivery vs. vaginal 0.6 (0.2; 2) 

Epidural analgesia vs. no analgesia 1.2 (0.7; 1.9) 

Episiotomy vs. no episiotomy 1 (0.4; 2.3) 

Forceps delivery vs. vaginal 1.2 (0.5; 2.9) 

Oxytocin augmentation vs. no 

oxytocin augmentation 

0.7 9 (0.3; 1.6) 

Casey, 2005202

N = 3,887 

Second stage >2 hours vs. <2 

hours 

Within 7 months of delivery, 

at or before their 6-month 

contraceptive followup after 

delivery 

0.4 (0.2; 1.1) 

Birth weight of baby (increment -

1kg) 

1.31 (0.34; 4.99) 

Head circumference of baby 

(increment cm) 

1.11 (0.74; 1.67) 

Narrow subpubic arch angle vs. 

normal 

8.69 (3.15; 23.94)*

Caesarean delivery vs. vaginal 0.31 (0.06; 1.62) 

Forceps delivery vs. no forceps 1.36 (0.35; 5.29) 

Second stage (hours) 0.89 (0.57; 1.39) 

Ultrasonic evidence of injury, 

perineal scar vs. no scar 

2.69 (0.7; 10.33) 

Frudinger, 2002692

N = 134 

22-39 

Ultrasonic evidence of injury, 

sphincter scar vs. no injury 

2.26 (0.69; 7.36) 

Episiotomy without extension into 

anal sphincter perineal injury vs. no 

episiotomy 

1.3 (0.9; 1.8) 

FI - degree tear perineal injury vs. 

no perineal injury 

1.2 (0.8; 1.7) 

Forceps delivery vs. vaginal 1.4 (1; 2.1) 

3rd or 4th-degree tear perineal 

injury vs. no injury 

2.1 (1.4; 3.1)* 

Vacuum delivery vs. vaginal 1.3 (0.9; 1.8) 

% of days perineal massage 

performed ≥67 days vs. <33 days 

0.8 (0.6; 1.1) 

% of days perineal massage 

performed 33-66 days vs. <33 days 

1 (0.8; 1.3) 

Episiotomy vs. no episiotomy 1.1 (0.8; 1.4) 

Infant birth weight, ≥4,000g vs. 

<4,000g 

1.2 (0.9; 1.6) 

Length of second stage of labor, 

≥1.5 hour (vaginal delivery only) vs. 

<0.5 hour 

0.9 (0.7; 1.2) 

Length of second stage of labor, 

0.5-0.9 hour (vaginal delivery only) 

vs. <0.5 hour 

0.8 (0.6; 1.2) 

Eason, 2002228

N = 252 

Length of second stage of labor, 1-

1.4 hour (vaginal delivery only) vs. 

<0.5 hour 

3 months postpartum 

0.8 (0.6; 1.2) 

External and internal anal sphincter 3 months after delivery 7.4 (1.7; 31.4)* 

defect vs. no defect 30 months after delivery 5.3 (1.2; 24.1)* 

Isolated external anal sphincter 3 months after delivery 6.2 (1.2; 32) 

defect vs. no defect 30 months after delivery 6.5 (1.3; 33.4) 

Faltin, 2001696

N = 100 

15-93 

Isolated internal anal sphincter 

defect 

3 months after delivery 1.9 (0.2; 18.7) 
Table 40. Association between FI and pregnancy related risk factors (continued) 

169

Author 

Sample Age Risk Factors Time from Exposure to 

Outcome 

Odds Ratio 

(95% CI) 

Anal sphincter tear (clinically 3 months after delivery 4.3 (1.9; 9.7)* 

diagnosed) vs. no tear 30 months after delivery 3.4 (1.2; 9.8)* 

Baby weight >4,000g vs. <4,000g 0.7 (0.4; 1.4) 

Clinically occult anal sphincter 3 months after delivery 3.8 (0.8; 17.1) 

tears vs. no tears 30 months after delivery 7.7 (1; 60.1) 

No subsequent delivery vs. delivery 

again 

 2.8 (1; 8.3) 

Operative delivery vs. no operative 

delivery 

1.6 (0.9; 2.7) 

Parity vs. nulliparity 3.1 (1.6; 6)* 

Transient shortly after 

delivery 

2 (1.4; 2.8)* 

3 months after delivery 1.9 (1.4; 2.6)* 

Sphincter defects diagnosed after 

endosonography 3 months after 

delivery vs. no defect 

30 months after delivery 1.9 (1.3; 2.8)* 

Boreham, 2005 Nulliparity vs. parity 0.63 (0.4; 0.99) 212

N = 457 

18-64 

Vaginal parity (per delivery) 1.16 (1; 1.35) 

10 years increase in maternal age 3.00 

(1.40; 6.40)* 

Zetterstrom, 

1999703

N = 349 

30 

Sphincter tear vs. no tear 

9 months postpartum 

2.40 

(1.04; 4.90)* 

AI at 5 months vs. anal continence 3.80 

(2.00; 7.30)* 

AI at 9 months vs. anal continence 4.30 

(2.20; 8.20)* 

Sphincter tear vs. no tear 2.30 

(1.10; 5.00)* 

Pollack, 2004209

N = 349 

30 

Subsequent childbirth 

Five years after first vaginal 

delivery 

2.40 

(1.10; 5.60)* 

Anal sphincter and rectal mucosa 

tears vs. intact perineum and 

superficial tears 

8.78 

(2.60; 134.10)* 

Pregazzi, 2002704

N = 218 

2,143 

Perineal muscle tears vs. intact 

perineum and superficial tears

Immediately after vaginal 

delivery 

1.48 (0.10; 14.60)

Cesarean delivery vs. spontaneous 

vaginal delivery 

0.61 (0.25; 1.53) 

Cesarean delivery with labor vs. 

vaginal delivery 

1.66 (0.83; 3.32) 

Lal, 2003698

N = 184 

28 

Cesarean delivery without labor vs. 

vaginal delivery 

10 months postpartum 

1.62 (0.81; 3.23) 

Huang, 2006187 History of 3rd or 4th degree vaginal 

tear vs. no tear, Asian American 

women 

2.41 (1.14; 5.1)* 

Number of Cesarean deliveries 0.84 (0.55; 1.29) 

Number of children 1.11 (0.86; 1.44) 

Richter, 2005208

N = 180 

16-55 

Number of vaginal deliveries 

Morbid obesity before 

laparoscopic weight loss 

surgery 1.18 (0.92; 1.53) 

Nichols, 2004681

N = 100 

57 Operative vaginal delivery vs. no 

operative 

3.75 

(1.60; 8.70)* 

Chen, 2003213

N = 1,253 

≥20 Parity ≥1 vs. nulliparity 3.4 (1.2; 9.5)* 

Peschers, 2003694

N = 100 

34 Vacuum vs. spontaneous vaginal 

delivery 

6-24 weeks postpartum 0.83 (0.36; 1.93) 

Ng, 2002210

N = 320 

 Vaginal delivery vs. no vaginal 

delivery 

1.09 (0.34; 1.25) 
Table 40. Association between FI and pregnancy related risk factors (continued) 

170

Author 

Sample Age Risk Factors Time from Exposure to 

Outcome 

Odds Ratio 

(95% CI) 

FI 

>1 pregnancy vs. no term 

pregnancy 

 2.26 

(1.22; 4.19)* 

>1 pregnancy and >1 vaginal 

delivery vs. no vaginal delivery 

 2.15 (0.97; 4.77) 

>1 pregnancy and >1 vaginal 

delivery vs.>1 pregnancy, no 

vaginal delivery 

1.93 (0.81; 4.60) 

>1 pregnancy and >1 vaginal 

delivery vs. no term pregnancy 

 2.41 

(1.30; 4.49)* 

>1 pregnancy and vaginal delivery 

vs. no term pregnancy 

 1.13 (0.43; 2.96) 

McKinnie, 2005657

N = 1,004 

42.7 

>1 pregnancy vs. no term 

pregnancy 

1.35 (0.69; 5.74) 

Extent of perineal damage (per 

grade: grade-IV vs. grade-IIIb vs. 

grade-IIIa) 

2.54 (1.45; 

4.45)* 

Mediolateral episiotomy, primiparity 

vs. no episiotomy 

0.17 (0.05; 0.61) 

Primiparity, without episiotomy 1.16 (0.41; 3.29) 

Subsequent vaginal delivery 2.32 (0.85; 6.33) 

Mediolateral episiotomy, multiparity 1.25 (0.27; 5.83) 

De Leeuw, 2001229

N = 250 

Primiparity, with episiotomy 

After anal sphincter damage 

during delivery 

0.15 

(0.02; 0.98)* 

Instrumental delivery vs. no 

instrumental delivery 

0.83 (0.31; 2.2) 

Marked abdominal striae 2.34 (0.91; 6.02) 

Multiparity vs. nulliparity 1.42 (0.53; 3.83) 

Chiarelli, 2003658

N = 568 

15-44 

Perineal trauma (tear with sutures 

and/or episiotomy) 

At 12 months postpartum 

1.67 (0.67; 4.14) 

Cesarean deliveries only 0.87 (0.42; 1.8) 

History of operative vaginal delivery 

vs. no history 

1.52 

(1.09; 2.12)* 

Mixed/unknown delivery types vs. 

vaginal 

1.44 (0.82; 2.54) 

Melville, 2005163

N = 6,888 

30 - 

90 

Nulliparity 1.35 (0.88; 2.08) 

Signorello, 2000 3 months postpartum 1.40 (0.40; 5.00) 697

N = 626 

 2nd/3rd/4th degree tear vs. 

intact/1st degree tear 6 months postpartum 1.20 (0.20; 6.40) 

van Brummen, 

2006662

N = 487 

30 3rd/4th degree tear vs. no tear 1 year after delivery 6.82 

(4.20; 11.00)* 

Age (years) 12 months instrumental 

delivery 

1.00 (1.00; 1.00) 

Birth weight (g) 18 months instrumental 

delivery 

1.00 (1.00; 1.00) 

Episiotomy vs. no episiotomy 16 months instrumental 

delivery 

1.00 (1.00; 1.00) 

Length of labor 15 months instrumental 

delivery 

1.00 (1.00; 1.00) 

Mazouni, 2005689

N = 159 

29.4 

3rd-degree tears 17 months instrumental 

delivery 

1.00 (1.00; 1.00) 

Sultan, 1993705

N = 124 

18-43 Any anal-sphincter defect after 

vaginal delivery vs. no defect 

 2.70 

(1.97; 3.71)* 

Sultan, 1993699

N = 90 

 Forceps delivery 1.81 (0.12; 27.72)

Abramov, 2005 At least 1 episiotomy 1.03 (0.45; 2.32) 226 26-86 

At least 1 forceps delivery 0.98 (0.4; 2.41) 
Table 40. Association between FI and pregnancy related risk factors (continued) 

171

Author 

Sample Age Risk Factors Time from Exposure to 

Outcome 

Odds Ratio 

(95% CI) 

At least 1 prolonged second stage 

of labor (>2 hrs) 

N = 274 1.12 (0.49; 2.54) 

At least 1 birth weight >4,000g 1.19 (0.56; 2.53) 

Abramov, 2005226

N = 346 

26-86 Cesarean only 0.39 (0.13; 1.04) 

Parity ≥2 3.09 

(1.25; 7.65)* 

Abramov, 2005226

N = 542 

26-86 

Parity, 1 1.32 (1; 2.3) 

van Brummen, Birth weight g 3107 vs. >3,445 0.99 (0.99; 1.01) 

2006662

N = 487 

30 

FI at 12 weeks gestation 

1 year after delivery 

2.60 

(0.90; 12.10) 

Breech delivery vs. vaginal 1.49 (0.42; 5.24) 

Caesarean section vs. vaginal 0.58 (0.35; 0.97) 

Forceps delivery 1.94 

(1.30; 2.89)* 

MacArthur, 

2001214

N = 7,879 

42.9 

Vacuum delivery 

3 months postpartum 

1.26 (0.77; 2.07) 

Number of births, ≥4 2.12 

(1.34; 3.35)* 

Number of births, 1 1.00 (1.00; 1.00) 

Number of births, 3 1.61 

(1.08; 2.41)* 

Number of births, 2 1.23 (0.85; 1.78) 

≥1 forceps 1.48 

(1.18; 1.87)* 

Macarthur, 2005215

N = 4,046 

Only Caesarean section(s) 

6 years postpartum 

1.04 (0.72; 1.50) 

Cesarean section only, no surgery 0.7 (0.3; 1.5) 

Vaginal delivery with forceps or 

stitches, no surgery 

1.2 (0.9; 1.6) 

Bharucha, 2006225

N = 2,800 

≥20 

Vaginal delivery without forceps or 

stitches, no surgery 

0.8 (0.5; 1.1) 

3 months postpartum 3.20 

(1.30; 7.90)* 

Episiotomy vs. 2nd/3rd/4th degree 

tear 

6 months postpartum 2.90 

(0.70; 11.20) 

3 months postpartum 5.50 

(1.80; 16.20)* 

Signorello, 2000697

N = 626 

Episiotomy vs. intact/1st degree 

tear 

6 months postpartum 3.70 

(0.90; 15.60) 

Meyer, 2000700

N = 107 

29 Forceps delivery vs. spontaneous 

delivery 

10 month after delivery 0.80 (0.75; 1.05) 

Incident 3-4 years after 

delivery 

Schraffordt Koops, 1.25 (0.69; 2.27) 

2003701 N = 479 

 Forceps delivery vs. spontaneous 

delivery 

3-4 years after delivery 0.80 (0.44; 1.44) 

Instrumental delivery 3.10 

(1.20; 7.90)* 

Internal anal sphincter defect 

thickness; partial (1 quadrant) 

2.10 (0.50; 10.70)

Internal anal sphincter defect 

thickness; partial (>1 quadrant) or 

full thickness 

5.10 (1.50; 22.90)*

Parity >3 1.40 (0.30; 5.50) 

Mahony, 2007230

N = 500 

18-46 

Parity 2 1.70 (0.60; 4.90) 

Number of children: ≥4 Prevalence 0.81 (0.49; 1.36) 

Incidence 0.79 (0.55; 1.14) 

Ostbye, 2004186

N = 8,949 

>65 

Number of children: 3 Prevalence 1.25 (0.73; 2.12) 
Table 40. Association between FI and pregnancy related risk factors (continued) 

172

Author 

Sample Age Risk Factors Time from Exposure to 

Outcome 

Odds Ratio 

(95% CI) 

Incidence 0.78 (0.51; 1.18) 

Number of children: 2 Prevalence 1.03 (0.62; 1.73) 

Incidence 0.89 (0.6; 1.31) 

Number of children: 1 Prevalence 1.07 (0.59; 1.95) 

Incidence 0.92 (0.58; 1.45) 

Borello-France, At 6 weeks postpartum 2.8 (1.8; 4.3)* 

2006231

N = 721 

 Sphincter tear 

At 6 months postpartum 1.9 (1.2; 3.2)* 

Borello-France, At 6 weeks postpartum 1.1 (0.49; 2.5) 

2006231

N = 472 

 Vaginal control 

At 6 months postpartum 1.01 (0.38; 2.71) 

Sphincter tear vs. vaginal delivery 

without anal sphincter tear 

6-12 months after delivery 4.40 

(1.60; 12.30)* 

Richter, 2006706

N = 251 

3rd vs. 4th degree tear of anal 

sphincter 

6-12 months after delivery 2.00 (0.70; 5.80) 

Incident 3-4 years after 

delivery 

Schraffordt Koops, 0.85 (0.48; 1.51) 

2003701

N = 479 

 Vacuum extraction vs. 

spontaneous delivery 

3-4 years after delivery 1.18 (0.66; 2.09) 

MacLennan, 20007

N = 3,010 

42.9 Vaginal vs. caesarean delivery 1.50 (0.50; 4.90) 

Fecal Soiling

Peschers, 2003694

N = 100 

34 Vacuum vs. spontaneous vaginal 

delivery 

6-24 weeks postpartum 0.68 (0.20; 2.32) 

Flatus

Augmentation 3 months postpartum 0.8 (0.2; 2.8) 

Epidural analgesia 3 months postpartum 0.9 (0.7; 1.3) 

Fetal head circumference 3 months postpartum 0.9 (0.6; 1.2) 

Fetal weight 3 months postpartum 2.9 (0.8; 10.2) 

First stage (reference) 3 months postpartum 1 

Mode of delivery 3 months postpartum 1.1 (0.6; 2.2) 

Perineal trauma 3 months postpartum 1 (1; 1) 

Second stage (active) 3 months postpartum 1 (1; 1) 

Chaliha, 1999205

N = 549 

17-46 

Second stage (passive) 3 months postpartum 1 (1; 1) 

Chaliha, 1999205

N = 549 

17-46 Didn't receive labor epidural 3 months postpartum 1 (1; 1) 

Signorello, 2000 3 months postpartum 0.80 (0.50; 1.40) 697

N = 626 

 2nd/3rd/4th degree tear v intact/1st 

degree tear 6 months postpartum 1.10 (0.50; 2.10) 

Wagenius, 2003693

N = 654 

 Anal sphincter rupture following 

vaginal delivery 

4 years after delivery 2.71 

(1.78; 4.15)* 

At least 1 episiotomy 1.22 (0.7; 2.11) 

At least 1 forceps delivery 0.76 (0.33; 1.21) 

At least 1 prolonged second stage 

of labor (>2 hours) 

1.04 (0.58; 1.78) 

Abramov, 2005226

N = 274 

26-86 

At least 1 birth weight >4kg 1.02 (0.63; 1.63) 

Abramov, 2005226

N = 346 

26-86 Cesarean only 0.92 (0.52; 1.56) 

Parity ≥2 2.72 

(1.65; 4.51)* 

Abramov, 2005226

N = 542 

26-86 

Parity, 1 2.27 

(1.28; 4.05)* 

Borello-France, At 6 weeks postpartum 1 (1; 1) 

2006231

N = 472 

 Cesarean control 

At 6 months postpartum 1 (1; 1) 

Borello-France, At 6 weeks postpartum 1.6 (1.1; 2.4)* 

2006231

N = 721 

 Sphincter tear 

At 6 months postpartum 1.7 (1.1; 2.7)* 
Table 40. Association between FI and pregnancy related risk factors (continued) 

173

Author 

Sample Age Risk Factors Time from Exposure to 

Outcome 

Odds Ratio 

(95% CI) 

Vaginal control, n = 721 At 6 weeks postpartum 1 (1; 1) 

Vaginal control, n = 472 At 6 weeks postpartum 1.3 (0.67; 2.6) 

Vaginal control, n = 721 At 6 months postpartum 1 (1; 1) 

Borello-France, 

2006231

Vaginal control, n = 472 At 6 months postpartum 0.48 (0.24; 

0.96)* 

Delivery by vacuum extractor 1.40 (0.50; 4.50) 

Large tear at delivery 1.80 (1.00; 3.30) 

Sphincter rupture 6.10 

(2.30; 16.50)* 

3 or more births 0.90 (0.60; 1.40) 

1.10 (0.40; 3.00) 

Uustal Fornell, 

2004185

N = 885 

>40 

Vaginal delivery 

1.50 (0.80; 2.70) 

3 months postpartum 2.10 

(1.30; 3.40)* 

Episiotomy vs. 2nd/3rd/4th degree 

tear 

6 months postpartum 2.10 

(1.20; 3.70)* 

3 months postpartum 1.70 (1.00; 2.80) 

Signorello, 2000697

N = 626 

Episiotomy vs. intact/1st degree 

tear 6 months postpartum 2.30 

(1.20; 4.30)* 

van Brummen, 

2006662

N = 487 

30 Flatus incontinence at 12 weeks 

gestation 

1 years postpartum 6.82 (4.20; 11.00)*

Peschers, 2003694

N = 100 

34 Vacuum vs. spontaneous vaginal 

delivery 

6-24 weeks postpartum 1 (0.375; 2.664) 

MacLennan, 20007

N = 3,010 

42.9 Vaginal vs. Caesarean delivery 1.80 (0.80; 3.80) 

Liquid Feces Incontinence

Delivery by vacuum extractor 2.00 (0.70; 6.00) 

Large tear at delivery 2.70 

(1.30; 5.50)* 

Sphincter rupture 4.20 (1.60; 11.30)*

3 or more births 1.00 (0.70; 1.50) 

0.80 (0.30; 2.10) 

Uustal Fornell, 

2004185

N = 885 

>40 

Vaginal delivery 

1.00 (0.50; 1.80) 

Peschers, 2003694

N = 100 

34 Vacuum vs. spontaneous vaginal 

delivery 

6-24 weeks postpartum 1 (0.236; 4.241) 

Wagenius, 2003693

N = 654 

 Anal sphincter rupture following 

vaginal delivery 

5 years after delivery 3.29 

(1.93; 5.60)* 

Solid Feces Incontinence

Wagenius, 2003693

N = 654 

 Anal sphincter rupture following 

vaginal delivery 

1.91 (0.71; 5.17) 

Delivery by vacuum extractor 1.20 (0.00; 7.50) 

Large tear at delivery 2.90 (0.60; 14.60)

Sphincter rupture 9.10 (3.00; 27.30)*

3 or more births 

6 years after delivery 

1.10 (0.50; 2.30) 

Uustal Fornell, 

2004185

N = 885 

>40 

Vaginal delivery 1.00 (0.30; 2.70) 

Peschers, 2003694

N = 100 

34 Vacuum vs. spontaneous vaginal 

delivery 

6-24 weeks postpartum 3.13 (0.31; 31.14)

Bold - multivariate odds ratios 

* Significant difference 
174 

Table 41. Association between risk of FI and severity of FI and factors related to pregnancy and birth 

Author 

Sample Age Fecal Incontinence Factors Related to Pregnancy and Birth Time From Exposure to Outcome 

Augmentation Epidural analgesia Fetal head circumference Fetal weight First stage (reference) Mode of delivery No perineal trauma Perineal trauma Second stage (active) 

3 months postpartum 

Chaliha, 1999205

N = 549 

17-46 Fecal urgency 

Second stage (passive) 3 months postpartum 

Abnormal results of pelvic floor muscle assessment; digital test 

Anal sphincter and rectal mucosa tears vs. intact perineum and superficial tears 

Immediately after vaginal delivery 

Pregazzi, 2002 

704

N = 218 

21-43 

Abnormal results of pelvic floor muscle assessment; vaginal manometry 

Anal sphincter and rectal mucosa tears vs. intact perineum and superficial tears 

immediately after vaginal delivery 

Anal sphincter tear Baby weight, ≤4,000g 

Faltin, 2001232

N = 1,228 

15-93 Fecal urgency 

Baby weight, >4,000g 

Borello-France231

N = 472 

 Fecal urgency Cesarean control 6 weeks postpartum 

Sultan, 1993699

N = 90 

 Urgency Forceps delivery 

Pain on opening bowels Instrumental delivery vs. Cesarean 6 weeks postpartum Constipation Instrumental delivery vs. Cesarean 6 weeks postpartum Increased passage of flatus Instrumental delivery vs. Cesarean 6 weeks postpartum 

Hemorrhoids Instrumental delivery vs. Cesarean 6 weeks postpartum 

Loss of control of bowels 6 weeks postpartum Pain on opening bowels Constipation Increased passage of flatus Hemorrhoids 

Liebling, 2004707

N = 393 

Loss of control of bowels 

Instrumental delivery vs. Cesarean 

1 year postpartum 

Faltin, 2001 Operative delivery 

232

N = 1,228 

15-93 Fecal urgency 

Parity 

Pregazzi, 2002704 21-43 Abnormal results of pelvic floor 

muscle assessment: digital test 

Perineal muscle tears vs. intact perineum and superficial tears 

Immediately after vaginal delivery 
Table 41. Association between risk of FI and severity of FI and factors related to pregnancy and birth (continued)

175

Author 

Sample Age Fecal Incontinence Factors Related to Pregnancy and Birth Time From Exposure to Outcome 

N = 218 Abnormal results of pelvic floor 

muscle assessment: vaginal manometry 

Borello-France, At 6 weeks postpartum 2006231N = 721, 

 Fecal urgency Sphincter tear 

At 6 months postpartum 

Peschers, 2003694

N = 100 

34 Fecal urgency Vacuum vs. spontaneous vaginal 

delivery 

6-24 weeks postpartum 

At 6 weeks postpartum At 6 months postpartum 

Borello-France, 2006231N = 472 

 Fecal urgency Vaginal control 

At 6 months postpartum 

Birth weight, >4,000g 18 years after rupture of ana

sphincter tear during childbir

Birth weight, 3,000-3,499g 18 years after rupture of ana

sphincter tear during childbir

Birth weight, 3,500-3,999g 18 years after rupture of ana

sphincter tear during childbir

No episiotomy 18 years after rupture of ana

sphincter tear during childbir

Faltin, 2006695

N = 240 

 Severity, at least 2 symptoms 

at least once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

Episiotomy 18 years after rupture of ana

sphincter tear during childbir

Cesarean in this delivery Cesarean in this delivery, labored without push Cesarean in this delivery, never labored Cesarean labored and pushed Ever had Cesarean 

Guise, 2007218

N = 8,774 

 Severity, incontinence of stool 

Forceps use, ever 

Multiparity 18 years after rupture of ana

sphincter tear during childbir

Non Cesarean delivery 18 years after rupture of ana

sphincter tear during childbir

Non operative vaginal delivery 18 years after rupture of ana

sphincter tear during childbir

Faltin, 2006695

N = 240 

 Severity, at least 2 symptoms 

at least once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

Primiparity 18 years after rupture of ana

sphincter tear during childbir

Pushing time ≥1 hour in this delivery This infant weight, ≥4,000g Vacuum only, ever 

Guise, 2007218

N = 8,774 

 Severity, incontinence of stool 

≥3 parity 
Table 41. Association between risk of FI and severity of FI and factors related to pregnancy and birth (continued)

176

Author 

Sample Age Fecal Incontinence Factors Related to Pregnancy and Birth Time From Exposure to Outcome 

1 parity 2 parity 

MacArthur, 2001214

N = 7,879 

42.9 Frequent FI Caesarean section 3 months postpartum 

 Persistent FI Caesarean section 6 years postpartum among 

primiparae at index delivery. 

Macarthur, 2005 

215

N = 4,046 

 Persistent FI Caesarean section 6 years postpartum 

Faltin, 2006695

N = 240 

 Severity, at least 2 symptoms 

at least once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

Cesarean delivery 18 years after rupture of ana

sphincter tear during childbir

Hojberg, 2000227 ≥15 Severity, isolated flatus 

incontinence at least once a week 

Episiotomy At 16 weeks of gestation in t

index-pregnancy 

Sultan, 1993699

N = 90 

 Fecal and urgency Forceps delivery 

MacArthur, 2001214

N = 7,879 

42.9 Frequent FI Forceps delivery 3 months postpartum 

6 years postpartum among primiparae at index delivery. 

Macarthur, 2005 

215

N = 4,046 

 Persistent FI Forceps delivery 

6 years postpartum 

FI, Grade 2 Forceps delivery vs. spontaneous 

delivery 

3-4 years after delivery 

FI, Grade 3 Forceps delivery vs. spontaneous 

delivery 

3-4 years after delivery 

Schraffordt Koops, 2003701N = 479 

FI, Grade 4 Forceps delivery vs. spontaneous 

delivery 

3-4 years after delivery 

Guise, 2007 Forceps use, this delivery 

218

N = 8,774 

 Severity, incontinence of stool 

Heaviest infant weight, ≥4,000g 

infant weight, <4,000g At 16 weeks of gestation in t

index-pregnancy 

Hojberg, 2000 

227 ≥15 Severity, isolated flatus 

incontinence at least once a week Infant weight, ≥4,000g At 16 weeks of gestation in t

index-pregnancy 

Laceration, cut/tear with anus injury in this delivery Laceration, cut/tear with no/unknown anus injury in this delivery 

Guise, 2007218

N = 8,774 

 Severity, incontinence of stool 

Laceration, ever had cut/tear with anus injury 
Table 41. Association between risk of FI and severity of FI and factors related to pregnancy and birth (continued)

177

Author 

Sample Age Fecal Incontinence Factors Related to Pregnancy and Birth Time From Exposure to Outcome 

Laceration, ever had cut/tear with no/unknown anus injury 

Hojberg, 2000227 ≥15 Severity, isolated flatus 

incontinence at least once a week 

Length of second stage >90 minutes At 16 weeks of gestation in t

index-pregnancy 

Number of births, ≥4 6 years postpartum among 

primiparae at index delivery 

Number of births, ≥4 6 years postpartum Number of births -1 6 years postpartum among 

primiparae at index delivery 

Number of births -1 6 years postpartum Number of births -3 6 years postpartum among 

primiparae at index delivery 

Number of births -3 6 years postpartum Number of births -2 6 years postpartum among 

primiparae at index delivery 

Macarthur, 2005215N = 4,046 

 Persistent FI 

Number of births -2 6 years postpartum 

Operative delivery vs. vaginal delivery in stage II pelvic organ prolapse and/or UI 

Nichols2005 

6792 

N = 190 

53 Bothersome FI 

Operative vaginal delivery pelvic floor disorders vs. not operative delivery 

 

Hojberg, 2000227 ≥15 Severity, isolated flatus 

incontinence at least once a week 

Outlet forceps At 16 weeks of gestation in t

index-pregnancy 

Faltin, 2006695

N = 240 

 Severity, at least 2 symptoms 

at least once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

Overactive vaginal delivery 18 years after rupture of ana

sphincter tear during childbir

Oxytocin stimulation Parity, ≥3 caesarean section only Parity, ≥3 vaginal delivery only Parity, 0 Parity, 1, first delivery caesarean section Parity, 2, caesarean section only Parity, 2, vaginal delivery only Parity, vaginal delivery 

Hojberg, 2000227 ≥15 Severity, isolated flatus 

incontinence at least once a week 

Pudendal block 

At 16 weeks of gestation in tindex-pregnancy 
Table 41. Association between risk of FI and severity of FI and factors related to pregnancy and birth (continued)

178

Author 

Sample Age Fecal Incontinence Factors Related to Pregnancy and Birth Time From Exposure to Outcome 

Guise, 2007218

N = 8,774 

 Severity, incontinence of stool Pushing time ever ≥1 hour 

Spontaneous perineal rupture 3rd degree anal sphincter tear Time since last delivery ≤1 year 

Hojberg, 2000227 ≥15 Severity, isolated flatus 

incontinence at least once a week 

Time since last delivery >1 year 

At 16 weeks of gestation in tindex-pregnancy 

MacArthur, 2001214

N = 7,879 

42.9 Frequent FI Vacuum delivery 3 months postpartum 

6 years postpartum among primiparae at index delivery 

Macarthur, 2005 

215

N = 4,046 

 Persistent FI Vacuum delivery 

6 years postpartum 

Hojberg, 2000227 ≥15 Severity, isolated flatus 

incontinence at least once a week 

Vacuum extraction At 16 weeks of gestation in t

index-pregnancy 

Schraffordt Koops, FI Grade 2 2003701N = 479 

FI Grade 3 

Vacuum extraction vs. spontaneous delivery 

3-4 years after delivery 

Guise, 2007218

N = 8,774 

 Severity, incontinence of stool Vacuum only, this delivery 

Flatus incontinence >1/week Incontinence for liquid stood >1/week 

Peschers, 2003694

N = 100 

34 

Incontinence for solid stool >1/week 

Vacuum vs. spontaneous vaginal delivery 

6-24 weeks postpartum 

Hojberg, 2000227 ≥15 Severity, isolated flatus 

incontinence at least once a week 

Vaginal rupture At 16 weeks of gestation in t

index-pregnancy 

Schraffordt Koops, 2003701N = 479 

 FI Grade 4 Vacuum extraction vs. spontaneous 

delivery 

3-4 years after delivery 

Bold - multivariate odds ratios * Significant difference 
179 

Table 42. Association between baseline FI, number of pregnancies, and FI 

Author 

Sample Definition of FI Risk Factors Time Since Exposure 

to FI 

Odds Ratio 

(95% CI) 

Zetterstrom, 1999703

N = 349 

AI 10 increase in maternal age 9 months postpartum 3.00 (1.40; 6.40)* 

Mazouni, 2005689

N = 159 

FI Incremental increase in 

maternal age 

12 months after 

instrumental delivery 

1.00 (1.00; 1.00) 

AI at 5 months of pregnancy 3.80 (2.00; 7.30)* 

AI at 9 months of pregnancy 4.30 (2.20; 8.20)* 

Pollack, 2004209

N = 349 

AI 

Subsequent childbirth 

5 years after vaginal 

delivery 

2.40 (1.10; 5.60)* 

van Brummen, FI FI at 12 weeks gestation 1 year after delivery 2.60 (0.90; 12.10) 

2006662

N = 487 

Flatus Flatus incontinence at 12 

weeks gestation 

1 year postpartum 6.82 (4.20; 11.00)*

Any term pregnancy vs. no 

term pregnancy 

 2.26 (1.22; 4.19)* 

>1 pregnancy and >1 vaginal 

delivery vs. no vaginal 

delivery 

 2.15 (0.97; 4.77) 

>1 pregnancy and >1 vaginal 

delivery vs.>1 pregnancy, no 

vaginal delivery 

1.93 (0.81; 4.60) 

>1 pregnancy and >1 vaginal 

delivery vs. no term 

pregnancy 

 2.41 (1.30; 4.49)* 

>1 pregnancy and vaginal 

delivery vs. no term 

pregnancy 

 1.13 (0.43; 2.96) 

McKinnie, 2005657

N = 1,004 

FI 

>1 pregnancy vs. no term 

pregnancy 

1.35 (0.69; 5.74) 

Faltin, 2006695

N = 240 

Severity, at least 2 

symptoms at least 

once a week or 3 

symptoms (flatus, 

liquid or solid stool; 

pad use; lifestyle 

alteration) 

Multiparity 18 years after rupture 

of anal sphincter tear 

during childbirth 

0.99 (0.53; 1.85) 

Faltin, 2001 Delivery again 1 (1; 1) 696 AI 

No subsequent delivery 2.8 (1; 8.3) 

Faltin, 2001 FI Parity 3.1 (1.6; 6)* 232

N = 1,228 Fecal urgency Parity 2.7 (1.1; 6.8)* 

Chiarelli, 2003658

N = 568 

FI Multiparity At 12 months 

postpartum 

1.42 (0.53; 3.83) 

Boreham, 2005212

N = 457 

AI Nulliparity 0.63 (0.4; 0.99)* 

De Leeuw, 2001229

N = 250 

FI Primiparity, without 

episiotomy 

After anal sphincter 

damage during 

delivery 

1.16 (0.41; 3.29) 

Melville, 2005163

N = 6,888 

FI Nulliparity 1.35 (0.88; 2.08) 

Severity, 

incontinence of 

stool 

≥3 parity 1.03 (0.84; 1.27) 

1 parity 1 (1; 1) 

Guise, 2007218

N = 8,774 

Solid feces 

2 parity 0.9 (0.75; 1.09) 

Macarthur, 2005 FI 6 years postpartum 2.12 (1.34; 3.35)* 215

N = 4,046 Persistent FI 

Number of births: ≥4 

6 years postpartum 

among primiparae at 

index delivery 

3.65 (0.80; 16.60) 
Table 42. Association between baseline FI, number of pregnancies and FI (continued) 

180

Author 

Sample Definition of FI Risk Factors Time Since Exposure 

to FI 

Odds Ratio 

(95% CI) 

6 years postpartum 3.22 (1.34; 7.76)* 

FI 6 years postpartum 1.00 (1.00; 1.00) 

6 years postpartum 

among primiparae at 

index delivery 

Persistent FI 1.00 (1.00; 1.00) 

Number of births: 1 

6 years postpartum 1.00 (1.00; 1.00) 

FI 6 years postpartum 1.61 (1.08; 2.41) 

6 years postpartum 

among primiparae at 

index delivery 

Persistent FI 2.57 (0.94; 6.99) 

Number of births: 3 

6 years postpartum 2.91 (1.32; 6.41)* 

FI 6 years postpartum 1.23 (0.85; 1.78) 

6 years postpartum 

among primiparae at 

index delivery. 

Persistent FI 2.15 (0.97; 4.79) 

Number of births: 2 

6 years postpartum 2.13 (1.00; 4.52) 

Number of children Morbid obesity before 

laparoscopic weight 

loss surgery 

Richter, 2005 1.11 (0.86; 1.44) 208

N = 180 

AI 

Number of vaginal deliveries Morbid obesity before 

laparoscopic weight 

loss surgery 

1.18 (0.92; 1.53) 

Number of children: ≥4 Prevalence 0.81 (0.49; 1.36) 

Incidence 0.79 (0.55; 1.14) 

Number of children: 3 Prevalence 1.25 (0.73; 2.12) 

Incidence 0.78 (0.51; 1.18) 

Number of children: 2 Prevalence 1.03 (0.62; 1.73) 

Incidence 0.89 (0.6; 1.31) 

Prevalence 1.07 (0.59; 1.95) 

Ostbye, 2004186

N = 8,949 

FI 

Number of children: 1 

Incidence 0.92 (0.58; 1.45) 

AI 1-2 births 1.00 (1.00; 1.00) 

Flatus 0.90 (0.60; 1.40) 

Liquid feces 1.00 (0.70; 1.50) 

Uustal Fornell, 

2004185

N = 885 

Solid feces 

3 or more births 

 1.10 (0.50; 2.30) 

Chen, 2003213

N = 1,253 

AI Parity ≥1 3.4 (1.2; 9.5)* 

FI Parity ≥2 3.09 (1.25; 7.65)* 

Flatus Parity ≥2 2.72 (1.65; 4.51)* 

FI Parity, 1 1.32 (1; 2.3) 

Abramov, 2005226

N = 542 

Flatus Parity, 1 2.27 (1.28; 4.05)* 

Mahony, 2007 Parity >3 1.40 (0.30; 5.50) 230

N = 500 

FI 

Parity 2 1.70 (0.60; 4.90) 

Parity, ≥3 Caesarean section 

only 

 N/A 

Parity, ≥3 vaginal delivery 

only vs. parity, 0 

1.3 (0.6; 2.4) 

Parity, 1, first delivery 

Caesarean section 

0.7 (0.3; 1.6) 

Parity, 2; Caesarean section 

only 

2.5 (0.3; 20.7) 

Parity, 2, vaginal delivery 

only 

0.8 (0.5; 1.3) 

Parity, vaginal delivery 0.9 (0.7; 1.2) 

Hojberg, 2000227 Severity, isolated 

flatus incontinence 

at least once a 

week 

Time since last delivery ≤1 

year 

At 16 weeks of 

gestation in the indexpregnancy 

0.5 (0.1; 4.3) 
Table 42. Association between baseline FI, number of pregnancies and FI (continued) 

181

Author 

Sample Definition of FI Risk Factors Time Since Exposure 

to FI 

Odds Ratio 

(95% CI) 

Time since last delivery >1 

year 

At 16 weeks of 

gestation in the indexpregnancy 

1 (1; 1) 

Frudinger, 2002692

N = 134 

AI Narrow subpubic arch angle 

vs. normal subpubic arch 

angle 

8.69 (3.15; 23.94)*

Bold - multivariate odds ratios 

* Significant difference 
182 

Table 43. Association between FI and birth related anal trauma 

Author 

Sample Risk Factor Fecal Incontinence Time from Exposure to 

FI 

Odds Ratio 

(95% CI) 

FI 6 weeks postpartum 2.8 (1.8; 4.3)* 

6 months postpartum 1.9 (1.2; 3.2)* 

FI urgency 6 weeks postpartum 1.5 (1.1; 2.1)* 

6 months postpartum 1.5 (1.02; 2.2)* 

6 weeks postpartum 1.6 (1.1; 2.4)* 

Borello-France, 

2006231

N = 721 

Sphincter tear 

Flatus 

6 months postpartum 1.7 (1.1; 2.7)* 

Casey2005202

N = 3,887 

3rd-or 4th-Degree 

laceration 

AI Within 7 months of 

delivery, at or before 

their 6-month 

contraceptive followup 

after delivery 

1 (0.5; 2) 

Chaliha, FI urgency 3 months postpartum 0.9 (0.5; 1.8) 

1999205

N = 549 

Perineal trauma 

Flatus 3 months postpartum 1 (1; 1) 

Chiarelli, No perineal trauma FI 12 months postpartum 1 (1; 1) 

2003658

N = 568 

Perineal trauma (tear 

with sutures and/or 

episiotomy) 

FI 12 months postpartum 1.67 (0.67; 4.14) 

Extent of perineal 

damage (per grade: 

grade-IV vs. gradeIIIb vs. grade-IIIa) 

FI After anal sphincter 

damage during delivery 

2.54 

(1.45; 4.45)* 

De Leeuw, 

2001229

N = 250 

Primiparity, with 

episiotomy 

FI After anal sphincter 

damage during delivery 

0.15 

(0.02; 0.98) 

First-degree tear 

perineal injury 

Eason, 2002 1.2 (0.8; 1.7) 228

N = 252 

3rd or 4th degree tear 

perineal injury 

AI 3 months postpartum 

2.1 (1.4; 3.1)* 

External and internal 3 months after delivery 7.4 (1.7; 31.4)* 

anal sphincter defect 

AI 

30 months after delivery 5.3 (1.2; 24.1)* 

3 months after delivery 6.2 (1.2; 32)* 

30 months after delivery 6.5 (1.3; 33.4)* 

Faltin696

N = 100 

Isolated external anal 

sphincter defect 

AI 

3 months after delivery 1.9 (0.2; 18.7) 

Faltin, 20012322 

N = 1,228 

Anal sphincter tear FI urgency 2.8 (0.9; 9.1) 

Anal sphincter tear 3 months after delivery 4.3 (1.9; 9.7)** 

(clinically diagnosed) 30 months after delivery 3.4 (1.2; 9.8)* 

Clinically occult anal 3 months after delivery 3.8 (0.8; 17.1) 

sphincter tears 

AI 

30 months after delivery 7.7 (1; 60.1) 

Transient shortly after 

delivery 

2 (1.4; 2.8)* 

3 months after delivery 1.9 (1.4; 2.6)* 

Faltin, 2001696

N = 100 

Sphincter defects 

diagnosed after 

endosonography 3 

months after delivery 

AI 

30 months after delivery 1.9 (1.3; 2.8)* 

No ultrasonic 

evidence of injury 

1 (1; 1) 

Ultrasonic evidence of 

injury, perineal scar 

2.69 

(0.7; 10.33) 

Frudinger, 

2002692

N = 134 

Ultrasonic evidence of 

injury, sphincter scar 

AI 

2.26 

 (0.69; 7.36) 

Laceration, cut/tear 

with anus injury in this 

delivery 

2.31 

(1.61; 3.32)* 

Guise, 2007218

N = 8,774 

Laceration, cut/tear 

with no/unknown anus 

injury in this delivery 

Severity, incontinence of 

stool 

1.06 

(0.89; 1.26) 
Table 43. Association between FI and birth related anal trauma (continued) 

183

Author 

Sample Risk Factor Fecal Incontinence Time from Exposure to 

FI 

Odds Ratio 

(95% CI) 

Laceration, ever had 

cut/tear with anus 

injury 

1.61 

 (1.21; 2.15)* 

Laceration, ever had 

cut/tear with 

no/unknown anus 

injury 

1 (0.81; 1.23) 

Laceration, no 

cut/tear ever 

1 (1; 1) 

Laceration, no 

cut/tear in this 

delivery 

1 (1; 1) 

No spontaneous 

perineal rupture 

1 (1; 1) 

No vaginal rupture 1 (1; 1) 

Pudendal block 0.6 (0.3; 1.2) 

Spontaneous perineal 

rupture 

1.2 (0.4; 3.8) 

3rd degree anal 

sphincter tear 

6.3 (1.1; 37.4)* 

Hojberg, 

2000227

Vaginal rupture 

Severity, isolated flatus 

incontinence at least once 

a week 

At 16 weeks of gestation 

in the index-pregnancy 

0.8 (0.4; 1.8) 

History of 3rd or 4th 

degree vaginal tear, 

Asian women 

Huang, 2006 2.41 (1.14; 5.1)* 187

No history of 3rd or 

4th degree vaginal 

tear, Asian women 

AI 

1 (1; 1) 

Internal anal sphincter 

defect thickness; 

partial (1 quadrant) 

2.10 

(0.50; 10.70) 

Mahony, 

2007230

N = 500 

Internal anal sphincter 

defect thickness; 

partial (>1 quadrant) 

or full thickness 

FI 

5.10 

 (1.50; 22.90) 

Mazouni, 

2005689

N = 159 

3rd-degree tears FI 17 months instrumental 

delivery 

1.00 (1.00; 1.00) 

Pollack, 2004209

N = 349 

Sphincter tear AI 5 years after delivery 2.30 

(1.10; 5.00)* 

AI Immediately after 

vaginal delivery 

8.78 

(2.60; 134.10)* 

Abnormal results of 

Pelvic Floor Muscle 

Assessment: digital test 

1.04 (0.24; 4.49) 

Anal sphincter and 

rectal mucosa tears 

vs. intact perineum 

and superficial tears 

Abnormal results of 

Pelvic Floor Muscle 

Assessment: vaginal 

manometry 

0.91 (0.18; 4.69) 

FI 1.48 

(0.10; 14.60) 

Abnormal results of 

Pelvic Floor Muscle 

Assessment: digital test 

1.82 (0.90; 3.67) 

Pregazzi, 

2002704

N = 218 

Perineal muscle tears 

vs. intact perineum 

and superficial tears 

Abnormal results of 

Pelvic Floor Muscle 

Assessment: vaginal 

manometry 

Immediately after 

vaginal delivery 

1.53 (0.73; 3.20) 
Table 43. Association between FI and birth related anal trauma (continued) 

184

Author 

Sample Risk Factor Fecal Incontinence Time from Exposure to 

FI 

Odds Ratio 

(95% CI) 

Sphincter tear vs. 

vaginal delivery 

without anal sphincter 

tear 

FI 6-12 months after 

delivery 

4.40 

(1.60; 12.30)* 

Richter706

N = 251 

3rd vs. 4th-degree 

tear of anal sphincter 

FI 6-12 months after 

delivery 

2.00 (0.70; 5.80) 

FI 3 months postpartum 1.40 (0.40; 5.00) 

6 months postpartum 1.20 (0.20; 6.40) 

3 months postpartum 0.80 (0.50; 1.40) 

Signorello, 

2000697

N = 626 

2nd/3rd/4th degree 

tear vs. intact/1st 

degree tear Flatus 

6 months postpartum 1.10 (0.50; 2.10) 

Sultan, 1993705

N = 124 

Any anal-sphincter 

defect after vaginal 

delivery 

FI 2.70 

(1.97; 3.71)* 

Flatus 1.80 (1.00; 3.30) 

Solid 2.90 

(0.60; 14.60) 

Large tear at delivery 

Liquid 2.70 

(1.30; 5.50)* 

Flatus 6.10 

(2.30; 16.50)* 

Liquid 4.20 

(1.60; 11.30) 

Uustal Fornell, 

2004185

N = 885 

Sphincter rupture 

Solid 9.10 

(3.00; 27.30)* 

van Brummen, 

2006662

N = 487 

3rd/4th degree tear FI 1 year after delivery 6.82 

(4.20; 11.00)* 

Flatus 4 years after delivery 2.71 

(1.78; 4.15)* 

Liquid 5 years after delivery 3.29 

(1.93; 5.60)* 

Wagenius693

N = 654 

Anal sphincter rupture 

following vaginal 

delivery 

Solid 6 years after delivery 1.91 (0.71; 5.17) 

Zetterstrom, 

1999703 Sphincter tear AI 9 months postpartum 2.40 

(1.04; 4.90)* 

Bold - multivariate odds ratios 

* Significant difference 
185

Question 3. What is the Evidence to Support Specific 

Clinical Interventions to Reduce the Risk of UI and FI? 

 Baseline mechanisms of incontinence include abnormal detrusor and sphincter functions. 

Detrusor muscle contraction is regulated by a complex pathway of cholinergic innervations by 

the pelvic nerves, prostaglandins, and calcium ions.22,23 A hyperactive bladder would lead to urge 

UI. Urethral sphincter function is regulated by alpha-adrenergic activity and an anatomically 

correct position of the urethra in the abdominal cavity to transfer increased abdominal pressure to 

urethra. Poor urethral sphincter function can result in primary urethral incompetence and stress 

UI. Effective clinical interventions aim to improve control over bladder contractions, increase 

strengths of pelvic floor muscles supporting bladder, correct anatomic disposition of 

dispositional uterus in women, decrease atrophy of tissues and muscles related to estrogen 

deficiency, and treat injuries due to childbirth.

Effects of Clinical Interventions on UI in Adults in LTC Settings 

Implementation of evidence-based guidelines. The implementation of guidance-driven 

continence care in nursing homes238,708 did not improve the incontinence status of the residents 

(Appendix Table F58). The protocol included staff education and direct patient care 

implemented by advanced practice gerontological nurses in a consecutive cohort of newly 

admitted residents in three licensed proprietary nursing homes. A quasi-experimental study708

evaluated UI using the Incontinence Monitoring Schedule with frequent observations for 3 days 

before and after the continence protocol was implemented (Appendix Table F58). The 

implementation resulted in a nonsignificant tendency to reduce the proportion of incontinence 

episodes and total prevalence of UI from 71 percent in patients after regular care to 64 percent in 

the intervention group (Appendix Table F59).708 A multicenter uncontrolled intervention of a 

computerized quality management model in nursing homes, based on guidelines for medical 

assessment and individualized prompted voiding protocols of UI, was associated with a 

nonsignificant reduction in wet episodes among total checks by nurses from 31 to 17 percent.238 

Conservative management programs. Conservative management programs in nursing 

homes709,710 resulted in inconsistent improvement in UI in female residents (Appendix Table 

F60). Behavioral therapy included hourly wet checks, prompted and assisted toileting, positive 

reinforcement, and bladder training implemented by trained nursing research assistants. Nursing 

research assistants reported an improvement in UI in females after active intervention three times 

more often compared to usual care (26 percent vs. 8 percent, RR 3.1, 95 percent CI 1.3; 7.4) 

(Appendix Table F61)710 However, the changes in urinary wet episodes were not statistically 

significant (Appendix Table F62).709 Conservative management programs reduced the 

progression of UI in the majority of RCTs that included male and female residents of nursing 

homes (Appendix Table F63).233-237 The effect size was small and differed depending on the 

definition of the outcomes. Integrated incontinence care that included fluid prompting, prompted 

toileting, and regular wet checks in combination with exercises reduced the frequency of UI by 

1.6 percent (95 percent CI -2.5;-0.8) compared to regular care (Appendix Table F64).235

Prompted voiding treatment increased the proportion of appropriate toileting to 60 percent 

compared to 17 percent after regular care (mean difference 1.7 percent, 95 percent CI 1.3; 2.2.233

Individualized habit training for UI with verbal encouragement administered by nursing staff237

significantly decreased the frequency of incontinence episodes by 19 percent in elderly residents 
186

without neurological diseases but not in memory-impaired residents.236 Individualized prompted 

voiding and intensive endurance and pelvic floor muscle training significantly reduced the 

proportion of wet checks by nurses among total checks to 25 percent compared to 50 percent 

after usual care.234 One RCT239 examined the effects of rehabilitation based on the Functional 

Independence Measure scale on risk of UI in 34 patients with acute hemispheric stroke 

(Appendix Table F65). The number cured at discharge was four times larger after active 

rehabilitation compared to a conventional rehabilitation program (RR 4.1, 95 percent CI 1.5; 

11.2) (Appendix Table F66). 

 One RCT of 32 women examined the effects of oral estrogen (0.63 mg) combined with 

progesterone (2.5 mg) and regular toileting assistance (prompted voiding) by trained research 

and did not report significance on rates of positive cough test or appropriate toileting rate.711

 Level of evidence. The evidence from nine RCTs233-237,708-711 and one nonrandomized trial238

was analyzed in relation to a variety of clinical outcomes in residents of nursing homes. One trial 

reported preplanned intention to treat analysis; four justified sample size;234,237,709,710 allocation 

concealment was unclear in all open label trials. Baseline characteristics of the participants did 

not differ and confirmed adequacy of randomization in five trials.234-236,708,711 Adherence of 

nursing staff to the protocol was not consistently analyzed, thus preventing valid comparisons of 

the treatment effects between the studies. 

Summary. In conclusion, in contrast to numerous studies of the management of UI, only a 

few RCTs aimed at slowing progression in LTC settings. Individualized management programs 

that included prompted voiding, exercise, and positive feedback modestly improved the severity 

of symptoms. Active rehabilitation with self management of urinary symptoms resulted in 

continence in the majority of the patients after stroke. Fully powered RCTs would better estimate 

the effectiveness of individualized evidence-based conservative management programs. Cluster 

trials with randomization of nursing units, adequate allocation concealment, and preplanned 

intention to treat analysis are needed to provide valid results. The effectiveness of clinical 

interventions should be examined in subgroups of residents by cognitive and physical 

functioning, gender, and ethnicity. The effects of conservative management programs on the 

quality of life in these populations have not been investigated in RCTs. Staff participation in 

developing combined management protocols and adherence to protocols should be continuously 

measured as quality of care indicators in LTC facilities. 

Effects of Clinical Interventions on UI in Community Dwelling Adults 

Implementation of evidence-based guidelines (Appendix Table F67). National evidencebased guidelines were implemented in gynecology units in four district general hospitals across 

Scotland. Women were advised to follow the recommended appropriate protocol for 1 year. This 

intervention did not improve self-reported severity of UI and quality of life in women at 1 year 

of followup (Appendix Table F68).712

Conservative management programs. Urinary continence service delivered by specially 

trained nurses included advice on diet and fluids, bladder training, and pelvic floor muscle 

awareness240 in a large, well designed RCT of 3,746 incontinent men and women living in 

private households (Appendix Table F69). The proportion of cured patients was 1.5 times higher 

after the continence service (RR 1.5, 95 percent CI 1.3; 1.7) (Appendix Table F70). More 

patients reported improvement in UI 6 months after active treatment (RR 1.2, 95 percent CI 1.1; 

1.3). The continence service also reduced progression of urgency to very strong or overwhelming 
187

by 30 percent (RR 0.7, 95 percent CI 0.7; 0.8). The complex rehabilitation program by nurse 

continence advisors and consulting urogynecologists including bladder training, gradual increase 

in fluid intake, pelvic floor muscle training, and transvaginal electrical stimulation resulted in 

urinary continence in 50 percent of women but with no statistically significant differences 

compared to usual care (Appendix Table F71).510 Small significant improvement compared to 

usual care was detected in two quality of life measures, the Life Urogenital Distress Inventory 

(2.9 percent) and in the Short Form Urogenital Distress Inventory (16 percent) (Appendix Table 

F72). Community-based interventions, including education, bladder training, managing the urge 

to urinate, and pelvic floor muscle training, resulted in continence in 35 percent of women vs. 30 

percent after usual care (RR 1.7, 95 percent CI 1; 2.9).241 The majority of women reported more 

than 50 percent improvement in incontinence (RR 1.6, 95 percent CI 1.1; 2.2).241 A continence 

management program implemented by nurse continence advisers with physician expertise 

included lifestyle modification sessions for 446 incontinent subjects.242 Daily incontinence 

events were significantly reduced after active treatment with no changes in pad use (Appendix 

Table F73).242 Educational programs about bladder health and recorded incontinence episodes in 

a voiding diary, in addition to listening to an audiotape daily, were examined in one RCT.713 The 

combination of education and cognitive interventions significantly reduced the number of 

incontinent episodes (RR 1.7, 95 percent CI 1.1; 2.7) but did not improve perceived incontinence 

measured using the Urinary Incontinence and Frequency Comfort Questionnaire (Appendix 

Table F74). 

Dietary and other lifestyle interventions in females (Appendix Table F75). A standard low 

calorie liquid diet, increased physical activity to 60 minutes per day, training by a nutritionist, 

and exercise supervised by a physiologist or behavioral therapist improved stress UI in 92 

percent, urge UI in 70 percent, and overall UI in 60 percent of participating women (RR of 

improvement in overall UI 3.5, 95 percent CI 1.3; 9.1) (Appendix Table F76).714 Self-selected 

diet with low fat and low cholesterol foods and 25g of soy protein (Appendix Table F75) did not 

reduce the risk of stress and urge UI in women compared to a diet without soy (Appendix Table 

F77).715 Increasing fluid intake by 500cc did not change the frequency of UI.716 Restriction in 

caffeine intake in combination with increasing decaffeinated fluids significantly reduced the 

number of UI episodes by 87 percent but did not change urine loss in the pad weight test 

(Appendix Table F77).717 A significant decrease in daytime episodes of involuntary urine loss 

after caffeine restriction was reported in another RCT.718 A positive insignificant tendency to 

reduce the risk of stress UI was observed after the lifestyle interventions associated with the 

Diabetes Prevention Program RCT (RR 0.9, 95 percent CI 0.7; 1) (Appendix Table F78).245

 In adults, bladder training, fluid intake modification, and restricted caffeine intake to 

<100mg/day significantly decreased the number of voids by 6 percent, and daily urgency 

episodes by 21 percent, with random differences in daily leakage episodes compared to bladder 

training alone (Appendix Table F79).719

Attributable to conservative management program events. We analyzed the number of 

avoided/excessive events per 1,000 treated from RCTs that reported significant effects of 

conservative combined interventions on UI (Table 44). Compared to usual care, continence 

service resulted in 90 additional cases of resolved UI (continent) 1,000 treated community 

dwelling adults (95 percent CI 49; 136).240 A specially designed rehabilitation program resulted 

in 722 additional cases of resolved UI (continent) per 1,000 treated adults with stroke (95 percent 

CI 121; 235).239 With continence service, UI was improved in an additional 100 subjects per 

1,000 subjects treated (95 percent CI 56; 146), quality of life improved in 90 subjects (95 percent 
188

CI 52; 129), and satisfaction with present urinary symptoms in 110 (95 percent CI 66; 157).240 A 

computerized quality management model for medical assessment and individualized prompted 

voiding would avoid progression of UI in 140 per 1,000 treated residents of nursing homes (95 

percent CI 13; 216).238

 Primary prevention of female UI related to pregnancy and birth was examined in eight 

large RCTs with more than 100 women246-253 (two studies were published twice with different 

duration of followup246,251) and one smaller trial254 (Appendix Table F80). Conservative advice 

about self-administered pelvic floor muscle training at 5, 7, and 9 months after delivery 

supplemented with bladder training did not change the risk of stress UI and tended to decrease 

the risk of severe UI at 12 months postpartum (Appendix Table F81).251,252 No improvement was 

seen in women with severe (>1 week) UI at baseline.252 Self-rated severity was significantly 

reduced by 87 percent (95 percent CI -93.0; -81.1) compared to usual postpartum care (Appendix 

Table F82). Pelvic floor muscle training that occurred within 48 hours of delivery reduced the 

risk of self-reported UI 3 months postpartum (RR 0.8, 95 percent CI 0.7; 1.0),246 but the effect 

was attenuated at 12 months248 (Appendix Table F83). Pelvic floor muscle training that started 1 

month before delivery reduced the risk of postpartum stress incontinence (RR 0.6, 95 percent CI 

0.4; 0.9).247 Standardized instruction in pelvic floor muscle training started before delivery did 

not decrease the risk of stress UI compared to regular care in a small RCT without justified 

sample size.254 In addition to visits and phone calls by community midwives, reminders, 

feedback to self measure squeeze pressure, and voiding diary, pelvic floor muscle training did 

not reduce the risk of incontinence 3 months postpartum in an RCT of 1,800 participants.253 The 

combination of pelvic floor muscle training with biofeedback and intravaginal electrostimulation 

resulted in a continence rate of 19 percent vs. 2 percent after usual care (RR of continence 11.0, 

95 percent CI 1.5; 82.8) with no significant improvement in urodynamic outcomes (Appendix 

Table F84).249 Self-administered perineal massage daily from the 34th or 35th week of pregnancy 

until delivery did not improve the continence rate in a large sample of pregnant women with (n = 

493) and without (n = 1,034) a previous vaginal birth.250

 We estimated that assessment of UI by nurses with conservative advice on pelvic floor 

muscle training supplemented with bladder training could avoid 121 cases of UI (95 percent CI 

7; 152) and 59 cases of severe incontinence (95 percent CI 5; 99) among 1,000 treated (Table 

45).251

Pelvic floor muscle training for secondary prevention of UI in community dwelling 

females. Complex behavioral modification programs, including pelvic floor muscle training, 

bladder training, and individualized testing of knowledge, adherence, and skills, were 

implemented in 359 postmenopausal, continent women 55 years and older (Appendix Table 

F85).243,244 Behavioral modification did not cure UI at 1 year of followup, although the 

improvement rate in urinary symptoms was 36 percent higher after intervention vs. standard care 

(RR 1.4, 95 percent CI 1.1; 1.7).243

 The effects of behavioral interventions on UI in females were examined in 21 RCTs.267-287

The effects of pelvic floor muscle training on stress UI in women were examined in 18 RCTs 

(Appendix Table F86).288-290,292,299,316,720-731 The rates of cure of UI, improvement or progression 

of UI, continuous severity measures, and urodynamic outcomes after active treatments were 

compared to usual care or active controls. 

 Outcome - continence. Several RCTs reported subjective cure of UI275,290,299 or objective 

continence during a stress test or urodynamic exam268,299,721,731 (Appendix Table F87). Curative 

behavioral interventions included pelvic floor muscle training, bladder training, and 
189

electromyography biofeedback. The rate of continence after treatment varied from less than 10 

percent253,299,730 to more than 75 percent.288 Smaller trials tended to report greater continence 

rates.275,288,731 The largest relative benefit on continence was observed after electromyography 

(EMG)-assisted biofeedback with pelvic floor muscle training compared to usual care in 

postmenopausal women with stress UI taking hormone replacement therapy (RR 17.3, 95 percent 

CI 1.1; 261.7).288 Pelvic floor muscle training in groups with skilled physical therapists increased 

subjective cure from stress UI (RR 15.4, 95 percent CI 2.2; 110.3).299 Women with stress UI 

experienced objective cure after this treatment six times more often compared to untreated 

controls (RR 6.1, 95 percent CI 1.5; 25.1).299 Older women with sphincteric incompetence 

reported cure from stress UI eight times more often compared to regular care (RR 8.8, 95 percent 

CI 1.2; 66).289 Individualized behavioral intervention with pelvic floor muscle training for stress 

UI or bladder training for urge UI resulted in continence in 19 percent of women with substantial 

relative benefit compared to regular care (RR 10.4, 95 percent CI 14; 78.3).280 The trials with 

active controls reported comparable rates of continence without significant relative benefit on 

urinary continence.268,269,271,274-276,721,727,730,731

 Outcome - Improvement in UI in community dwelling females. The majority of RCTs that 

examined behavioral interventions reported improvement in self-reported severity of UI and 

quality of life (Appendix Table F88).243,268,269,278-281,283,286,288,289,292,299,724,725,727,730 The rates of 

improvement varied from 20 percent in improved pad test after pelvic floor muscle training with 

intravaginal EMG biofeedback288 to 94 percent in improved stress test after pelvic floor muscle 

training.725

 Individual pelvic floor muscle training and bladder training with delayed voiding resulted in 

self-reported improvement in 94 percent of women.286 Behavioral training that included 

biofeedback-assisted pelvic floor muscle training, home exercises, bladder control strategies, and 

self monitoring with bladder diaries reduced weekly incontinence episodes by more than 50 

percent in 86 percent of women ages 40-78 years with all types of UI.268 The same consistent 

effect was observed after bladder training with positive reinforcement in older women with 

clinical and urodynamic UI >1 leakage/week.281 Significant improvement in restriction of daily 

activities attributable to UI was reported after pelvic floor muscle training (RR 12.5, 95 percent 

CI 3.2; 48.6).292 Two small RCTs of pelvic floor muscle training292 and exercises with 

biofeedback724 reported substantial relative benefits when no women reported improvement in 

UI after usual care. Other RCTs showed more than 25 percent relative benefit after biofeedbackassisted behavioral training (RR 1.6, 95 percent CI 1.1; 2.3279 or after bladder training (RR 3.1, 

95 percent CI 2.0; 4.9;281 RR 3.4, 95 percent CI 1.9; 6.1278) compared to usual care. Women 

reported more than 50 percent reduction in UI episodes after bladder training (RR 3.1, 95 percent 

CI 2.0; 4.9) compared to usual care.281 Two RCTs reported significantly larger benefits of 

behavioral training compared to self-administered behavioral changes using a booklet.268,283

 Outcome - Progression of UI in community dwelling females. Severity of UI was estimated 

with self-reported frequency of leakage episodes, pad utilization, and bothersomeness of UI. 

Community-based intervention that included bladder training and performing pelvic floor muscle 

training among elderly women resulted in 30 percent reduction in pad use for UI (RR 0.7, 95 

percent CI 0.6; 0.9). (Appendix Table F89)291 Intensive pelvic floor muscle training with 8-12 

maximum contractions in 3 series/day and 45 minutes/week group sessions among women with 

clinically and urodynamically proven stress UI reduced the prevalence of UI with sexual 

intercourse by 80 percent (10.5 percent vs. 41.7 percent RR 0.2, 95 percent CI 0.2; 0.8).720 The 

adverse impact on quality of life was reduced by 30 percent (RR 0.7, 95 percent CI 0.6; 0.9)291 to 
190

40 percent (RR 0.6, 95 percent CI 0.4; 0.9)720 The relative benefit of behavioral interventions 

was demonstrated when compared to usual care but not to active controls. 

Clinical interventions for primary prevention of UI in community dwelling males. 

Outcome - Continence. The behavioral interventions on UI in males with prostate diseases 

were examined in 12 RCTs (Appendix Table F90).255-266 Pelvic floor rehabilitation programs 

resulted in continence rates from 77 percent255 to 99 percent257 (Appendix Table F91). The 

highest continence rate was reported in a large well designed RCT of early pelvic floor 

rehabilitation in patients who had radical retropubic prostatectomy for clinical stage T1 or T2 

prostate cancer.257 The majority of patients (99 percent) reported continence after the 

intervention that included verbal explanations, palpation, and Kegel exercises with a small 

significant relative benefit compared to usual care (RR 1.1, 95 percent CI 1.1; 1.2).257 The 

relative effect in the same RCT was larger when continence status was measured with a scale 

specific for UI (RR 1.3, 95 percent CI 1.2; 1.5).257 Continence rates in the control groups were 

more than 60 percent across all RCTs with no statistically significant differences compared to 

active treatments (Figure 29).

 Outcome - UI in community dwelling males. The effects of behavioral interventions on 

severity of UI were inconsistent in direction and size compared to usual care (Appendix Table 

F92). Few RCTs reported significant benefits of behavioral treatments to reduce the risk of UI. 

The rate of self-reported UI was 70 percent less after verbal instruction and feedback on 

contractions of pelvic floor muscles in 63 patients with bladder outflow obstruction and 

diagnosis of symptomatic benign prostatic hyperplasia who undergo transurethral prostatectomy 

(RR 0.3, 95 percent CI 0.1; 0.9).263 Pelvic floor muscle training, including a strong post-void 

“squeeze out” pelvic floor muscle contraction, biofeedback, and suggestions to change lifestyle, 

significantly reduced post micturition dribble and urine loss in men with erectile dysfunction.266

One large trial showed a substantial benefit of a complex floor rehabilitation program including 

patient education, assessment of pelvic floor muscles strength, and visualization of Kegel pelvic 

floor muscle training compared to regular care with reduction in severity and pad utilization (RR 

of using two pads/day 0.1, 95 percent CI 0; 0.7).257

Behavioral clinical interventions for secondary prevention of urinary continence in 

adults. The effects of behavioral interventions in males and females were examined in four 

RCTs (Appendix Table F93).43,732-734 One large RCT of pelvic floor muscle training and bladder 

retraining supervised by non-specialist nurses in 561 adults 35 years and older with regular UI 

reported a significant increase in cure (RR 15.5, 95 percent CI 2.1; 112.5) and improvement of 

UI (RR 12.6, 95 percent CI 6; 26.2) (Appendix Table F94).43

Effects of Behavioral Interventions on Severity of UI and Quality of 

Life 

Surrogate outcomes. 

 Subjective measures of severity of UI and quality of life in females (continuous surrogate 

variables). The authors measured severity of UI using self-reported numbers of episodes of UI 

per time period. The effects of behavioral interventions on quality of life were estimated from 

questionnaires and scales expressing the effects as mean differences between active and control 

treatments (Appendix Table F95). We calculated the effect size as the percent change in outcome 

variables compared to the control group. Overall, behavioral interventions resulted in small 

random changes in outcomes compared to control groups. No consistent benefit was seen across 
191

RCTs on severity or quality of life. The largest differences were reported in one RCT that 

showed a reduction in the number of daily leakages after pelvic floor muscle training in groups 

supervised with skilled physical therapists (mean difference -0.7, 95 percent CI -1.2;-0.2).299 The 

same RCT reported a significant increase in the Social Activity Index (mean differences 0.6, 95 

percent CI 0.1; 1.1).299 The results were inconsistent within trials. Pelvic floor muscle training 

improved self-reported UI measured with the Visual Analog Scale of UI but also increased the 

number of stress incontinence episodes.288 Behavioral interventions reduced the number of 

incontinence episodes by 0.5-1 per day.282,292 The effect on quality of life was also small with 

less than 1 percent differences in scores on the Incontinence Impact Questionnaire (mean 

difference -0.5, 95 percent CI -0.9;-0.2).284

 Objective measures of severity of UI in females (pad test, urodynamic cystometry, and 

perineometry). Few behavioral interventions improved objective severity compared to either 

regular care or other treatments (Appendix Table F96). Behavioral management for continence 

reduced urine loss per 24 hours in the pad weight test compared to regular care (mean difference 

-0.5, 95 percent CI -0.8; -0.2).282 The same benefit (approximately 1 percent difference compared 

to the control group) was reported after bladder training.281 The largest significant differences 

(44 percent compared to usual care) in the 1 hour pad test was shown after pelvic floor muscle 

training with digital biofeedback (mean difference -12.3, 95 percent CI -15.6; -9).288 Several 

RCTs of behavioral interventions reported small significant reductions in vaginal pressure274 and 

significant increase in peak pressure285,729 and pelvic floor muscle training.288,725

 One RCT examined the effects of contracting the pelvic floor muscles before and during a 

cough (Knack Maneuver) in 27 women with self-reported stress UI and did not show significant 

improvement in urine leakage during the cough paper towel test.722

 Subjective measures of severity of UI in males. Self-reported urinary symptoms and pad use 

did not change after active treatments compared to regular care (Appendix Table F97). One RCT 

reported increased urine loss in the pad weight test after intensive pelvic floor muscle training 

conducted by a physiotherapist (Appendix Table F98). 

 Subjective measures of severity of UI in adults. The frequency of UI in adults after behavioral 

interventions was reported in two RCTs (Appendix Table F99).732,733 The larger RCT showed 

reduced UI episodes/day (mean difference -0.6, 95 percent CI -1.0; -0.2) after biofeedbackassisted pelvic floor muscle training.732

Pooled estimates of behavioral interventions on urinary continence in adults. The 

differences in populations and treatments, including difference in training regimes and 

frequency, made a pooled analysis questionable. We compared the relative benefit of urinary 

continence after behavioral interventions to usual care (Table 46). Pelvic floor muscle training, 

biofeedback assisted pelvic floor muscle training, and a combination of pelvic floor muscle 

training with bladder training showed an inconsistent relative benefit across studies. Pooled 

relative benefits of pelvic floor muscle training in females (RR 7.1, 95 percent CI 2.8; 

18)280,288,289,299 and pelvic floor muscle training combined with biofeedback (RR 11.2, 95 percent 

CI 2.2; 56.4)288,289 were sensitive to one small RCT288 with 2 month followup (Figure 30). Pelvic 

floor muscle training combined with bladder training increased continence by 175 percent 

compared to usual care (pooled RR 1.8, 95 percent CI 1.1; 2.9).241,243,280,290

 The majority of RCTs demonstrated significant improvement in UI after pelvic floor muscle 

training compared to regular care. An improvement was shown eight times more often after 

pelvic floor muscle training (RR 8.1, 95 percent CI 2.3; 28.4), twice as frequently after 

biofeedback assisted pelvic floor muscle training (RR 1.9, 95 percent CI 1.0; 3.5), and 2.5 times 
192

more often after pelvic floor muscle training and bladder training (RR 2.5, 95 percent CI 1.4; 

4.6) (Figure 31).

Attributable benefits of behavioral interventions. Few RCTs showed significant relative 

benefit of behavioral interventions on urinary continence (Table 47). The number of avoided 

stress UI cases per 1,000 varied from 170249 to 749288 when treated with behavioral interventions. 

The relative benefits on total UI was smaller.43,257 Ignoring different definitions of improvements 

and possible attenuation of the improvement over time, weight reduction would result in 

improved stress UI in 990 adults per 1,000 treated (Table 48).714

 Intensive lifestyle changes would avoid 54 cases of stress UI per 1,000 treated (Table 49).245

Pelvic floor muscle training and strategies to improve adherence among pregnant women would 

avoid 390 cases of UI per 1,000 treated (Table 50).246

Level of evidence. The evidence from RCTs (level I) was analyzed to compare the effects of 

behavioral interventions on UI. 

Summary. In conclusion, behavioral interventions resulted in improvement in UI across 

RCTs, but the estimation of the overall effect was difficult due to heterogeneity between studies. 

The long-term continence outcomes among subjects that experienced improvement while 

participating in RCTs are restricted to 1 year of followup. Several large well-designed RCTs 

reported a significant benefit of behavioral interventions on cure of incontinence with greater 

effects on stress UI in females and very limited evidence on urge incontinence and male 

incontinence. Weight reduction in combination with physical activity showed promising 

protection against incident UI. Preventive complex pelvic floor rehabilitation programs in 

specific populations, including males undergoing prostate surgery and pregnant women, 

demonstrated relative benefit on several measures of urinary continence. The effects on quality 

of life and objective instrumental outcomes are inconsistent and small. Active interventions 

provided better outcomes compared to usual care with no relative benefit compared to each 

other. 

Effects of Physiotherapeutic Interventions on UI in Community 

Dwelling Adults

 Electrical or magnetic stimulation of pelvic floor muscles were examined in 17 RCTs293-

295,297,298,300-302,512,735-742 and one large prospective cohort study,304 and neuromodulation of sacral 

nerve roots in nine RCTs296,303,305,306,743-747 (Appendix Table F100). One RCT examined the 

effects of massage and stretching of perineum during the second stage of labor with a water 

soluble lubricant514 and one study examined the effects of acupuncture to improve UI.748 The 

majority of RCTs included less than 100 subjects; only three RCTs included more than 100 

patients.302,736,746

 Patient outcomes. 

 Continence in community dwelling females. Urinary continence after electrical stimulation in 

females was reported in five RCTs (Appendix Table F101)293-295,297,298 and the effects of 

neuromodulation in one RCT.296 The rates of cure from urge UI were more than 70 percent in 

one RCT after functional magnetic stimulation.298 Electrical stimulation resulted in continence in 

about 20 percent of women.293,294 The significant relative benefit of active magnetic to sham 

stimulation was shown in only one trial (RR 3.5, 95 percent CI 1.6; 7.8).298 Other RCTs did not 

demonstrate significant relative benefit of cure compared to Kegel exercises,293 biofeedback 
193

assisted training,297 or placebo stimulation.295 Magnetic stimulation of sacral roots did not 

provide better continence rates compared to sham neuromodulation.296

 In community dwelling adults, implantation of a multiprogrammable neurostimulator cured 

47 percent of adults with urge UI305 with significant relative benefit compared to standard 

medical therapy (RR 43.5, 95 percent CI 2.7; 695).305 Sacral root neuromodulation resulted in 

urge continence more than nine times more often than conservative management with 

medications or pelvic floor muscle training (RR 9.9, 95 percent CI 1.4; 71.4).306 

 Studies that examine the effects of electrical stimulation of pelvic floor failed to provide 

relative cure more often than control treatments.300,301 

 Improvement in UI in community dwelling females. Several RCTs reported improvement in UI 

after stimulation in females;293-297,302,303,735,737,740,745 with an improvement rate from 8 percent after 

percutaneous neuromodulation303 to 85 percent after intravaginal stimulation737 (Appendix Table 

F102). The improvement after magnetic stimulation varied from 23 percent in urge UI after 

electrical298 to 74 percent in stress UI after neuromodulation therapy.296 The greatest improvement 

in urge UI (85 percent) was observed after intravaginal electrical stimulation in women with 

predominantly urge UI.737 The greatest improvement in stress UI (74 percent) was reported in 

women with mild stress incontinence after magnetic stimulation of sacral roots.296 The rates of 

quantitative improvement were less than qualitative from 38 percent after neuromodulation303 to 

46 percent after electrical stimulation294 in rates of negative pad test and only 15 percent in daily 

pad usage.303 Transvaginal electric stimulation for 40 minutes/day was more effective than sham 

stimulation in women with either UI due to detrusor instability or stress UI, or both (mixed 

incontinence) (RR 2.1, 95 percent CI 1.1; 4.1).302 However, the superiority of electrical stimulation 

compared to placebo treatment or regular care was not confirmed in other RCTs.294,737,740

 Magnetic neuromodulation of sacral roots compared to placebo improved UI twice as often 

in women with stress UI (RR 2.3, 95 percent CI 1.3; 4.0).296 Magnetic stimulation of pelvic floor, 

in contrast, did not improve predominant urge UI.740 However, abdominal pain related to urge UI 

was reported less often after magnetic stimulation compared to placebo (RR 8.1, 95 percent CI 

1.1; 57.9).740

 Electrical stimulation was not more effective than Kegel exercises.293,735 Home-managed 

electrical stimulation with vaginal/anal stimulators for at least 3 months reduced the frequency of 

urine loss in a large prospective cohort of Norwegian women (RR 0.7, 95 percent CI 0.7; 0.8).304

 Neuromodulation with surgical first stage lead placement compared to percutaneous needle 

electrode significantly improved refractory urge UI in women who failed medical, behavioral, 

and pelvic floor reeducation management.303

 UI in community dwelling females. Electrical302,739 and magnetic740stimulation of pelvic floor 

and neuromodulation745 did not reduce the prevalence of urge UI and detrusor over-activity 

compared to sham treatment (Appendix Table F103). Intravaginal electrical stimulation did not 

decrease the progression of mixed UI compared to Kegel exercises.735 One prospective cohort 

study showed a significant reduction in frequency of urine loss and self perceived severity of UI.304

 One RCT of acupuncture in 85 women older than 18 years with symptoms of overactive 

bladder with urge UI did not significantly reduce self-reported severity of urge UI and did not 

improve the Urinary Distress Inventory scores or urodynamic outcomes compared to placebo 

acupuncture treatment designed to promote relaxation.748 However, a small reduction in the 

number of total UI episodes (mean difference -0.6, 95 percent CI -1; -0.1) was detected 

compared to placebo treatment. 
194

Continence in community dwelling adults. Electrical stimulation of pelvic floor301 or 

neuromodulation 305,306,744 resulted in urinary continence in males and females in several RCTs 

(Appendix Table F104). The rates of continence varied from 8 percent after electrical300 to 47 

percent after neuromodulation.305 The highest continence rate (>40 percent) was achieved with a 

sacral neurostimulator in patients with refractory urinary urge incontinence.305,306 Electrical 

stimulation with intravaginal electrodes in women and anal in men resulted in continence in a 

small proportion of subjects with no relative benefit compared to sham treatment.300 Larger cure 

rates were substantially higher after subcutaneous implantation of a multiprogrammable 

neurostimulator in the lower quadrant of the abdomen with the lead positioned to target sacral 

nerve compared to standard medical care (RR 43.5, 95 percent CI 2.7; 695.0).305 Sacral root 

stimulation compared to prior conservative management, including medications and pelvic floor 

muscle training, cured urge UI (RR 9.9, 95 percent CI 1.4; 71.4).306 Both trials showed a wide 95 

percent CI because of zero305 or only one case of improvement306 after control interventions. 

 Improvement in UI in community dwelling adults. Stimulation improved UI with rates 

varying from 0.5 percent after electrical stimulation of pelvic floor512 to 77 percent after 

neuromodulation of sacral nerve roots305 (Appendix Table F105). Functional magnetic 

stimulation improved UI in 30 percent of 32 patients with UI due to detrusor overactivity.512 The 

highest rate of improvement in urge UI (89.7 percent) was observed after combined therapy of 

Stoller afferent neuromodulation and 5mg of oral oxybutynin hydrochloride with no significant 

relative benefit compared to stimulation alone.744 Implantation of a multiprogrammable sacral 

neurostimulator improved severe urge incontinence (RR 8.8, 95 percent CI 3.4; 22.8) and 

increased the proportion of patients who did not need to use absorbent pads (RR 23.0, 95 percent 

CI 3.2; 162.9) compared to standard care.305 A significant reduction was also seen in daily urge 

incontinent episodes (>50 percent) (RR 6.6, 95 percent CI 1.6; 27.5).305 Electrical stimulation did 

not show relative benefit compared to sham treatment in an underpowered RCT of 68 patients 

with UI due to detrusor overactivity.301

Surrogate outcomes. 

 Subjective measures of severity and quality of life of UI in community dwelling females. The 

effects of electrical stimulation on frequency and amount of urine loss were compared to sham 

treatment or behavioral interventions (Appendix Table F106). Only two RCTs reported 

significant relative differences in urinary leakage episodes after active compared to sham 

stimulation. Women with urodynamically proven stress incontinence reported a 12 percent 

reduction in incontinence episodes (mean difference -0.7, 95 percent CI -1.3; -0.1) and a 6 

percent reduction in pad use compared to placebo treatment (mean difference -0.7, 95 percent CI 

-1.3; -0.1).294 Women with stress, urge, or mixed UI experienced a 59 percent reduction in 

urinary leakage after transvaginal electrical stimulation with adjustable current intensity 

compared to inactive stimulation (mean difference -1.8, 95 percent CI -2.6; -0.9).742

 The impact on quality of life of UI was measured using the Urogenital Distress Inventory 

scores, the Incontinence Impact Questionnaire, and the Visual Analog Scale of UI. Only one 

RCT showed a significant improvement in quality of life from the complex pelvic floor 

rehabilitation program that included electrical stimulation of the pelvic floor muscle combined 

with an assisted pelvic floor muscle training program in premenopausal women with persistent 

postnatal stress UI.267

 Objective measures of severity of UI in community dwelling females. Severity of UI after 

electrical stimulation was estimated with the pad test and urodynamic cystometry (Appendix 

Table F107). Random changes or small improvements compared to control interventions were 
195

reported in the majority of the RCTs. The largest improvement was seen in pelvic floor muscle 

maximum strength (mean difference 0.9, 95 percent CI 0.3; 1.6, 194 percent compared to 

control) and changes from baseline in maximum rate of force development (mean difference 0.9, 

95 percent CI 0.3; 1.6, 201 percent compared to control) after a complex pelvic floor 

rehabilitation program in women with persistent postnatal stress UI compared to relaxation 

massage for the back and extremities.267 

 Subjective measure of severity of UI in community dwelling adults. The effects of electrical 

stimulation or neuromodulation on the frequency and amount of urine loss were compared to 

sham treatment or behavioral interventions (Appendix Table F108). 

 Sacral root neuromodulation with an implantable impulse generator reduced pad use for urge 

UI by 28 percent and leakage episodes of urge UI by 18 percent compared to the control group in 

patients with refractory urge incontinence.306 The same effect was observed in another RCT after 

implantation of a multiprogrammable neurostimulator; severity rank of urge UI was decreased by 

78 percent; pad use was decreased by 29 percent, and urge incontinence episodes by 14 percent 

compared to sham treatment.305

Objective measure of severity of UI in community dwelling adults. The effects of electrical 

stimulation or neuromodulation on the frequency and amount of urine loss were reported 

compared to sham treatments or active controls (Appendix Table F109).300,301,746 Functional 

magnetic stimulation compared to electrical stimulation did not show differences in urodynamic 

outcomes in patients with UI due to detrusor overactivity.512

Events attributable to stimulation therapy. We estimated that functional magnetic stimulation 

would avoid 390 cases of urge UI per 1,000 treated women (Table 51). Transvaginal electric 

stimulation with individually adjusted intensity would result in improvement in UI in 180 

women per 1,000 treated.302 Home-managed electrical stimulation with vaginal/anal stimulators 

would avoid 50 cases of UI per 1,000 treated women (Table 52).304 

 Sacral nerve stimulation would avoid 385306 to 460305 cases of urge UI per 1,000 treated 

adults. Electrical stimulation with surgical first stage lead placement would improve UI in more 

than 400 women per 1,000 treated compared to placebo.303

Summary. In conclusion, evidence from several small RCTs (<100 subjects), three large 

RCTs, and one prospective cohort suggested that electrical and magnetic stimulation of pelvic 

floor and sacral nerve roots neuromodulation can improve predominantly urge UI in adults but 

the curative effects are not consistent. 

Effects of Medical Devices on UI in Community Dwelling Females 

 Eight RCTs examined different devices to treat UI in females, including Hodge pessary,311

disposable intravaginal devices,312,313 urethral plug,314 and vaginal cones299,315,316 (Appendix 

Table F110). 

Patient outcomes. 

Continence and improvement of UI in community dwelling females. A new blocking leakage 

urethral sterile device with disposable applicator resulted in the highest continence rate (67 

percent) in women with mixed or stress UI with no relative benefit compared to a sterile balloon 

device (Appendix Table F111).313 Continence during physical activity was achieved in 36 

percent of exercisers ages 33-73 with stress UI after using a Hodge pessary but there was no 

relative benefit compared to a super tampon.311 A Conveen continence disposable intravaginal 
196

device cured stress UI in 36 percent compared to 48 percent with a Contrelle continence tampon 

with no statistically significant difference between treatments. 

 The use of vaginal cones of 20, 40, and 70g for 20 minutes/day resulted in nonsignificant 

improvement in subjective and objective cure in women with clinically and urodynamically 

proven stress UI.299 Use of vaginal cones showed no improvement in UI compared to pelvic floor 

muscle training and functional electrical stimulation biofeedback.315

 Severity of UI and quality of life with UI in community dwelling females. A continence 

disposable intravaginal device and tampon reduced urine loss during the 24-hour pad weight test 

compared to no treatment.312 

 Vaginal cones did not improve the results of the stress pad test and the 24-hour pad weight 

test compared to no treatment but improved the leakage index.299 Vaginal cones were not more 

effective in reducing self-reported severity of UI than biofeedback assisted pelvic floor muscle 

training315 or regular care299 (Appendix Table F112). The effects of vaginal cones on restricting 

exercise and avoiding places due to incontinence were less than those of biofeedback-assisted 

pelvic floor muscle training.315

 UI in community dwelling males. Two RCTs examined medical devices on UI in males 

(Appendix Table F113).317,318 One small RCT did not show a relative benefit of a UroLume 

sphincteric stent inserted cystoscopically to conventional external sphincterotomy in 57 men 

with spinal cord injury and electromyographic and manometric evidence of external detrusorsphincter dyssynergia (Appendix Table F114).317 A second small crossover RCT compared 

penile compression devices in men 6 months after radical prostatectomy318 and did not show 

differences in resistance index and urine loss during the 4-hour pad test compared to no device 

(Appendix Table F115). 

 In conclusion, limited evidence suggests that medical devices result in modest improvement 

in UI in women with a tendency to provide relative benefit compared to no treatments but not to 

other interventions. 

Effects of Bulking Agents on UI in Community Dwelling Females 

 The effects of different bulking agents on female UI were examined in two RCTs with more 

than 100 females307,749 and three smaller RCTs309,310,750 with 6-24 months of followup (Appendix 

Table F116). 

Outcomes. 

Continence. Curative effects at 12 months of followup were shown after intraurethral 

collagen injection in women with stress UI (51.5 percent were dry during 24-hour pad test) 

(Appendix Table F117).307 Transurethral porcine dermal implant injection resulted in negative 

pad test (cure) in 60 percent of women with urodynamically proven stress UI at 6 months of 

followup.309 Peri-urethral injections of autologous fat from the anterior abdominal wall or 

buttock with up to three injections depending on individual response cured or improved UI at 24 

months of followup in 17 percent of women with stress UI.750 Transurethral injection of the 

bulking agent, dextran copolymer, resulted in objective cure at 12 months of followup in 15 

percent of women with stress or mixed incontinence with minor and controlled urge component, 

who failed prior conservative treatments.310 

Improvement in UI. Four RCTs reported improvement in UI after bulking agents. The highest 

rates of improvement (60 percent of women had an improved pad test) were reported after 

periurethral porcine dermal implant injection.309 The same treatment improved the UI scores in 
197

50 percent of women and the results of the Kings College Hospital Quality of Health 

Questionnaire in 56 percent.309 Injection of the bulking agent Durasphere improved UI in 43 

percent of women with refractory stress UI due to intrinsic sphincter deficiency.749 

UI. The risk of complete urinary retention was lower after intraurethral collagen submucosal 

injection compared to surgical procedures, including needle bladder neck suspensions, Burch 

colposuspensions, and intravaginal slings (RR 0.1, 95 percent CI 0.0; 0.9). However, no RCTs 

showed a significant relative benefit of bulking agents compared to placebo750 or other 

treatments.307,309,310,749 The incidence of urgency was higher after the synthetic bulking agent 

compared to bovine collagen (RR 2.1, 95 percent CI 1.3; 3.3).749 Bulking agents did not result in 

consistent improvement in urodynamic outcomes, pad weight test results, or quality of life 

measures (Appendix Table F118). We estimated that 119 patients would avoid complete urinary 

retention after collagen injection compared to surgical interventions (Table 53). In conclusion, no 

evidence suggests that bulking agents improve efficacy compared to placebo or effectiveness 

compared to other treatments in females. 

 Transurethral radiofrequency energy collagen micro-remodeling was examined in one RCT 

of 110 women with stress UI and showed no significant improvement in a quality of life 

questionnaire in women with stress UI and bladder outlet hypermobility compared to placebo 

injections.751

Clinical Effects of Obstetric Interventions on UI 

 Patient outcome - UI. The effects of different obstetric strategies to reduce the risk of UI 

were examined in seven large RCTs386-389,391,752,753 and one smaller RCT382 with justified sample 

size that evaluated surgical techniques for the primary repair of obstetric anal sphincter 

lacerations on UI (Appendix Table F119). Planned Cesarean delivery compared to vaginal birth 

reduced the risk of stress UI by 40 percent (RR 0.6, 95 percent CI 0.4; 0.9) at 3 months but not 2 

years postpartum (Appendix Table F120).389 Caesarean section was more protective against UI 

compared to vaginal delivery 3 months postpartum in the large RCT with no intention to treat 

and a 4.3 percent rate of cross treatments decided by the attending physician.752 Caesarean 

section reduced the risk of any UI by 70 percent (RR 0.3, 95 percent CI 0.1; 0.7) in primiparous 

women and in the subgroup of primiparous women with a history of UI (RR 0.3, 95 percent CI 

0.1; 0.9).752 The risk of stress UI was reduced by 70 percent in primiparous women (RR 0.3, 95 

percent CI 0.2; 0.5), with the same reduction in females with and without previous UI. The 

protective effect was not seen in multiparous women. 

 Restrictive vs. liberal policies for episiotomy386,753 did not reduce the risk of UI 1.5-3 years 

postpartum. Mediolateral episiotomy compared to no episiotomy387 did not decrease the risk of 

stress or urge UI 3 months after delivery. The same proportion of women requiring assisted 

vaginal delivery reported stress and urge UI after delivery with vacuum extractor or forceps 

delivery 5 years postpartum.391 End-to-end repair compared to overlapping technique did not 

result in a lower risk of UI in 51 women with complete third or fourth degree anal sphincter 

laceration who underwent primary repair at the time of vaginal delivery.382 Episiotomy did not 

affect urodynamic outcomes (Appendix Table F121).386,387
198

Effects of Hysterectomy on UI

 Patient outcome - UI. Three powered RCTs320,754,755 and two smaller RCTs with no 

justification for sample size319,756 examined the effects of hysterectomy on the incidence and 

progression of UI (Appendix Table F122). Total abdominal hysterectomy was compared to 

subtotal supracervical hysterectomy in women with benign diseases of the uterus (Appendix 

Table 123). No differences in total, urge, or stress UI were detected between the two treatments. 

Intrafascial total abdominal hysterectomy significantly reduced the risk of urge UI compared to 

the extrafascial approach.319 

 Surrogate outcome - Objective measures of severity of UI. Two RCTs evaluated 

urodynamic outcomes and self-reported severity of UI and did not show differences between 

subtotal and total hysterectomy (Appendix Table F124).754,756

Effects of Vaginal Tapes and Sling Procedures on UI 

 The effects of vaginal tapes and sling procedures to reduce the progression of UI in women 

with predominantly stress UI were examined in 25 RCTs (Appendix Table 

F125).325,327,331,338,749,757,758 323,324,326,329,332-337,339-342,485,488,491,759,760

 Patient outcomes. 

 Continence (curative effects). The majority of the RCTs (20/25) reported continence after 

vaginal tapes and sling procedures (Appendix Table F126).323-342 The sample size included more 

than 100 women in nine RCTs.325-327,331,332,334,340,341 The rate of continence was above 75 percent 

in the majority of RCTs; only two RCTs reported cure rates <75 percent,334,337 All RCTs 

compared the effectiveness of vaginal tapes and sling procedures to active controls; no efficacy 

trials were identified. Cure rates were comparable after all tested procedures with no significant 

relative benefits. Only two RCTs reported significant relative increase in objective cure.330,331

Tension-free vaginal tape procedures increased the rate of negative postoperative cough 

provocation tests by 60 percent compared to plication of the endopelvic fascia (RR 1.6, 95 

percent CI 1.1; 1.4) in a small trial that examined women with severe genital prolapse treated 

with vaginal hysterectomy, culdoplasty, and cystocele repair for pelvic floor defects.330 Tensionfree vaginal tape under local anesthesia with polypropylene mesh tape placed under the 

midurethra resulted in a negative stress test 50 percent more often than laparoscopic mesh 

colposuspension under general anesthesia (RR 1.5, 95 percent CI 1.1; 2.4).331

 Improvement of UI in females. The majority of RCTs reported improvement in UI after 

vaginal tape and sling procedures (Appendix Table F127).323,325-327,329,332,334,336,339,342,485,760 The 

rates of improvement differed from 2.2 percent after transobturator suburethral sling procedure339

to 100 percent after transvaginal antimicrobial mesh synthetic mesh,323 depending on definitions 

of improvement. The rates were higher for stress UI after transvaginal antimicrobial synthetic 

mesh,323 vesicourethral suspension by allogenic sling,485 and suprapubic arc sling.760 The rates 

were lower (19.4 percent) after the same procedure on quantitative improvement in stress UI 

defined as a decrease of >50 percent in urine loss.336 The largest rate of improvement in urge UI 

(71.1 percent) was reported after intra-vaginal sling procedures.760 A significant relative benefit 

was shown in one RCT that compared suburethral slingplasty with the suprapubic arc to 

intravaginal sling in 195 patients with urodynamic UI refractory to conservative management. 

Improvement in urge UI occurred 2.7 times more often after suprapubic arc compared to 

intravaginal sling (RR 2.7, 95 percent CI 1.3; 5.5).334
199

 UI in females. The effects of vaginal tape and sling procedures were evaluated on selfreported incontinence and quality of life and objective measures of severity of UI including the 

pad weight test (Appendix Table F128). Few trials reported significant reduction in the 

progression of stress UI. Persistent subjective symptoms of stress UI were reported less often 

after tension-free vaginal tape than suprapubic urethral support sling in one trial (RR 0.5, 95 

percent CI 0.3; 0.9).341 Tension-free vaginal tape reduced stress UI by 90 percent compared to 

plication of the endopelvic fascia in one trial (RR 0.1, 95 percent CI 0; 0.8.330 Women after 

tension-free vaginal tape reported subjective treatment failure less often (RR 0.6, 95 percent CI 

0.3; 0.9) compared to suprapubic urethral support sling in one trial.341

 Surrogate outcomes. 

 Subjective measure of severity of UI. RCTs compared self-reported frequency and severity of 

UI and quality of life of UI after tape and sling procedures compared to other active treatments 

(Appendix Table F129). Inconsistent progression in UI was reported in one RCT after tensionfree vaginal tape under local anesthesia compared to laparoscopic mesh colposuspension under 

general anesthesia (mean difference in UI Severity Score 1.6, 95 percent CI 0.27; 2.94, mean 

difference in Visual Analog Scale of UI 1.3, 95 percent CI 0.7; 2.1).331 One RCT reported 

improvement in global discomfort related to UI after suburethral sling procedure with retropubic 

routes compared to transobturator routes (mean difference 0.5, 95 percent CI 0.1; 0.9).342 

Objective measure of severity of UI. Inconsistencies in direction and effect size in 

urodynamic cystometry after tested treatments were found in the majority of RCTs (Appendix 

Table F130). 

Effects of Surgical Interventions on UI in Community Dwelling Women

(Appendix Table F131) 

 Six RCTs examined the effects of surgical treatments of prolapse to prevent 

UI.322,330,486,487,761,762 One well designed RCT tested the effects of preoperative physiotherapy on 

UI.763 The majority of RCTs included women with stress UI and compared different surgical 

techniques to treat UI.321,343-350,353-362,764-778

 Patient outcomes. 

Continence. Forty RCTs reported continence rates after different surgical procedures (Table 

54).319,345-351,353,355-362,486,487,764,767-770,772-774,777,778 321,343,344,491,757,766,771,775,776 The definitions varied 

from subjective cure with no symptoms or complaints, and need for pad use to objective cure 

during urodynamic evaluation and stress test. The continence rates demonstrated a substantial 

variability after the same procedures from 3.1 percent770 to 85.1 percent346 after laparoscopic 

colposuspension and from 8.7 percent777 to 93.3 percent490 after laparoscopic Burch procedures. 

Burch retropubic urethropexy resulted in continence in more than 90 percent of women and 

provided the largest relative benefit compared to modified anterior colporrhaphy (RR 5.1, 95 

percent CI 1.8; 14.1)353 and anterior colporrhaphy with Kelly plication (RR 1.4, 95 percent CI 

1.1; 1.8).345 The relative benefit of continence after Burch urethropexy was larger in another 

RCT that examined the same procedures (RR 2.3, 95 percent CI 1.3; 3.8).774 Burch 

colposuspension with abdominal hysterectomy compared to anterior colporrhaphy with vaginal 

hysterectomy resulted in higher continence rates (RR 1.6, 95 percent CI 1.1; 2.3) in women 

undergoing surgery for primary stress incontinence and a concurrent grade 2 or 3 cystocele.362

The relative benefit of the same procedure differed depending on the definition of cure. For 

example, the same trial that showed a 60 percent relative benefit for urinary continence with the 
200

Burch procedure compared to anterior colporrhaphy reported a 300 percent relative benefit on 

cure defined as a negative cotton swab test (RR 3.2, 95 percent CI 1.6; 6.4).362 The largest 

relative benefit of Burch retropubic suspension or pubovaginal sling was shown when compared 

with Oxybutynin 5mg three times/day (RR 41.3, 95percent CI 2.6; 645).769

 Improvement in UI. Improvement in self-reported UI and the pad weight test was reported in 

12 RCTs (Appendix Table F132).346,347,354-356,766-768,771,775,776,778 One RCT reported improvement 

in more than 80 percent of women after laparoscopic colposuspension and Burch open 

colposuspension.346 No significant relative benefit was detected when different treatments were 

compared. 

Incidence of UI. The incidence of UI was 3.8 times higher after sacropexy combined with a 

Burch colposuspension compared to sacropexy alone (RR 3.8, 95 percent CI 1.2; 12.1) in 

continent women with advanced prolapse and a negative stress test before and after prolapse 

reduction (Appendix Table F133).321 Another RCT demonstrated the opposite association with a 

lower incidence of stress UI after sacrocolpopexy with Burch colposuspension vs. 

sacrocolpopexy alone (RR 0.5, 95 percent CI 0.3; 0.7).761 A large well-designed RCT also 

reported a significant reduction in severe stress UI after prophylactic surgery (RR 0.3, 95 percent 

CI 0.1; 0.5).761 The sling procedure resulted in a significant reduction in stress UI 2 years after 

surgery compared to the Burch procedure in 665 women with predominant stress UI.343

Surrogate outcomes. 

Subjective measures of UI. Burch retropubic urethropexy decreased the frequency of 

incontinent episodes and pad use compared to modified anterior colporrhaphy (Appendix Table 

F134).353 Three RCTs reported improvement in quality of life after Burch colposuspension 

compared to other treatments.353,761,765 The comparative effectiveness of different surgical 

procedures was not consistent in direction and effect size. 

Objective measures of UI. Inconsistent differences in urodynamic outcomes with less than 10 

percent of control levels were reported in all RCTs (Appendix Table F135). 

Possible predictors of better effect. The trials used stratified randomization by a surgeon761

and by participating centers343,771,779 to estimate valid treatment effects independent of provider 

differences. Patient age, previous bladder neck surgery,771 and concomitant rectocele repair for 

symptomatic rectocele779 were balanced between treatment groups with stratified randomization 

to avoid effect measure modification. One trial reported the incidence of UI after sarcopexy 

combined with a Burch colposuspension compared to colposacropexy without prophylactic 

colposuspension in subgroups with baseline maximum urethral closure pressure above and below 

35cmH20.321 No evidence suggested a significant effect modification by patient baseline 

conditions. 

 We analyzed the comparative effectiveness of different surgical procedures on urinary 

continence in females (Table 55). The laparoscopic Burch procedure with sutures did not provide 

significant benefit compared to staples.361,777 The laparoscopic Burch procedure compared to 

open Burch surgery resulted in higher continence rates in one RCT, lower in another, and 

random differences in three RCTs. Sling procedures were compared to Burch colposuspension 

with significant relative benefit of continence in one RCT and random differences in four RCTs. 

The Burch procedure compared to the tension-free tape procedure did not result in higher cure 

rates in four RCTs. An increase in continence was observed after the Burch procedure compared 

to colporrhaphy in two RCTs. One RCT reported higher continence rates after Burch operation 

vs. retropubic urethropexy with random differences in two other RCTs. No significant 

differences in cure were observed in two RCTs that compared retropubic urethrocystopexy and 
201

pelvic floor repair. Tension-free tape procedures resulted in a very small relative benefit in 

continence compared to the sling procedure in five RCTs, while six RCTs reported random 

differences. 

 We estimated that different surgical procedures may result in a large number of avoided stress 

and total UI in women with no consistent benefit of one procedure over others (Tables 56-58). 

Summary. In conclusion, a large body of evidence suggests that surgical procedures of stress 

UI in women result in continence and improvement in UI in more than 75 percent of treated 

women. Different surgical procedures have comparable effectiveness with no differences in 

incident urge incontinence. The absolute risk of de novo urgency and urge incontinence after 

surgery for stress UI requires an RCT, powered to estimate the balance between benefits and 

harms in continent women with prolapse and patients with stress incontinence. The comparative 

effectiveness of behavioral interventions and surgery are not known. Individual patient factors 

that may modify the effects of different procedures also require future research. 

Reducing the Adverse Effects of Clinical Interventions Done for Other 

Purposes 

 Effects of clinical interventions on UI in adults with adenocarcinoma of the rectum. One 

large RCT of 1,861 patients with histologically confirmed adenocarcinoma of the rectum 

compared the effects of surgery and adjuvant radiotherapy on UI (Appendix Table F136). The 

incidence of UI and incontinence that required pad use was the same among patients after total 

mesorectal excision and adjuvant radiotherapy before surgery (Appendix Table F137). 

 Effects of clinical interventions on UI in males with urological diseases. Eleven RCTs 

examined clinical interventions to prevent UI in patients with prostate cancer780-790 and three 

RCTs included patients with benign prostate diseases489,791-793 (Appendix Table F138). 

Patient outcome - Continence. Urinary continence was reported in four RCTs.782,783,785 The 

highest rate of urinary continence (>92 percent) was reported after radical retropubic 

prostatectomy with bladder neck preservation (Appendix Table F139).783

 Artificial urethral sphincter implantation and macroplastique injection in the sphincter region 

of the urethra resulted in continence in 80 percent and 91 percent of patients with minimal 

baseline incontinence, respectively.785 The rates of “social continence” were lower and differed 

substantially depending on baseline incontinence.785 Only one RCT reported continence (77 

percent) after combined therapy of prostate cancer.782 No evidence showed a significant relative 

benefit of continence between compared interventions. 

 Patient outcome - Incidence of UI. The highest rates of UI were reported in one RCT that 

examined the effects of bladder neck mucosal eversion during retropubic radical prostatectomy 

(Appendix Table F140). 

 Almost all patients with benign prostate diseases were continent after transurethral resection 

of the prostate with the thick vapor resection loop792 and transurethral resection of the prostate.793

In contrast, Holmium laser enucleation resulted in 50 percent of UI in the same population of 

men with bladder outflow obstruction secondary to benign prostatic hyperplasia.489 

 Patients with prostate cancer reported different rates of UI depending on the type and 

definition. Retropubic radical prostatectomy and vesico-urethral anastomosis with and without 

bladder neck eversion resulted in UI in more than 90 percent of patients.781 The highest rate of 

urge UI (44 percent) was shown after radiation therapy with a four-field box technique to a dose 

of 70Gy.780 The same treatment resulted in only 7 percent of self-reported stress UI in this 
202

trial.780 The lowest incidence of UI among patients with prostate cancer was reported after 

supplemental beam radiation with I-125 (144Gy) (1 percent).784

 Indirect comparisons showed inconsistent relative risks of UI after surgical treatments and 

radiotherapy. The largest relative differences were observed in the risk of transient stress 

incontinence after transurethral resection of the prostate compared electro vaporization in 

patients with benign hypertrophy of prostate (0.1 percent vs. 18.6 percent respectively.793 The 

rates of UI were substantially higher after adjuvant hormone therapy and surgery (300mg of 

diethylstilbestrol diphosphate/day) compared to adjuvant hormone therapy and external beam 

radiation (RR 35.5, 95 percent CI 2.2; 569.3). Patients with total baseline incontinence for >6 

months after radical retropubic prostatectomy, transvesical prostatectomy, or transurethral 

prostatectomy reported cure more often after macroplastique injection to the sphincter region of 

the urethra compared to artificial urethral sphincter implantation (RR 0.3, 95 percent CI 0.1; 

0.9.785 Pad utilization was higher after radiotherapy compared to active surveillance (RR 8.3, 95 

percent CI 1.1; 62.6).790

Surrogate outcome - Subjective measures of quality of life. Few RCTs examined the effects 

of clinical interventions on quality of life specific for UI (Appendix Table F141).489,784,790,791

Two regimens of radiotherapy resulted in different urinary scores of the American Urologic 

Association and Radiation Therapy Oncology Group criteria (mean difference 11.0, 95 percent 

CI 9.5; 12.5).784 Bother from urinary difficulties was greater after transurethral resection of 

prostate compared to watchful waiting (mean difference 0.7 on a scale of 100 for least 

impairment, 95 percent CI 0.5; 0.9) in patients with benign prostate hypertrophy.791 No 

differences in quality of life were seen in patients with prostate cancer after radiotherapy 

compared to active surveillance.790 

Surrogate outcome - Objective measures of UI. No differences in urodynamic outcomes were 

reported after different treatments of benign prostate diseases (Appendix Table F142).489,791,793

Summary. In conclusion, some limited evidence suggests that UI as a secondary outcome 

related to both baseline diseases and treatments is more severe after surgery and radiotherapy 

compared to active surveillance. The baseline level of incontinence may modify the effects of the 

treatments. Bladder preservation surgical techniques did not provide consistent and significant 

benefit on UI. No consistent evidence across RCTs suggests that different treatments for prostate 

cancer and benign hyperplasia can provide better long-term outcomes. The reproducibility of 

large relative differences in outcomes in several RCTs requires future confirmation. 

 Effects of hormone therapy on UI in community dwelling women. The effects of systemic 

oral hormone therapy on continence status in postmenopausal women were examined in 19 

RCTs (Appendix Table F143).352,365-367,369,513,794-806 The effects of transdermal and intravaginal 

estrogen therapy to improve continence status in postmenopausal women were administered in 

10 RCTs (Appendix Table F144).363,364,368,370,490,807-811 

Patient outcome - Continence. The preventive effects of systemic hormone replacement 

therapy in postmenopausal women were examined in several large RCTs (Appendix Table 

F145).797,801,806 Only two RCTs reported positive significant effects of oral hormone therapy 

compared to baseline levels or placebo.364,797 The administration of 2mg 17β-oestradiol 

combined with either 2.5, 5, 10, or 15mg dydrogesterone, orally once a day for 6 months cured 

incontinence in 23 percent of healthy postmenopausal nonhysterectomized women (RR 47.0, 95 

percent CI 2.9; 763.5).797 Oral hormone administration was less effective in achieving continence 

compared to local estrogen therapy (RR 0.4, 95 percent CI 0.3; 0.6).368
203

 Urinary continence was reported in RCTs that examined the curative effects of local therapy 

among incontinent women.364,368-370 The highest rates of continence were reported after 

transdermal administration of an estrogen patch (100 percent) and gel 1.25g/day (90 percent) 

among postmenopausal women with self-reported urinary symptoms (Appendix Table F145).368

Local estrogen in vagitories or jelly combined with physiotherapy and electrostimulation cured 

22 percent of women 50-74 years of age with regular mild incontinence (>2 leakage episodes per 

month) compared to 0 percent after no hormone treatment (RR 20.7, 95 percent CI 1.2; 346.5).364

 Patient outcome - Improvement of UI. Several RCTs reported improvement in UI after local 

and oral hormone use363,364,794,797,798,802,806,808 with the rates varying from 7 percent794 to 68 

percent,363 depending on the route of the administration and the definition of the improvement 

(Appendix Table F146). The highest rate of improvement (68 percent) was reported after 6 

months of intravaginal estrogen administration in incontinent postmenopausal women.363

Combined estrogen and progesterone therapy cured nocturia, one of the risk factors of UI, in 65 

percent of women.797 Self-reported improvement in incontinence symptoms occurred in 45 

percent of women after combined therapy of estrogen with alpha-adrenoreceptor agonist and in 

40 percent after estrogen alone.802 

 The combination of local estrogen administration with physiotherapy and electrostimulation 

reduced the frequency of wet episodes in 39 percent of incontinent women.364

 Hormone therapy improved UI compared to placebo treatments, but the effects were not 

consistent across RCTs. Intravaginal estrogen administration resulted in cure or improvement 

four times more often compared to placebo suppositories (RR 4.3, 95 percent CI 2.1; 8.7).363 The 

same relative effect was reported after the combination of intravaginal estrogen with electrical 

stimulation (RR 4.3, 95 percent CI 1.5; 11.9).364 In contrast, only one RCT showed a greater 

reduction in the number of incontinent episodes after placebo vs. ultra low dose of transdermal 

estrogen (RR 0.7, 95 percent CI .5; 0.9).808 

 Patient outcome - UI. The investigations that were designed to evaluate protective effects of 

hormone therapy on postmenopausal UI reported either random differences or relative increase 

in UI after estrogen therapy compared to placebo controls (Appendix Table F147).363,365-367,513,794-

796,798,801,806,808,809Only one RCT showed a reduction in subjective complaints of stress UI after 

intravaginal estrogen administration (RR 0.4, 95 percent CI 0.2; 0.6).363 The majority of RCTs 

demonstrated a consistent significant relative increase in UI across different routes of 

administration and definitions of UI. Incident mixed UI was increased by 50 percent (RR1.5, 95 

percent CI 1.1; 2.2) and incident stress UI by 80 percent (RR 1.8, 95 percent CI 1.6; 2.2) after 

estrogen therapy.365 Incident urge UI increased by 30 percent and total UI by 40 percent (RR 1.4, 

95 percent CI 1.3; 1.6) after estrogen combined with progestin (RR 1.3, 95 percent CI 1.2; 

1.5).366 Oral estrogen alone without progestin increased incident stress UI by 210 percent (RR 

2.1, 95 percent CI 1.7; 2.5)365 and worsened UI by 530 percent (RR 5.3, 95 percent CI 1.2; 

23.5).367

 Patient outcome - Subjective progression of UI. Several RCTs obtained self-reported changes 

in severity after hormone therapy364,367,794,796,801,808 and did not demonstrate differences compared 

to placebo (Appendix Table F148). One RCT reported a reduction in worsening of UI after 

transdermal estrogen (RR 0.2, 95 percent CI 0.1; 0.6).808 

Surrogate outcome - Subjective measures of severity of UI. No differences were found after 

hormone therapy compared to placebo treatments (Appendix Table F149).369,794,800,801,803,805,807

One RCT reported an increase in daily incontinence episodes after estrogen (mean difference 

0.9, 95 percent CI 0.3; 1.4).801 
204

Surrogate outcome - Objective measures of severity. There were no differences compared to 

controls or demonstrated small inconsistent changes (Appendix Table F150). 

Summary. In conclusion, consistent evidence suggests that system hormone therapy increased 

the risk and progression of UI in postmenopausal females (Table 59). The relative harm varied 

from 42 to 106 percent for stress UI, 129 to 906 percent for any, and differed substantially for 

trials that measured urge UI. 

 Few RCTs demonstrated relative benefits of local estrogen administration for treatment of 

stress UI by 64 percent363 and urge by 55 percent.364 

 The effective clinical interventions that resulted in long-term stress urinary continence in 

more than 75 percent of participating females (Table 60) included Burch colposuspension 

techniques and sling and tension-free tape procedures. Total urinary continence in more than 75 

percent of women was observed in several RCTs after tension-free tape and sling procedures 

(Table 60). The effective clinical interventions that resulted in long-term urinary continence in 

males with prostatic diseases included pelvic floor muscle training, electrical stimulation with 

biofeedback, radical retropubic prostatectomy with bladder neck preservation, and implantation 

of an artificial urethral sphincter (Table 61). Overall, consistent evidence from RCTs suggests 

that pelvic floor muscle training augmented with biofeedback, Burch colposuspension, and 

tension-free tape and sling procedures are effective to reduce the absolute risk of stress UI in 

women (Tables 62 and 63). 

 Tension-free tape and sling procedures decreased the absolute risk of total UI. No clinical 

interventions demonstrated consistent reduction in absolute risk of urge UI. 

 The largest relative benefits with more than 300 excessive cases of resolved stress 

incontinence were reported in RCTs per 1,000 females treated with pelvic floor muscle training, 

Burch colposuspensions, and tension-free vaginal tape compared to usual care or other 

treatments (Table 64). Few RCTs reported large relative benefits on total urinary continence in 

females with local estrogen, Burch colposuspension with abdominal hysterectomy, and 

pubovaginal sling. Few small RCTs reported more than 300 cases of resolved urge incontinence 

in males and females after electrical or magnetic stimulation. 

 Effects of pharmacological agents on UI. Three systematic Cochrane reviews reported UI 

after drug administration. The reviews analyzed randomized trials of anticholinergic drugs on 

overactive bladder,812 of adrenergic drugs for urinary incontinence,813 and of serotonin and 

noradrenaline reuptake inhibitors for stress UI in adults.642 We estimated attributable events of 

cure, improvement, or progression from the RCTs published after 1990. Adrenergic drugs were 

better than placebo in two of five RCTs (Table 65). Continence rates after pelvic floor muscle 

exercise were comparable with rate after adrenergic drugs. A combination of 

phenylpropanolamine that was withdrawn from the market when it was linked to intracerebral 

hemorrhage with estrogen resulted in continence in 0-40 percent of women. No trials included 

males. Clenbuterol resulted in continence 2 to 4.6 times more often than placebo in two trials but 

was not more effective compared to pelvic floor muscle training. 

 The Cochrane review of 61 trials of adults with overactive bladder syndrome that compared 

anticholinergic drugs with placebo treatment or no treatment reported the combined outcome of 

cure or improvement in UI from eight RCTs (Table 66). The other 53 RCTs did not report 

patient outcomes. No trials were conducted in men. Administration of propiverine (two RCTs) or 

extended release tolteradine (two RCTs) for 2-12 weeks resulted in greater rates of cure or 

improvement compared to placebo. Pooled analysis of six RCTs of different drugs resulted in 

139 percent higher rates of cure of improvement (RR 1.4, 95 percent CI 1.3; 1.5).812 The authors 
205

also reported significant reduction in daily leakage episodes (mean difference -0.5, 95 percent CI 

-0.7; -0.4) after drug administration. 

 The review of eight RCTs of duloxetine administered for 3-12 weeks in patients with 

predominantly stress UI concluded that the drug failed to show better curative effects than 

placebo (Table 67). However, improvement rates and quality of life scores were better after 

active duloxetine compared to placebo. The long-term effects of pharmacological agents on UI 

are not clear. The effects on surrogates reported in many trials may not reflect patient outcomes. 

The comparative effectiveness of drugs compared to other conservative interventions remains 

unclear. 

 One multicenter RCT of 695 males 40 years or older with overactive bladder examined the 

effects of alpha 1 adrenoreceptor blocker tamsulosin for treatment of benign prostatic 

hyperplasia.814 Men were treated with 0.4mg of tamsulosin, 4mg of tolterodine ER, both 

tolterodine ER plus tamsulosin, or placebo for 12 weeks. Urge incontinence rates were the same 

after tamsulosin (RR 1.1, 95 percent 0.8; 1.6), tolterodine (RR 1.1, 95 percent CI 0.8; 1.7), or the 

combinations of both drugs (RR 1.1, 95 percent CI 0.8; 1.6) compared to placebo. 

Summary. Clenbuterol was more effective than a placebo in achieving continence in females 

with stress UI but not compared to pelvic floor muscle training. Extended release tolteradine for 

2-12 weeks resulted in greater rates of cure or improvement compared to placebo in adults with 

overactive bladder syndrome. Duloxetin administered for 3-12 weeks in patients with 

predominantly stress UI improved UI, but the rates of continence did not differ from placebo. 

Long-term effects of medications combined with pelvic floor training on continence are 

unknown. Comparative effectiveness of combined treatments, including medication, requires 

future research. 
206 

Table 44. Comparative effectiveness of combined conservative management interventions on UI (significant relative benefit of con

individual studies) 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Existing primary care including GP+ continence advisory services in the area. Outcome: continence 

828/2958 150/788 28.00 19.00 1.47 

(1.26; 1.72) 

Williams, 2005240N = 3,746 60% female 6 month followup 

Continence service that included advice on diet and fluids; bladder training; pelvic floor awareness and lifestyle advice 

Outcome: Satisfied with current urinary symptoms for rest of life 

1,893/2958 418/788 64.00 53.00 1.21 

(1.12; 1.30) 

Conventional rehabilitation program Outcome: continence 

20/21 3/13 95.24 23.08 4.13 

(1.52; 11.19) 

Wikander, 1998239* N = 34 56% female 3 month followup 

Specially designed rehabilitation program to increase patient independent management of incontinence 

Outcome: Number discharged to a nursing home due to incontinence 

2/21 8/13 9.52 61.54 0.15 

(0.04; 0.62) 
Table 44. Comparative effectiveness of combined conservative management interventions that significantly reduced the risk of UI 

207

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Schnelle, 1995238* N = 85 6 month followup 

After gradual implementation of computerized quality management model for medical assessment and individualized prompted voiding protocols of incontinence 

Before implementation of quality management model. Outcome: proportion of wet residents 

14/85 26/85 17.00 31.00 0.54 

(0.30; 0.96) 

*Long-term care settings; Bold - significant differences in outcomes at 95% confidence level; number needed to treat to benefit one patieoutcomes (continence and improvement in incontinence) or to harm one patient for negative patient outcomes (incontinence); E - numbe

1,000 treated, A - number of avoided events per 1,000 treated 
208 

Table 45. Comparative effectiveness of combined conservative management intervention on female UI related to pregnancy anprevention) 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Nu

Nee

T

(95

Outcome: severe incontinence (at least once a week) at 12 months postpartum 

55/371 78/376 14.82 20.74 0.71 

(0.52; 0.98) 

(10

Glazener, 2001251N = 747 100% female 12 month followup 

Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises supplemented with bladder training 

Outcome: severe incontinence in women with high initial severity (>1/week) 

43/371 65/376 11.59 17.29 0.67 

(0.47; 0.96) 

(11

Bold - significant differences in outcomes at 95% confidence level; A - number of avoided events per 1,000 treated. Number needed to tr

for positive patient outcomes (continence and improvement) or to harm one patient for negative patient outcomes (incontinence) 
209

Figure 29. Relative benefit of urinary continence after active treatment compared to usual care in males with 

urological diseases (efficacy RCTs, primary prevention) 

PFMT pelvic floor muscle training; PFMT + BFB pelvic floor muscle training with biofeedback; Stimulation = electrical 

stimulation 

* incontinence was measured using International Continence Society male questionnaire 

Relative benefit of continence 

0.63 1 1.6

Study (sample)

Relative benefit of continence

(95% CI)

PFMT

Wille (139) 0.98 (0.84, 1.14) 

Parekh (38) 1.14 (0.82, 1.60) 

Wille (139) 0.84 (0.70, 1.01) 

PFMT+BFB

Filocamo (300) 1.12 (1.05, 1.20) 

Mathewson-Chapman (53) 0.97 (0.87, 1.07) 

Van Kampen (102) 1.16 (1.00, 1.35) 

Filocamo* (300) 1.32 (1.17, 1.51) 

Van Kampen (102) 1.27 (1.03, 1.57) 

Bales (100) 0.91 (0.82, 1.03) 

Franke (30) 1.00 (0.76, 1.32) 

Stimulation 

Yokoyama (36) 1.00 (0.70, 1.43) 

Wille (139) 0.90 (0.76, 1.07) 

Favors usual care Favors active treatment
210

Table 46. Relative benefit of urinary continence after behavioral interventions in adults compared to regular 

care (random effects models, secondary prevention) 

Author 

Sample; Followup 

Relative Risk 

(95% CI) 

Pelvic Floor Muscle Training 

Parekh, 2003265

N = 38; 0% female; 12 month followup 

1.07 (0.79; 1.44) 

O’Brien, 199143

N = 561; 76% female; 3 month followup 

15.49 (2.13; 112.49) 

Aksac, 2003288

N = 50; 100% female; 2 month followup 

16.24 (1.07; 246.51) 

Burns, 1993289

N = 135; 100% female; 39 month followup 

6.35 (0.82; 49.32) 

Lagro-Janssen, 1992280

N = 66; 100% female; 3 month followup 

7.00 (0.91; 53.78) 

Sleep, 1987253

N = 1,800; 100% female; 3 month followup 

0.96 (0.53; 1.72) 

Kim, 2001290

N = 33; 100% female; 3 month followup 

3.19 (0.75; 13.55) 

Biofeedback-assisted Pelvic Floor Muscle Training

Filocamo, 2005257

N = 300; 0% female; 12 month followup 

1.12 (1.05; 1.19) 

Mathewson-Chapman, 1997259

N = 53; 0% female; 3 month followup 

0.97 (0.87; 1.07) 

Franke, 2000 264

N = 30; 0% female; 6 month followup 

1.00 (0.76; 1.32) 

Williams, 2005240

N = 3,746; 60% female; 6 month followup 

1.47 (1.26; 1.72) 

Meyer, 2001249

N = 107; 100% female; 10 month followup 

10.98 (1.46; 82.8) 

Aksac, 2003288

N = 50; 100% female; 2 month followup 

17.29 (1.14; 261.69) 

Burns, 1993289

N = 135; 100% female; 6 month followup 

8.78 (1.17; 66.04) 

Pelvic Floor Muscle Training and Bladder Training 

Diokno, 2004243

N = 359; 100% female; 12 month followup 

1.32 (0.98; 1.78) 

Lagro-Janssen, 1991292

N = 106; 100% female; 3 month followup 

10.37 (1.37; 78.28) 

McFall, 2000241

N = 145; 100% female; 3 month followup 

1.69 (0.97; 2.93) 
211

Figure 30. Relative benefit of urinary continence after active treatment compared to usual care in females 

(efficacy RCTs, secondary prevention) 

PFMT pelvic floor muscle training; BT bladder training; PFMT+BT pelvic floor muscle training combined with bladder 

training; PFMT+ EMG BFB pelvic floor muscle training with electromyography biofeedback; * continence was defined 

as negative pad test 

Relative benefit of continence

Favors usual care Favors active treatment

 1 79

Study (sample) Relative benefit of continence

(95% CI) BT

Fantl (131) 4.06 (0.90, 18.41) 

PFMT 

Aksac* (50) 16.23 (1.07, 246.41) 

Bo (122) 15.44 (2.16, 110.28) 

Bo* (122) 6.07 (1.47, 25.13) 

Lagro-Janssen (66) 7.00 (0.91, 53.79) 

Burns (135) 6.35 (0.82, 49.30) 

PFMT+BT

Kim (33) 3.19 (0.75, 13.56) 

Diokno (359) 1.32 (0.98, 1.78) 

McFall (145) 1.69 (0.97, 2.93) 

Lagro-Janssen (106) 10.37 (1.37, 78.26) 

PFMT+EMG BFB 

Aksac* (50) 17.29 (1.14, 261.65) 

Burns (135) 8.78 (1.17, 66.02) 
212

Figure 31. Relative benefit of improvement in UI after active treatment compared to usual care (pooled results 

RCTs, random effects model) 

PFMT pelvic floor muscle training; PFMT + BFB pelvic floor muscle training with biofeedback; PFMT + BT - pelvic 

floor muscle training with bladder training 

Relative benefit of improvement

Favors Usual Care Favors Active Treatment

.3 1 3

Author (sample) Relative benefit of improvement

(95% CI)

PFMT

Lagro-Janssen (66) 57.00 (3.62, 896.38)

Aksac (50) 1.25 (0.29, 5.35)

O’Brien (561) 12.59 (6.04, 26.22)

Burns (135) 10.43 (2.63, 41.39)

1.00 (1.00, 1.00)

Subtotal 8.13 (2.33, 28.42)

PFMT+BFB

Meyer (107) 1.28 (0.78, 2.12)

Goode (70) 1.59 (1.12, 2.27)

Aksac (50) 1.00 (0.22, 4.56)

Burns (135) 11.70 (2.96, 46.20)

Subtotal 1.86 (0.98, 3.50)

PFMT+BT

McFall (145) 1.59 (1.13, 2.25)

Subak (152) 3.41 (1.89, 6.15)

Lagro-Janssen (106) 20.74 (5.27, 81.63)

Diokno (359) 1.37 (1.10, 1.70)

Subtotal 2.53 (1.38, 4.63)
213 

Table 47. Comparative effectiveness of behavioral interventions on urinary continence in adults from the community (significaRCTs) 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Need

Tre

(95% 

Continence in Patients with Stress UIMeyer, 2001249* 

N = 107 100% female 10 month followup 

12 sessions of PFMT with 20 minutes of biofeedback and 15 minutes of electro stimulation 

Usual care 10/51 1/56 19.00 2.00 10.98 

(1.46; 82.80) 

6 

(1; 

Bo, 2005275

N = 47 100% female Acute 

PFMT with 8-12 max contractions for 6-8 seconds 3 series/day under the supervision of physical therapist 

Home exercise groups 

13/21 4/26 60.00 17.00 4.02 

(1.54; 10.53) 

2 

(1; 

PFMT (contractions for 10 seconds and relaxation for 20 seconds, 10 times/ session, 3 sessions/day) BFB digital palpation at home 

15/20 0/10 75.00 0 16.24 

(1.07; 246.51) 

Aksac, 2003 1 

288

N = 50 100% female 2 month followup 

The same PFMT+ EMG BFB via vaginal probe 

Usual care 

16/20 0/10 80.00 0 17.29 

(1.14; 261.69) 

1 
Table 47. Comparative effectiveness of behavioral interventions on urinary continence in adults from the community (significa

RCTs) (continued) 

214

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Need

Tre

(95% 

Burns, 1993289

N = 135 100% female 6 month followup 

PFMT (contraction for 10 seconds and relaxations for 10 seconds 10 times in each weekly session)+ vaginal EMG BFB 

Usual care 9 1 23.00 3.00 8.78 

(1.17; 66.04) 

5 

(1;2

Untreated control group offered the use of continence guard. Objective cure as <2g leakage on the pad test with standardized bladder volume 

11/29 2/32 37.93 6.25 6.07 

(1.47; 25.12) 

3 

(1; 

Bo, 1999299

N = 122 100% female 6 month followup 

PFMT with 8-12 contractions 3 times/day, in groups with skilled physical therapists 1/week 

Subjective cure (number of women stating that the condition was “unproblematic” after the treatment) 

14/29 1/32 48.28 3.13 15.45 

(2.16; 110.28) 

2 

(0; 
Table 47. Comparative effectiveness of behavioral interventions on urinary continence in adults from the community (significa

RCTs) (continued) 

215

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Need

Tre

(95% 

Continence in Patients with Any UIJanssen, 2001286

N = 530 100% female 12 month followup 

Individual PFMT 5 times/day and bladder training with delay voiding, training with 11 30-minute sessions. 

Group PFMT 5 times/day and bladder training with delay voiding, training with 9 2-hour sessions 

28/126 57/404 22.00 14.00 1.58 

 (1.05; 2.36) 

1

(5; 

O’Brien, 199143

N = 561 76% female 3 month followup 

Four sessions of PFMT and BT supervised by non-specialist nurse 

Usual care 32/378 1/183 8.47 0.55 15.49 

(2.13; 112.49) 

1

(2; 

Lagro-Janssen, 1992280N = 106 100% female 3 month followup 

PFMT alone (stress) or BT (urge) or its combination (mixed) 

Usual care 10/54 1/56 18.52 1.79 10.37 

(1.37; 78.28) 

6 

(1; 

No formal training on PFMT Outcome: Selfreported urinary continence 

148/150 132/150 98.70 88.00 1.12 

(1.05; 1.19) 

9 

(6; 

Filocamo, 2005257* 

N = 300 0% female 12 month followup

Early pelvic floor rehabilitation program with verbal explanation, PFMT +BFB (digital anal control, visualization: 3 sets of 10 contractions for 5 seconds and 10 seconds of muscular relaxation 

Outcome: International Continence Society (ICS)-male questionnaire: completely dry 

134/150 101/150 89.33 67.33 1.33 

(1.17; 1.50) 

5 

(3; 
Table 47. Comparative effectiveness of behavioral interventions on urinary continence in adults from the community (significa

RCTs) (continued) 

216

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Need

Tre

(95% 

Van Kampen, 2000261N = 102 0% female 12 month followup 

Pelvic-floor re-education program with PFMT+BFB for as long as patients were incontinent. 

Placebo electrotherapy (a false interferential current) via four skin electrodes 

44/50 36/52 88.00 70.00 1.27 

(1.03; 1.57) 

6 

(3; 

*Sampling of continent adults at baseline (primary prevention); PFMT - pelvic floor muscle training, BFB - biofeedback; BT - bladder train

Bold - significant differences in outcomes at 95% confidence level; E - number of excessive events per 1,000 treated; number needed to for positive patient outcomes (continence and improvement) or to harm one patient for negative patient outcomes (incontinence)
217 

Table 48. Comparative effectiveness of behavioral interventions to improve UI in adults (significant results from individual RCTs) 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

N

(

Improvement in Stress UISubak, 2005714

N = 48 100% female 3 month followup 

Weight reduction intervention 

Delayed weight reduction intervention 

22/24 0/24 92.00 0 45.00 

(2.89; 701.85) 

PFMT (contraction for 10 seconds and relaxations for 10 seconds 10 times in each weekly session)+vaginal EMG BFB 

24/40 2/39 61.00 6.00 11.70 

(2.96; 46.20) 

Burns, 1993289

N = 135 100% female 6 month followup 

PFMT with 4 sets of 20 increasing by 10/set until maximum 200 sets/day 

Usual care 

23/40 2/39 54.00 6.00 10.43 

(2.63; 41.39) 

Wells, 1991725

N = 157 100% female 6 month followup 

PFMT with contractions for 10 seconds and relaxation for 10 seconds 90-160 times/day 

Phenylpropanolamine hydrochloride in a dose of 50mg/ day, increasing to 50mg 2 times/day 

17/82 29/75 21.00 39.00 0.54 

(0.32; 0.89) 

Bo, 1999299

N = 122 100% female 6 month followup 

PFMT with 8-12 contractions 3 times/day in groups with skilled physical therapists 1/week 

Untreated control group offered the use of a continence guard 

12/29 1/32 41.38 3.13 13.24 

(1.83; 95.63) 

Lagro-Janssen, 1999 292N = 66 

Instructions in PFMT 5-10 sessions of 10 pelvic muscle contractions for 6 

No therapy. Outcome: improvement in urinary incontinence 

28/33 0/33 85.00 0 57.00 

(3.62; 896.38) 
Table 48. Comparative effectiveness of behavioral interventions to improve UI in adults (continued) 

218

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

N

(

Outcome: improvement in psychological impact of urinary incontinence 

23/33 0/33 70.00 0 47.00 

(2.97; 742.97) 

100% female 3 month followup 

seconds each day 

Outcome: improvement in restriction of activities 

25/33 2/33 75.00 6.00 12.50 

(3.22; 48.56) 

Improvement in Any UI Janssen, 2001286

N = 530 100% female 12 month followup 

Individual PFMT 5 times/day and bladder training with delay voiding, training with 11 30-minute sessions 

Group PFMT 5 times/day and bladder training with delay voiding, training with 9 2-hour sessions 

118/126 347/404 94.00 86.00 1.09 

(1.03; 1.16) 

Subak, 2005714

N = 48 100% female 3 month followup 

Weight reduction intervention 

Delayed weight reduction intervention 

14/24 4/24 60.00 15.00 3.50 

(1.35; 9.11) 

Diokno, 2004243* 

N = 359 100% female 12 month followup

Behavioral modification program: PFMT+BT 

Usual care 92/164 80/195 56.00 41.00 1.37 

(1.10; 1.70) 

Goode, 2003268

N = 200 100% female 2 month followup 

Behavioral training (PFMT+BFB, home exercises, bladder control strategies, and self-monitoring with bladder diaries) and pelvic floor electrical stimulation 

Self-administered behavioral training administered with a self-help booklet 

58/67 38/67 86.00 57.00 1.53 

(1.21; 1.92) 
Table 48. Comparative effectiveness of behavioral interventions to improve UI in adults (continued) 

219

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

N

(

O’Brien, 199143

N = 561 76% female 3 month followup 

Four sessions of PFMT+BT supervised by non-specialist nurse 

Usual care 182/378 7/183 48.15 3.83 12.59 

(6.04; 26.22) 

Subak, 2002278

N = 152 100% female 1.5 month followup 

6 weekly 20-minute group instructional sessions on BT by nurse educators and followed individualized voiding schedules 

Usual care 39/77 11/75 50.00 15.00 3.41 

(1.89; 6.15) 

Lagro-Janssen, 1992280N = 106 100% female 3 month followup 

PFMT alone (stress) or BT (urge) or its combination (mixed) 

Usual care 40/54 2/56 74.00 3.00 20.74 

(5.27; 81.63) 

McFall, 2000241

N = 145 100% female 3 month followup 

Community-based intervention: BT, managing the urge to urinate, and PFMT 

Usual care 44/72 28/73 61.00 38.00 1.59 

(1.13; 2.25) 

Fantl, 1991281

N = 131 100% female 1.5 month followup 

BT using 6 weekly visits included patient education; voiding schedule to have micturition from every 30-60 minutes to every 2.5-3 hours; and positive reinforcement. 

Usual care 49/65 16/66 75.00 24.00 3.11 

(1.99; 4.87) 

BFB+PFMT+ behavioral training implemented by nurse practitioners 

33/73 20/75 45.21 26.67 1.70 

(1.08; 2.66) 

Burgio, 2002283N = 222 100% female 2 month followup 

4 visits of 

Self-administered behavioral treatment using a self-help booklet to advice PFMT 36/74 20/75 48.65 26.67 1.82 
Table 48. Comparative effectiveness of behavioral interventions to improve UI in adults (continued) 

220

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

N

(

behavioral training without BFB (verbal feedback based on vaginal palpation). PFMT with 10 second contractions and 10 second relation for 45 minutes/day 

and bladder control 

(1.17; 2.84) 

Hu, 1990710

N = 143 100% female 3 month followup 

Behavioral therapy program in nursing homes implemented by the project-trained NRAs. 

Usual care 19/72 6/71 26.00 8.00 3.12 

(1.32; 7.36) 

Dorey, 2004266N = 55 0% female 3 month followup 

PFMT including a strong post-void "squeeze out" pelvic floor muscle contraction, BFB, and suggestions for lifestyle changes. 

Advice on lifestyle changes 

14/28 1/27 50.00 3.70 13.50 

(1.90; 95.71) 

Burns, 1990724

N = 128 100% female 6 month followup 

Kegel PFMT 4 times/day 

Usual care 21/38 0/40 54.00 0 45.21 

(2.83; 720.96) 

Goode, 2003268

N = 200 100% female 2 month followup 

Behavioral training (BFB+PFMT, home exercises, bladder control strategies, and self-monitoring with bladder diaries) 

Self-administered behavioral training administered with a self-help booklet 

53/66 38/67 80.00 57.00 1.42 

(1.11; 1.80) 
Table 48. Comparative effectiveness of behavioral interventions to improve UI in adults (continued) 

221

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

N

(

Improvement in Urge UISubak, 2005714

N = 48 100% female 3 month followup 

Weight reduction intervention 

Delayed weight reduction intervention 

17/24 3/24 70.00 11.00 5.67 

(1.91; 16.84) 

Goode, 2002279

N = 70 100% female 2 month followup 

Four sessions (over 8 weeks) of biofeedbackassisted behavioral training by nurse practitioners 

Usual care 27/35 19/37 82.30 51.50 1.59 

(1.12; 2.27) 

* Sampling of continent adults at baseline, interventions to reduce the risk of incontinence 

Bold - significant differences in outcomes at 95% confidence level; PFMT - pelvic floor muscle training, BFB - biofeedback; BT - bladder tratreat to benefit one patient for positive patient outcomes (continence and improvement) or to harm one patient for negative patient outcome

number of excessive events per 1,000 treated; A - number of avoided events per 1,000 treated. 
222 

Table 49. Comparative effectiveness of behavioral interventions on UI in adults 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Outcome - Stress UIBrown, 2006245* 

N = 1,957 100% female 34.8 month followup Primary prevention 

Intensive lifestyle therapy to lose and maintain at least 7% of initial body weight through a low-fat diet and to engage in moderateintensity physical activity for at least 150 minutes each week 

Placebo twice daily 

206/659 242/660 31.30 36.70 0.85 

(0.73; 0.99) 

Reilly, 2002247* N = 268 100% female 5 month followup Primary prevention 

Supervised by physiotherapist PFMT 1/month before delivery 

Verbal advice on PFMT 

23/120 36/110 19.20 32.70 0.59 

(0.37; 0.92) 

Bo, 2000720

N = 59 100% female 6 month followup 

PFMT with 8-12 maximum contractions in 3 series/day and 45 minute/week group sessions 

Untreated control group 

3/29 13/30 10.50 41.70 0.24 

(0.08; 0.75) 

Outcome - Any UIChiarelli, 2002246* 

N = 720 100% female 3 month followup Primary prevention 

Training in PFMT and incorporated strategies to improve adherence 

Usual postpartum care 

115/370 134/350 31.00 38.40 0.81 

(0.66; 0.99) 
Table 49. Comparative effectiveness of behavioral interventions on UI in adults (continued) 

223

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

No formal training Outcome: occasional leakage in International Continence Society (ICS) - male questionnaire 

14/150 29/150 9.33 19.33 0.48 

(0.27; 0.88) 

Outcome ICS - male questionnaire: 2 pads/day 

1/150 11/150 0.67 7.33 0.09 

(0.01; 0.70) 

Filocamo, 2005257* 

N = 300 0% female 12 month followup Primary prevention 

Early pelvic floor rehabilitation program with verbal explanations, Kegel PFMT: 3 sets of 10 contractions for 5 seconds and 10 seconds of muscular relaxation under digital BFB 

Outcome: selfreported urinary incontinence 

2/150 18/150 1.33 12.00 0.11 

(0.03; 0.47) 

Porru, 2001263* N = 58 0% female 1 month followup Primary prevention 

Verbal instruction, BFB+PFMT, and verbal reinforcement to teach selective contractions of anal sphincter muscles and relaxation of abdominal muscles 45 times/day 

Standard care without instruction on PFMT 

4/30 12/28 13.33 42.86 0.31 

(0.11; 0.85) 

* Sampling of continent adults at baseline; Bold - significant differences in outcomes at 95% confidence level; PFMT - pelvic floor muscle biofeedback; BT - bladder training; A - number of avoided events per 1,000 treated; number needed to treat to benefit one patient for pos

(continence and improvement) or to harm one patient for negative patient outcomes (incontinence)
224 

Table 50. Comparative effectiveness of behavioral interventions on severity of UI in adults 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

N

(

Outcomes - Severity of Stress UI

Untreated control group. Outcome: problems with interference with social life 

1/29 12/30 3.70 40.70 0.09 

(0.01; 0.62) 

Bo, 2000720

N = 59 100% female 6 month followup 

PFMT with 8-12 maximum contractions in 3 series/day and 45 minutes/week group sessions 

Outcome: problem with interference with physical activity 

13/29 24/30 43.50 79.30 0.56 

(0.36; 0.87) 

Outcomes -Severity of Any UI

Lagro-Janssen, 1992280N = 106 100% female 3 month followup 

PFMT alone (stress) or BT (urge) or its combination (mixed) 

Usual care Outcome-severe UI 

4/54 23/56 7.41 41.07 0.18 

(0.07; 0.49) 

Usual care. Outcome: selfreported bothersomeness of UI 

42/72 62/73 58.90 85.20 0.69 

(0.55; 0.85) 

McFall, 2000291N = 145 100% female 3 month followup 

Communitybased intervention: BT, managing the urge to urinate, and PFMT 

Outcome: use absorbent pads for UI 

39/72 56/73 54.00 77.00 0.71 

(0.55; 0.90) 

Fantl, 1991281

N = 131 100% female 1.5 month followup 

BT (6 weekly visits) included patient education; voiding schedule and positive reinforcement 

Usual care Outcome: increase in episodes of UI 

5/65 28/66 8.00 43.00 0.18 

(0.07; 0.44) 
Table 50. Comparative effectiveness of behavioral interventions on severity of UI in adults (continued) 

225

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

N

(

Chiarelli, 2002246* 

N = 720 100% female 3 month followup

Training in PFMT and incorporated strategies to improve adherence 

Usual postpartum care outcome: severe mixed UI 

37/370 59/350 10.10 16.80 0.59 

(0.40; 0.87) 

* Sampling of continent adults at baseline; Bold - significant differences in outcomes at 95% confidence level; PFMT - pelvic floor muscle biofeedback; BT - bladder training; A - number of avoided events per 1,000 treated; number needed to treat to benefit one patient for pos

(continence and improvement) or to harm one patient for negative patient outcomes (incontinence) 
226 

Table 51. Comparative effectiveness of electrical stimulation or neuromodulation on UI in adults 

Author 

Sample 

Followup 

Active Treatment Control Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Urge specific Continence

Placebo treatment with sham not active device. Outcome: success of treatment 

24/30 5/22 79.00 22.00 3.52 

(1.60; 7.76) 

But, 2003298

N = 52 100% female 2 month followup 

Functional magnetic stimulation with Pulsegen device, which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10Hz Outcome: Cured 

from urge UI 

12/30 0/22 40.00 0 18.55 

(1.16; 297.42)

Schmidt, 1999305

N = 98 81% female 5 month followup 

Neuromodulation Therapy: Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place. 

Standard medical therapy Outcome: cured from urge UI 

24/52 0/46 47.00 0 43.45 

(2.72; 695.03)

Weil, 2000306N = 44 91% female 36 month followup 

Neuromodulation Therapy: Sacral root neuromodulation with an implantable impulse generator 

Prior conservative management: medications or PFMT Outcome: cured from urge UI 

9/21 1/23 42.86 4.35 9.86 

(1.36; 71.36) 
Table 51. Comparative effectiveness of electrical stimulation on UI in adults (continued) 

227

Author 

Sample 

Followup 

Active Treatment Control Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Improvement in Stress UIFujishiro, 2000296

N = 62 100% female 1 week followup 

Neuromodulation Therapy: Magnetic stimulation of sacral roots with 15Hz frequency, 50% intensity output for 5 seconds per minute for 30 minutes 

Sham stimulation with inactive device Outcome: improved stress UI 

23/31 10/31 74.00 32.00 2.30 

(1.33; 3.99) 

Improvement in UIBrubaker, 1997302N = 148 100% female 2 month followup 

Transvaginal electric stimulation for 20 minutes 2 times/day using frequency of 20Hz, a 2-second - 4-second work-rest cycle with a range of stimulation intensities, from 0 to 100mA 

Sham inactive device Outcome: improved UI 

21/61 10/60 35.00 17.00 2.14 

(1.10; 4.14) 

Electrical stimulation with surgical first stage lead placement: >50% improvement in 24 hour pad weight 

4/13 13/17 30.77 76.47 0.40 

(0.17; 0.95) 

>50% Improvement in 24 hour pad usage 

2/13 11/17 15.38 64.71 0.24 

(0.06; 0.89) 

Borawski, 2007303N = 30 100% female 2 week followup 

Neuromodulation Therapy: Electrical stimulation with percutaneous needle electrode (22-G spinal needle) placement 

>50% Improvement in daily incontinence episodes 

1/13 14/17 7.69 82.35 0.09 

(0.01; 0.62) 
Table 51. Comparative effectiveness of electrical stimulation on UI in adults (continued) 

228

Author 

Sample 

Followup 

Active Treatment Control Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Improvement in Urge UIBut, 2003298

N = 52 100% female 2 month followup 

Functional magnetic stimulation with Pulsegen device, which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10Hz 

Placebo treatment with sham not active device. Outcome- Less 

abdominal pain related to urge UI 

11/30 1/22 36.70 5.00 8.07 

(1.12; 57.95) 

Standard medical therapy. Improvement in severity: heavy urge incontinence at baseline and none at 5 months 

40/52 4/46 77.00 8.00 8.85 

(3.43; 22.83) 

Significant reduction in daily urge UI episodes (>50%) 

15/52 2/46 29.00 5.00 6.63 

(1.60; 27.48) 

Schmidt, 1999305

N = 98 81% female 5 month followup 

Neuromodulation Therapy: Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place 

No need of absorbent pads or diapers for urge UI 

26/52 1/46 50.00 2.00 23.00 

(3.25; 162.88)

Bold - significant differences in outcomes at 95% confidence level; number needed to treat to benefit one patient for positive patient outc

improvement) or to harm one patient for negative patient outcomes (incontinence); A - number of avoided and E - number of excessive e
229 

Table 52. Comparative effectiveness of electrical stimulation on any UI in adults 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Analyzed 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Analyzed 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

N

to 

(9

Outcome - UISpruijt, 2003735

N = 51 100% female 2 month followup 

Intravaginal electrical stimulation of the pelvic floor using stimulator generated biphasic current pulses with a duration of 1ms and a frequency of 50Hz (stress) or 20Hz (urge) 

Kegel PFMT with verbal instructions on how to exercise at home 

6/25 7/12 25.00 54.50 0.41 

(0.18; 0.96) 

Progression of UI

Baseline data. Outcome: substantial amounts of usual leakage 

331/3008 451/3008 11.00 15.00 0.73 

(0.64; 0.84) 

(

Indrekvam, 2001 N = 3,008 100% female 3 month followup 

Home-managed electrical stimulation with vaginal/anal stimulators (20-50Hz) Pad use >5 

during 24 hours 

391 632 13.00 21.00 0.62 

(0.55; 0.69) 

(

Bold - significant differences in outcomes at 95% confidence level; PFMT - pelvic floor muscle training; A - number of avoided events pe
230

Table 53. Comparative effectiveness of bulking agents on UI in females 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

N

to 

(9

Outcome - UrgencyLightner2001749

N = 355 100% female 12 month followup 

Injection of bulking agent 1.0ml durasphere maximum 5 times with a minimum 7 day interval 

Injection of bulking agent bovine collagen maximum 5 times with a minimum 7 day interval 

43/176 22/188 24.70 11.90 2.09 

(1.30; 3.34) 

(

Outcome - Complete Retention Corcos, 2005307

N = 133 100% female 12 month followup 

Intraurethral collagen sub mucosal injection 

Surgery (needle bladder neck suspensions, Burch, and slings) 

1/66 9/67 1.52 13.43 0.11 

(0.01; 0.87) 

(

Bold - significant differences in outcomes at 95% confidence level; number needed to treat to benefit one patient for positive patient outc

improvement) or to harm one patient for negative patient outcomes (incontinence); E - number of excessive events per 1,000 treated; A 

events per 1,000 treated .
231 

Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (sorted by rate of urinary cotreatment, from highest to lowest) 

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Colombo, 1996348

N = 36 6 month followup 

Burch colposuspension with placement of two couples of permanent polybutylatecoated polyester sutures 

Abdominal paravaginal defect repair with 5-7 pairs of permanent braided siliconecoated polyester suture. 

Cure as no incontinence episodes and no urine loss at stress test 

18/18 13/18 100.0 72.2 1.

(1.0; 

Laurikainen, 2007491N = 273 2 month followup 

Retropubic tension-free vaginal polypropylene tape procedure by Ulmsten 

Transobturator tension-free vaginal polypropylene tape procedure by de Leval 

Objective cure as negative stress test 

134/136 125/132 98.5 94.7 1.

(1.0; 

Kammerer-Doak, 1999353N = 35 12 month followup 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Subjective cure as no self-reported urinary incontinence 

18/19 3/16 94.7 18.8 5.

(1.8; 1

Sand, 2000358

N = 36 3 month followup 

Burch procedures with four 2-0 polytetrafluoroethylene sutures and tension placed on the periurethral sutures (modified Tanagho method) 

Suburethral sling with continuous polytetraflouroethylene strip from rectus fascia into retropubic space and beneath urethra at urethrovesical junction level 

Subjective cure 

18/19 17/17 94.7 100.0 1.

(0.8; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

232

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Zullo, 2001361N = 60 12 month followup 

Transperitoneal laparoscopic Burch procedure using nonabsorbable sutures 

Transperitoneal laparoscopic Burch procedure using Prolene mesh fixed with tacks or staples 

Subjective cure (visual analog scale) 

28/30 26/30 93.3 86.7 1.

(0.9; 

Schraffordt Koops, 2006757

N = 809 2-36 month followup 

Previous surgery for prolapse/ incontinence +TVT performed with Ulmsten’s method 

No prior surgery + TVT performed with Ulmsten’s method. 

Cured - no leakage during physical activity, coughing or sneezing 

122/131 628/378 92.9 92.6 1.

(1.0; 

Gilja1998, 351N = 204 36 month followup 

Burch retropubic urethropexy 

Modified bladder neck suspension by Raz 

Subjective cure from stress urinary incontinence as no leakage episodes and symptoms. 

52/56 39/46 92.9 84.8 1.

(0.9; 

Colombo, 1994347

N = 80 24-84 month followup 

Burch colposuspension 

Modified MarshallMarchetti-Krantz urethropexy 

Subjective cure as no incontinence symptoms 

37/40 34/40 92.5 85.0 1.

(0.9; 

Bergman, 1989345

N = 127 12 month followup 

Burch urethropexy 

Modified Pereyra needle urethropexy 

Objective cure as no urine loss on cough profile during urodynamic evaluation at maximum cystometric capacity 

35/38 24/35 91.0 72.0 1.

(1.0; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

233

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Burch urethropexy 

Anterior colporrhaphy with Kelly plication 

Objective cure as no urine loss on cough profile during urodynamic evaluation at maximum cystometric capacity 

35/38 23/35 91.0 65.0 1.

(1.1; 

Gilja, 1998351

N = 204 36 month followup 

Transvaginal Burch procedure 

Modified bladder neck suspension by Raz 

Subjective cure from stress urinary incontinence as no leakage episodes and symptoms 

40/44 39/46 90.9 84.8 1.

(0.9; 

Schraffordt Koops, 2006757

N = 809 2-36 month followup 

Previous surgery for prolapse/ incontinence +TVT performed with Ulmsten’s method 

No prior surgery + TVT performed with Ulmsten’s method 

Cured. As no leakage during physical activity, coughing or sneezing 

119/131 636/378 90.5 93.8 1.

(0.9; 

Zullo, 2001361N = 60 12 month followup 

Transperitoneal laparoscopic Burch procedure using nonabsorbable sutures 

Transperitoneal laparoscopic Burch procedure using Prolene mesh fixed with tacks or staples 

Objective cure no urine loss during cough and Valsalva maneuver in standing position with bladder filled to maximal cystometric capacity 

27/30 23/30 90.0 76.7 1.

(0.9; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

234

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Sand, 2000358

N = 36 3 month followup 

Burch procedures with four 2-0 polytetrafluoroethylene sutures and tension placed on the periurethral sutures (modified Tanagho method) 

Suburethral sling with continuous polytetraflouroethylene strip from rectus fascia into Retropubic space and beneath urethra at urethrovesical junction level 

Objective cure 17/19 17/17 89.5 100.0 0.

(0.7; 

Gilja, 1998351

N = 204 36 month followup 

Burch retropubic urethropexy 

Modified bladder neck suspension by Raz 

Objective cure as no urine loss in urodynamic exam 

50/56 37/46 89.3 80.4 1.

(0.9; 

Pubovaginal sling using autologous rectus muscle fascia 

Cure from stress urinary incontinence 

29/33 26/28 87.9 92.9 0.

(0.8; 

Bai, 2005344N = 92 12 month followup 

Burch colposuspension 

Tension-free vaginal tape 

Cure from stress urinary incontinence 

29/33 27/31 87.9 87.1 1.

(0.8; 

Gilja, 1998351

N = 204 36 month followup 

Transvaginal Burch procedure 

Modified bladder neck suspension by Raz 

Objective cure as no urine loss in urodynamic exam 

38/44 37/46 86.4 80.4 1.

(0.9; 

Liapis, 2002355

N = 71 24 month followup 

Burch colposuspension 

Tension-free vaginal tape procedure 

Objective cure as pad weight difference <1g

30/35 30/36 86.0 84.0 1.

(0.8; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

235

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Fatthy, 2001350

N = 74 18 month followup 

Laparoscopic Burch colposuspension 

Open Burch colposuspension 

Cure from stress urinary incontinence (no symptoms, negative stress test andurodynamic continence) 

29/34 34/40 85.3 85.0 1.

(0.8; 

Cheon, 2003346N = 90 12 month followup 

Laparoscopic colposuspension 

Burch open colposuspension 

Objective cure as dry during severe cough on urodynamic testing 

40/47 37/43 85.1 86.0 1.

(0.8; 

Culligan, 2003349

N = 36 72.6 month followup 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension 

Objective cure: negative stress test and negative padweight test 

16/19 17/17 84.6 100.0 0.

(0.7; 

Persson, 2002770

N = 79 12 month followup 

Laparoscopic colposuspension 

Tension-free vaginal tape by Ulmsten 

Objective cure: Cured 

27/32 33/38 84.4 86.8 1.

(0.8; 

Kammerer-Doak, 1999353N = 35 12 month followup 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Objective cure: negative cough and Valsalva test in the supine and standing positions, with the bladder filled to maximal cystometric capacity 

16/19 5/16 84.2 31.3 2.

(1.3; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

236

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Ustun, 2003360

N = 46 18 month followup 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Cure as no pad use and no urinary leakage in urodynamic exam 

19/23 19/23 82.6 82.6 1.

(0.8; 

Fatthy, 2001350

N = 74 18 month followup 

Laparoscopic Burch colposuspension 

Open Burch colposuspension 

Negative stress test 

28/34 31/40 82.4 77.5 1.

(0.8; 

Colombo, 2000362

N = 71 12 month followup 

Burch colposuspension with abdominal hysterectomy 

Anterior colporrhaphy with vaginal hysterectomy 

Subjective cure as no incontinence episodes 

30/37 17/34 81.1 50.0 1.

(1.1; 

Su, 1997359

N = 92 12 month followup 

Laparoscopic colposuspension 

Open Burch colposuspension 

Objective cure as no leakage during urodynamic exam 

37/46 44/46 80.4 95.6 0.

(0.7; 

Osman, 2003769N = 75 6 month followup 

Burch retropubic suspension or pubovaginal sling 

Oxybutynin hydrochloride 5mg 3 times/day 

Complete urinary continence 

40/50 0/25 80.0 0.0 41

(2.6; 6

Quadri, 1999357

N = 30 12 month followup 

Burch colposuspension 

MarshallMarchetti-Krantz urethropexy with video urethroscopic control 

Objective cure 12/15 15/15 80.0 100.0 0.

(0.6; 

Colombo, 1994347

N = 80 24-84 month followup 

Burch colposuspension 

Modified MarshallMarchetti-Krantz urethropexy 

Objective cure as no urine loss at stress test 

32/40 26/40 80.0 65.0 1.

(0.9; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

237

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Lalos, 1993354

N = 36 12 month followup 

Retropubic urethrocystopexy 

Pubococcygeal repair 

Subjective cure as selfreported urinary continence 

17/22 11/14 77.3 78.6 1.

(0.7; 

Ankarda, 2005775

N = 211 12 month followup 

Open Burch colposuspension using sutures 

Laparoscopic colposuspension using mesh and staples 

Subjectively dry 

58/79 45/53 73.4 84.9 0.

(0.7; 

Berglund, 1996768

N = 45 12 month followup 

Retropubic urethrocystopexy 

Pubococcygeal repair 

Subjective cure as selfreported urinary continence 

22/30 12/15 73.3 80.0 0.

(0.7; 

El-Barky, 2005766

N = 50 6 month followup 

Burch colposuspension 

Tension-free vaginal tape procedure 

Cured from urinary stress incontinence 

18/25 18/25 72.0 72.0 1.

(0.7; 

Anterior colporrhaphy with Kelly plication 

27/38 11/35 71.1 31.4 2.

(1.3; 

Bergman, 1995774

N = 127 60 month followup 

Burch urethropexy 

Modified Pereyra needle urethropexy 

Objective cure as no urine loss on cough profile during urodynamic evaluation at maximum cystometric capacity 

27/38 13/35 71.1 37.1 1.

(1.2; 

Ankardal, 2004776

N = 240 12 month followup 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

Subjectively dry 

85/120 64/120 70.8 53.3 1.

(1.1; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

238

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Colombo, 2000362

N = 71 12 month followup 

Burch colposuspension with abdominal hysterectomy 

Anterior colporrhaphy with vaginal hysterectomy 

Objective cure as negative stress test result 

26/37 14/34 70.3 41.2 1.

(1.1; 

Demirci, 2001764

N = 46 12-13 month followup 

Burch colposuspension (Tanagho), 9 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy. 

McGuire’s freerectus fascial sling from inferior leaf of rectus fascia; 8 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy 

Urinary continence (dry) 

16/23 15/23 69.6 65.2 1.

(0.7; 

Berglund, 1996768

N = 45 12 month followup 

Retropubic urethrocystopexy 

Pubococcygeal repair 

Objective cure as negative pad test 

20/30 7/15 66.7 46.7 1.

(0.8; 

Quadri, 1999357

N = 30 12 month followup 

Burch colposuspension 

MarshallMarchetti-Krantz urethropexy with video urethroscopic control 

Subjective cure 

10/15 15/15 66.7 100.0 0.

(0.5; 

Kitchener, 2006771N = 291 24 month followup 

Laparoscopic colposuspension 

Open abdominal retropubic colposuspension 

Objective cure (<1g pad test)

98/147 82/144 66.7 56.9 1.

(1.0; 

Colombo, 2000362

N = 71 12 month followup 

Burch colposuspension with abdominal hysterectomy 

Anterior colporrhaphy with vaginal hysterectomy 

Negative cotton swab test 

24/37 7/34 64.9 20.6 3.

(1.6; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

239

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Persson, 2000356

N = 161 12 month followup 

Laparoscopic Burch colposuspension using one double-bite of polytetrafluoroethylene sutures 

Laparoscopic Burch colposuspension using two singlebite sutures of polytetrafluoroethylene sutures 

Subjective cure 

50/78 72/83 64.1 86.7 0.

(0.6; 

Wang, 2003767

N = 98 12 month followup 

Modified Burch colposuspension 

Tension-free vaginal taping 

Objective cure as pad weight<2g and negative stress urodynamic test 

31/49 40/49 63.3 81.6 0.

(0.6; 

Colombo, 1997486

N = 109 6 month followup 

Posterior pubourethral ligament placation 

Pereyra suspension 

Negative postoperative cotton swab test (maximum straining angle <30 degrees) 

34/55 46/54 61.8 85.2 0.

(0.6; 

Klarskov, 1986778

N = 40 4 month followup 

Surgery: Burch colposuspension when patients had anterior suspension defect. Vaginal repair when patients had posterior bladder descent 

Pelvic floor training program 5 times in weekly lessons guided by trained physiotherapists 

Self-reported cure from urinary incontinence 

16/26 3/24 61.5 12.5 4.

(1.6; 1

Lalos, 1993354

N = 36 12 month followup 

Retropubic urethrocystopexy 

Pubococcygeal repair 

Objective cure-negative pad test 

13/22 6/14 59.1 42.9 1.

(0.7; 

German, 1994772

N = 50 24 month followup 

Modified needle suspension procedure 

Vagina/obturator shelf procedure 

Urinary continence 

15/26 17/24 57.7 70.8 0.

(0.5; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

240

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Persson, 2000356

N = 161 12 month followup 

Laparoscopic Burch colposuspension using one double-bite of polytetrafluoroethylene sutures 

Laparoscopic Burch colposuspension using two singlebite sutures of polytetrafluoroethylene sutures 

Objective cure-negative pad test 

43/78 62/83 55.1 74.7 0.

(0.6; 

Quadri, 1999357

N = 30 12 month followup 

Burch colposuspension 

MarshallMarchetti-Krantz urethropexy with video urethroscopic control 

Negative stress test 

8/15 14/15 53.3 93.3 0.

(0.3; 

Costantini, 2007321N = 66 40 month followup 

Sacropexy combined with a Burch colposuspension 

Colposacropexy, no prophylactic colposuspension 

Urinary continence in those with MUCP>35cm/H2O 

17/34 20/32 50.0 62.5 0.

(0.5; 

Persson, 2002770

N = 76 12 month followup 

Laparoscopic colposuspension 

Tension-free vaginal tape by Ulmsten 

Subjective cure: cured 

16/32 21/38 50.0 55.3 0.

(0.6; 

Colombo, 1997486

N = 109 6 month followup 

Posterior pubourethral ligament placation 

Pereyra suspension 

Negative stress test 

24/55 37/54 44.0 68.0 0.

(0.4; 

Persson, 2002770

N = 76 12 month followup 

Laparoscopic colposuspension 

Tension-free vaginal tape by Ulmsten 

Subjective cure: much improved 

14/32 10/38 43.8 26.3 1.

(0.9; 

No leakage, no bother 

52/120 26/120 43.3 21.7 2.

(1.3; 

Ankardal, 2004776

N = 240 12 month followup 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

No leakage, no bother (visual analog scale) 

33/120 18/120 41.8 34.0 1.

(0.8; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

241

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Albo, 2007343

N = 655 24 month followup 

Burch colposuspension 

Pubovaginal sling, using autologous rectus fascia 

No symptoms of urinary incontinence, an increase <15g in pad weight during a 24-hour pad test, no incontinence episodes recorded in a 3-day diary, a negative stress test and not treatment for any urinary incontinence 

141/329 187/326 42.9 57.4 0.

(0.6; 

Kitchener, 2006771N = 291 24 month followup 

Laparoscopic colposuspension 

Open abdominal retropubic colposuspension 

Subjective cure 

60/147 48/144 40.8 33.3 1.

(0.9; 

Colombo, 1997486

N = 109 6 month followup 

Posterior pubourethral ligament placation 

Pereyra suspension 

Objective continence 

20/55 25/54 36.4 46.3 0.

(0.5; 

Persson, 2002770

N = 79 12 month followup 

Laparoscopic colposuspension 

Tension-free vaginal tape by Ulmsten 

Objective cure: improved 

4/32 2/38 12.5 5.3 2.

(0.5; 

Bump, 1996487

N = 36 6 month followup 

Needle colposuspension 

Bladder neck endopelvic fascia plication 

Genuine stress incontinence 6 months after operation 

2/16 1/16 12.5 6.3 2.0 

(0.2; 1
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

242

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Costantini, 2007321N = 66 40 month followup 

Sacropexy combined with a Burch colposuspension 

Colposacropexy, no prophylactic colposuspension 

Urinary continence in those with –MUCP <35cm/H20 

4/34 8/32 11.8 25.0 0.

(0.2; 

Zullo, 2002773N = 60 12 month followup 

Transperitoneal laparoscopic retropubic urethropexy using nonabsorbable sutures 

Transperitoneal laparoscopic retropubic urethropexy using polypropylene mesh fixed with tacks or staples 

Objective cure as no leakage during cough and Valsalva maneuvre in standing position with bladder filled to maximum cystometric capacity during multichannel urodynamic exam. 

3/30 7/30 10.0 23.3 0.

(0.1; 

Ross, 1996777

N = 69 12 month followup 

Laparoscopic Burch procedure with sutures for bladder neck elevation 

Laparoscopic Burch procedure with mesh and staples for bladder neck elevation 

Objective cure as negative stress test 

3/35 2/34 8.6 5.9 1.

(0.3; 

Zullo, 2002773N = 60 12 month followup 

Transperitoneal laparoscopic retropubic urethropexy using nonabsorbable sutures 

Transperitoneal laparoscopic retropubic urethropexy using polypropylene mesh fixed with tacks or staples 

Subjective cure as selfreported continence in visual analog scale (0=dry sensation, 10=severe leakage). 

2/30 4/30 6.7 13.3 0.

(0.1; 
Table 54. Effects of surgical interventions on urinary continence in females (secondary prevention) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

243

Author 

Sample 

Followup 

Active Control Definition of Continence 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Rela

Ris

(95% 

Persson, 2002770

N = 79 12 month followup 

Laparoscopic colposuspension 

Tension-free vaginal tape by Ulmsten 

Subjective cure: little improved 

1/32 3/38 3.1 7.9 0.

(0.0; 

Bold - significant differences in outcomes at 95% confidence level; number needed to treat to benefit one patient for positive patient outc

improvement) or to harm one patient for negative patient outcomes (incontinence); E - number of excessive events per 1,000 treated; A 

events per 1,000 treated 
244 

Table 55. Comparative effectiveness of surgical procedures on urinary continence in females (results from 

RCTs) 

Author 

Sample Continence Relative Risk (95%CI) 

Burch Colposuspension vs. Abdominal Paravaginal Defect Repair 

Colombo, 1996(224) 

N = 36 

12 month followup 

U 1.37 (1.02; 1.84) 

Burch Colposuspension vs. Anterior Colporrhaphy 

Bergman, 1989(179) 

N = 127 

12 month followup 

U 1.40 (1.08; 1.81) 

Bergman, 1995(180) 

N = 127 

60 month followup 

U 2.26 (1.33; 3.84) 

Kammerer-Doak, 1999(178) U 2.69 (1.27; 5.72) 

N = 35 

12 month followup 

SR 5.05 (1.81; 14.09) 

Colombo, 2000(181) U 1.71 (1.08; 2.68) 

N = 71 

168 month followup 

SR 1.62 (1.12; 2.35) 

Burch Colposuspension vs. Sling Procedures

Sand, 2000(228) SR 0.95 (0.82; 1.10) 

N = 36 

3 month followup 

U 0.90 (0.75; 1.08) 

Bai, 2005(229) 

N = 92 

12 month followup 

SR 0.95 (0.80; 1.11) 

Culligan, 2003(82) 

N = 36 

73 month followup 

U+PT 0.85 (0.68; 1.05) 

Demirci, 2001(230) 

N = 46 

12 month followup 

SR 1.07 (0.71; 1.60) 

Albo, 2007(88) 

N = 655 

24 month followup 

SR+U+PT 0.75 (0.64; 0.87) 

Burch Colposuspension vs. TVT

Bai, 2005(229) 

N = 92 

12 month followup 

SR 1.01 (0.84; 1.21) 

Liapis, 2002(196) 

N = 71 

24 month followup 

PD 1.03 (0.84; 1.26) 

El-Barky, 2005(200) 

N = 50 

6 month followup 

SR 1.00 (0.71; 1.41) 

U 0.78 (0.60; 1.00) 

PT 0.80 (0.67; 0.97) 

Wang, 2003(197) 

N = 98 

12 month followup SR 0.87 (0.67; 1.12) 

Laparoscopic Burch Colposuspension vs. TVT

Persson, 2002(174) U 0.97 (0.80; 1.18) 

N = 79 

12 month followup 

SR 0.90 (0.58; 1.42) 

Ustun, 2003(84) 

N = 46 

18 month followup 

SR+U 1.00 (0.77; 1.30) 

Valpas, 2004(158) PT 0.81 (0.62; 1.05) 

N = 128 

12 month followup 

U 0.66 (0.51; 0.85) 
Table 45. Comparative effectiveness of surgical procedures on urinary continence in females (results from 

RCTs) (continued) 

245

Author 

Sample Continence Relative Risk (95%CI) 

Burch Colposuspension vs. Urethropexy

Colombo, 1994(192) SR 1.09 (0.93; 1.27) 

N = 80 

36 month followup 

U 1.23 (0.93; 1.62) 

U 0.81 (0.61; 1.06) 

SR 0.68 (0.47; 0.98) 

Quadri, 1999(226) 

N = 30 

12 month followup U 0.57 (0.35; 0.93) 

Laparoscopic Burch Colposuspension vs. Burch Colposuspension

Kitchener, 2006(201) PT 1.17 (0.98; 1.40) 

N = 291 

24 month followup 

SR 1.22 (0.91; 1.66) 

Su, 1997(231) 

N = 92 

12 month followup 

U 0.84 (0.72; 0.98) 

Fatthy, 2001(83) 

N = 74 

18 month followup 

U 1.00 (0.83; 1.21) 

Cheon, 2003(175) 

N = 90 

12 month followup 

U 0.99 (0.83; 1.17) 

Sling vs. TVT Procedures 

Arunkalaivanan, 2003(153) 

N = 142 

12 month followup 

SR 1.05 (0.92; 1.19)

Rechberger, 2003(154) 

N = 100 

14 month followup 

SR 0.91 (0.76; 1.08)

Abdel-Fattah, 2004(159) 

N = 142 

36 month followup 

SR 0.97 (0.81; 1.16)

Lim, 2005(161) 

N = 195 

12 month followup 

SR 0.93 (0.79; 1.09)

Andonian, 2005(162) 

N = 84 

12 month followup 

PT 0.87 (0.75; 1.01)

Tseng, 2005(163) 

N = 62 

24 month followup 

PT 0.93 (0.74; 1.15)

Wadie, 2005(165) 

N = 53 

0.5 month followup 

U 0.99 (0.85; 1.16)

SR+U 0.85 (0.73; 0.99)

U 0.82 (0.70; 0.97)

Meschia, 2006(85) 

N = 190 

24 month followup PT 0.81 (0.68; 0.96)

Lord, 2006(167) U 1.00 (0.96; 1.04)

N = 313 

1.5 month followup 

SR 0.88 (0.79; 0.98)

Bold- significant differences in outcomes at 95% confidence level; PT – negative pad test; U - urodynamic 

continence; SR - Self reported continence
246 

Table 56. Comparative effectiveness of surgical interventions on urinary continence in females (secondary prevention) 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Continence in Patients with Stress UIMeshcia, 2004330

N = 50 100% female 6 month followup

Tension-free vaginal tape 

Plication of the endopelvic fascia 

23/25 14/25 92.00 56.00 1.64 

(1.14; 2.37) 

Valpas, 2004331

N = 128 100% female 12 month followup 

Tension-free vaginal tape under local anesthesia with polypropylene mesh tape placed under the midurethra 

Laparoscopic mesh colposuspension under general anesthesia (Hannah and Chin) 

60/70 29/51 85.71 56.86 1.51 

(1.17; 1.95) 

Lord, 2006341

N = 313 100% female 1.5 month followup 

Tension-free vaginal tape 

Suprapubic urethral support sling

134/154 122/159 87.10 76.50 1.13 

(1.02; 1.26) 

Meschia, 2006340

N = 190 100% female 24 month followup 

Tension-free vaginal tape under local or epidural anesthesia 

Intravaginal slingplasty under local or epidural anesthesia 

80/95 68/95 84.21 71.58 1.18 

(1.01; 1.37) 

Colombo, 1997486

N = 109 100% female 6 month followup 

Posterior pubourethral ligament placation 

Pereyra suspension 

24/55 37/54 44.00 68.00 0.64 

(0.45; 0.90) 

Klarskov, 1986778

N = 40 100% female 4 month followup 

Surgery: Burch colposuspension when patients had anterior suspension defect. Vaginal repair when patients had posterior bladder descent 

Pelvic floor training program 5 times/week, lessons guided by trained physiotherapists 

16/26 3/24 61.54 12.50 4.92 

(1.64; 14.81) 
Table 56. Comparative effectiveness of surgical interventions on urinary continence in females (secondary prevention) (contin

247

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Colombo, 1996348

N = 36 100% female 6 month followup 

Burch colposuspension with placement of two couples of permanent polybutylatecoated polyester sutures 

Abdominal paravaginal defect repair with 5-7 pairs of permanent braided siliconecoated polyester suture 

18/18 13/18 100.00 72.22 1.37 

(1.02; 1.84) 

Su, 1997359

N = 92 100 % female 12 month followup 

Laparoscopic colposuspension 

Open Burch colposuspension 

37/46 44/46 80.40 95.60 0.84 

(0.72; 0.98) 

Colombo, 2000362

N = 71 100% female 12 month followup 

Burch colposuspension with abdominal hysterectomy 

Anterior colporrhaphy with vaginal hysterectomy 

26/37 14/34 70.27 41.18 1.71 

(1.08; 2.68) 

MarshallMarchetti-Krantz urethropexy with video urethroscopic control. Outcome: subjective cure 

10/15 15/15 66.67 100.00 0.68 

(0.47; 0.98) 

Quadri, 1999357

N = 30 100% female 12 month followup 

Burch colposuspension 

Outcome: negative stress test 

8 14 53.33 93.33 0.57 

(0.35; 0.93) 

Burch urethropexy 

Anterior colporrhaphy with Kelly plication 

27/38 11/35 71.05 31.43 2.26 

(1.33; 3.84) 

Bergman, 1995774

N = 127 100 % female 60 month followup 

Burch urethropexy 

Modified Pereyra needle urethropexy 

27/38 13/35 71.05 37.14 1.91 

(1.19; 3.08) 
Table 56. Comparative effectiveness of surgical interventions on urinary continence in females (secondary prevention) (contin

248

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Modified anterior colporrhaphy Outcome: subjective cure as no selfreported urinary incontinence 

18/19 3/16 94.74 18.75 5.05 

(1.81; 14.09) 

Kammerer-Doak, 1999353N = 35 100% female 12 month followup 

Burch retropubic urethropexy 

Outcome: objective cure negative cough and Valsalva test in the supine and standing positions 

16/19 5/16 84.21 31.25 2.69 

(1.27; 5.72) 

Anterior colporrhaphy with Kelly plication 

35/38 23/35 91.00 65.00 1.40 

(1.08; 1.81) 

Bergman, 1989345

N = 127 100% female 12 month followup 

Burch urethropexy 

Modified Pereyra needle urethropexy 

35/38 24/35 91.00 72.00 1.30 

(1.03; 1.65) 

Laparoscopic Burch colposuspension using two singlebite sutures of polytetrafluoroethylene sutures Outcome: objective cure - negative pad test 

43/78 62/83 55.13 74.70 0.74 

(0.58; 0.93) 

Persson, 2000356

N = 161 100% female 12 month followup 

Laparoscopic Burch colposuspension using one double-bite of polytetrafluoroethylene sutures 

Outcome: subjective cure 

50/78 72/83 64.10 86.75 0.74 ( 

0.61; 0.89) 

Albo, 2007343

N = 655 100% female 24 month followup 

Burch colposuspension 

Pubovaginal sling, using autologous rectus fascia 

141/329 187/326 42.86 57.36 0.75 

(0.64; 0.87) 
Table 56. Comparative effectiveness of surgical interventions on urinary continence in females (secondary prevention) (contin

249

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Continence in Patents with any UIMeschia, 2006340

N = 190 100% female 24 month followup 

Tension-free vaginal tape under local or epidural anesthesia 

Intravaginal slingplasty under local or epidural anesthesia 

78/95 63/95 82.11 66.32 1.24 

(1.04; 1.47) 

Maher,2005 337

N = 45 100% female 60 month followup 

Pubovaginal sling 

Transurethral Macroplastique 

2/22 17/23 9.09 73.91 0.12 

(0.03; 0.47) 

Colombo, 1997486

N = 109 100% female 6 month followup 

Posterior pubourethral ligament placation 

Pereyra suspension 

34/55 46/54 61.82 85.19 0.73 

(0.57; 0.92) 

Osman, 2003769N = 75 100% female 12 month followup 

Burch retropubic suspension or Pubovaginal sling 

Oxybutynin hydrochloride 5mg 3 times/day 

40/50 0/25 80.00 0.00 41.29 

(2.64; 645.03)

Anterior colporrhaphy with vaginal hysterectomy. Outcome: negative cotton swab test 

24/37 7/34 64.86 20.59 3.15 

(1.56; 6.35) 

Colombo, 2000362

N = 71 100% female 12 month followup 

Burch colposuspension with abdominal hysterectomy 

Outcome: subjective cure as no incontinence episodes 

30/37 17/34 81.08 50.00 1.62 

(1.12; 2.35) 
Table 56. Comparative effectiveness of surgical interventions on urinary continence in females (secondary prevention) (contin

250

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Continent 

After Active 

Treatment/ 

Number 

Randomized

Number 

Continent 

After Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples. Outcome: subjectively dry 

85/120 64/120 70.83 53.33 1.33 

(1.08; 1.63) 

Ankardal, 2004776

N = 240 100% female 12 month followup 

Open Burch colposuspension using sutures 

Outcome: no leakage, no bother 

52/120 26/120 43.33 21.67 2.00 

(1.34; 2.97) 

Albo, 2007343

N = 655 100% female 24 month followup 

Burch colposuspension 

Pubovaginal sling, using autologous rectus fascia 

94/329 140/326 28.57 42.94 0.67 

(0.54; 0.82) 

Bold - significant differences in outcomes at 95% confidence level; number needed to treat to benefit one patient for positive patient outc

improvement) or to harm one patient for negative patient outcomes (incontinence); E - number of excessive events per 1,000 treated; A 

events per 1,000 treated 
251 

Table 57. Comparative effectiveness of surgical interventions on improvement of urinary continence in adults 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Improved 

After Active 

Treatment/ 

Number 

Randomized

Number 

Improved 

After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Improvement in Stress UIDietz, 2005760

N = 196 100% female 23 month followup 

Suprapubic arc sling Intravaginal sling 42/47 35/45 95.45 77.78 1.23 

(1.04; 1.45) 

Klarskov, 1986778

N = 40 100% female 4 month followup 

Surgery: Burch colposuspension when patients had anterior suspension defect. Vaginal repair when patients had posterior bladder descent 

Pelvic floor training program 5 times in weekly lessons guided by trained physiotherapists 

7/26 14/24 26.92 58.33 0.46 

(0.23; 0.95) 

Kammerer-Doak, 1999353N = 35 100% female 12 month followup 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

15/19 6/16 78.95 37.50 2.11 

(1.07; 4.13) 

Laparoscopic Burch colposuspension using two single-bite sutures of polytetrafluoroethylene sutures Outcome: Improved pad test 

20/78 9/83 25.64 10.84 2.36 

(1.15; 4.87) 

Persson, 2000356

N = 161 100% female 12 month followup 

Laparoscopic Burch colposuspension using one double-bite of polytetrafluoroethylene sutures 

Outcome: subjective improvement 

25/78 6/83 32.05 7.23 4.43 

(1.92; 10.23)

Improvement in Any UI

Colombo, 1996322

N = 107 100% female 24 month followup 

Cystopexy alone Cystopexy with 

posterior pubourethral ligaments plication 

23/54 40/53 42.59 75.47 0.56 

(0.40; 0.80) 
Table 57. Comparative effectiveness of surgical interventions on improvement of urinary continence in adults (continued) 

252

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Improved 

After Active 

Treatment/ 

Number 

Randomized

Number 

Improved 

After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Imamoglu, 2005785N = 24 0% female 60 month followup 

Macroplastique injection (polydimethylslioxane elastomer implants as the solute component and hydrogel as the carrier) of 5–7.5cc above or around the striated sphincter region of the urethra submucosally 

Artificial urethral sphincter implantation 

3/13 8/11 23.10 72.70 0.32 

(0.11; 0.91) 

Akakura, 1999789

N = 100 0 % female 58.5 month followup

Radical prostatectomy with pelvic lymph node dissection with 300mg of diethylstilbestrol diphosphate/day 8 weeks before surgery or radiation, and continued thereafter 

External beam radiation by linear accelerator with 40 to 50Gy to the whole pelvis and a 20Gy boost to the prostatic area and with 300mg of diethylstilbestrol diphosphate/day 8 weeks before surgery or radiation, and continued thereafter 

22/56 0/44 40.00 0 35.53 

(2.21; 569.82)

Laparoscopic colposuspension using mesh and staples. Outcome: leakage <8g/24 hoursat 48-hour pad test 

56/79 51/53 70.89 96.23 0.74 

(0.63; 0.86) 

Ankardal, 2005775

N = 211 100% female 12 month followup 

Open Burch colposuspension using sutures 

Outcome: Improvement in Visual analog scale 

24/79 41/53 30.38 77.36 0.39 

(0.27; 0.57) 
Table 57. Comparative effectiveness of surgical interventions on improvement of urinary continence in adults (continued) 

253

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number 

Improved 

After Active 

Treatment/ 

Number 

Randomized

Number 

Improved 

After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Ankardal, 2004776

N = 240 100% female 12 month followup 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

37/120 62/120 30.83 51.67 0.60 

(0.43; 0.82) 

Improvement in Urge UI

Suburethral slingplasty with the Intravaginal sling multifilament threads. Outcome: free of symptoms of urge UI

23/58 32/54 39.66 59.26 0.67 

(0.45; 0.99) 

Suburethral slingplasty with the Suprapubic Arc Sling macroporous monofilament threads 

Outcome: improved but not cured urge UI

23/58 8/54 39.66 14.81 2.68 

(1.31; 5.47) 

Lim, 2005334

N = 195 100% female 12 month followup 

Suburethral slingplasty with the tension-free vaginal tape macroporous monofilament threads 

Suburethral slingplasty with the Intravaginal sling multifilament threads 

22/58 9/54 37.93 16.67 2.28 

(1.15; 4.50) 

Bold - significant differences in outcomes at 95% confidence level Number needed to treat to benefit one patient for positive patient outcomes (continence and improvement) or to harm one patient for neg

(incontinence); E - number of excessive events per 1,000 treated; A - number of avoided events per 1,000 treated 
254 

Table 58. Comparative effectiveness of surgical interventions on urinary continence in adults 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Outcome - Stress UIMeshcia, 2004330

N = 50 100% female 6 month followup 

Tension-free vaginal tape 

Plication of the endopelvic fascia 

1/25 9/25 4.00 36.00 0.11 

(0.02; 0.81) 

Sacrocolpopexy alone. Outcome: stress incontinence 

35/157 67/165 23.80 44.10 0.55 

(0.39; 0.78) 

Brubaker, 2006761

N = 322 100% female 3 month followup 

Sacrocolpopexy with Burch colposuspension 

Outcome: symptoms of stress incontinence 

29/157 60/165 19.00 39.70 0.51 

(0.35; 0.75) 

Gallucci, 1998793

N = 150 0% female 12 month followup 

Transurethral resection of the prostate 

Transurethral electro vaporization of the prostate 

0/80 13/70 0.10 18.60 0.03 

(0.00; 0.54) 

Osman, 2003769N = 75 100% female 12 month followup 

Burch retropubic suspension or Pubovaginal sling 

Oxybutynin hydrochloride 5mg 3 times/day 

1/50 12/25 2.00 48.00 0.04 

(0.01; 0.30) 

Costantini, 2007321

N = 66 100% female 40 month followup 

Sacropexy combined with a Burch colposuspension 

Colposacropexy, no prophylactic colposuspension 

9/34 1/32 26.47 3.13 8.47 

(1.14; 63.14)

Outcome - Any UICostantini, 2007321

N = 66 100% female 40 month followup 

Sacropexy combined with a Burch colposuspension 

Colposacropexy, no prophylactic colposuspension 

12/34 3/32 35.29 9.38 3.76 

(1.17; 12.12)
Table 58. Comparative effectiveness of surgical interventions on risk of urinary continence in adults (continued) 

255

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Pubovaginal sling, using autologous rectus fascia Outcome: Voiding with residual volume <100m 

319/329 280/326 97.00 86.00 1.13 

(1.08; 1.18) 

Albo, 2007343

N = 655 100% female 24 month followup 

Burch colposuspension 

Outcome: voiding dysfunction 

7/329 46/326 2.00 14.00 0.15 

(0.07; 0.33) 

Risk of Urge UIZullo, 2005490N = 59 100% female 6 month followup 

Tension-free vaginal tape procedure plus postoperative vaginal estrogen 1 estrogen ovule (1mg/day) for 1 month, then 2 ovules once weekly for 5 months 

Tension-free vaginal tape procedure alone 

1/28 8/28 4.00 29.00 0.13 

(0.02; 0.93) 

Bold - significant differences in outcomes at 95% confidence level; number needed to treat to benefit one patient for positive patient outc

improvement) or to harm one patient for negative patient outcomes (incontinence); E - number of excessive events per 1,000 treated; A 

events per 1,000 treated 
256 

Table 59. Comparative effectiveness of hormone therapy compared to placebo on risk of UI in females 

Author 

Sample 

Followup 

Active 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Number 

Needed to 

Treat 

(95% CI) 

Systemic Hormone Therapy Jackson, 1999801

N = 67 6 month followup 

Post oestradiol valerate 2mg/day 

24/33 16/34 73.00 47.00 1.55 

(1.02; 2.34) 

4 

(2; 95) 

Steinauer, 366

N = 1,208 50.4 month followup 

Oral conjugated estrogen (0.625mg) and medroxy progesterone acetate (2.5mg) in 1 pill/day 

322/597 232/611 54.00 38.00 1.42 

(1.25; 1.61) 

6 

(4; 10) 

0.625mg of CEE plus 2.5mg of medroxyprogesterone acetate 

429/ 2675 218/ 2507 16.00 8.70 1.84 

(1.58; 2.15) 

14 

(10; 20) 

Estrogen alone: 0.625 mg of conjugated equine estrogen Outcome-incident Stress UI 

266/2675 131/2507 17.40 8.50 2.06 

(1.69; 2.51) 

11 

(8; 17) 

Hendrix, 2005365N = 5,182 12 month followup 

Outcomeincident mixed UI 76/2675 50/2507 5.00 3.20 1.54 (1.09; 2.19) 56 (26; 363) 

Steinauer, 366

N = 1,208 50.4 month followup 

Oral conjugated estrogen (0.625mg) and medroxy progesterone acetate (2.5mg) in 1 pill/day 

382/597 302/611 64.00 49.00 1.29 

(1.17; 1.43) 

7 

(5; 12) 

Goldstein, 2002513

N = 2,924 10 month followup 

Levormeloxifene 0.5 mg/day 

338/978 37/970 17.00 4.00 9.06 

(6.53; 12.57) 

8 

(2; 5) 
Table 59. Comparative effectiveness of hormone therapy compared to placebo on risk of UI in females (continued) 

257

Author 

Sample 

Followup 

Active 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Number 

Needed to 

Treat 

(95% CI) 

Steinauer, 2005366

N = 1,208 50.4 month followup 

Oral conjugated estrogen (0.625mg) and medroxy progesterone acetate (2.5mg) in 1 pill/day 

287/597 220/611 48.00 36.00 1.34 

(1.17; 1.53) 

8 

(5; 17) 

Estrogen plus progestin (E + P): 0.625mg CEE plus 2.5mg medroxyprogesterone acetate 

1.20 

(1.06; 1.36) 

Hendrix, 2005365N = 5,182 12 month followup 

Estrogen alone: 0.625mg conjugated equine estrogen 

1.59 

(1.39; 1.82) 

Goldstein, 2005367

N = 619 13 month followup 

Conjugated equine estrogen 0.625mg/day 

11/152 2/152 7.00 1.30 5.29 

(1.19; 23.48) 

18 

(3; 400) 

Non systemic Hormone Therapy Dessole, 2004363

N = 88 6 month followup 

Intravaginal estriol ovules: 1 ovule/day (1mg) for 2 weeks, then 2 ovules/week for 6 months 

14/44 37/44 31.82 84.09 0.38 

(0.24; 0.59) 

2 

(2; 3) 

Lose, 2000809N = 251 6 month followup 

Oestradiolreleasing ring, 7.5mg oestradiol vs. estrogen pessaries 0.5mg every second day 

44/134 0/117 33.00 77.79 

(4.84; 1,249.40)

3 

Waetjen, 2005808

N = 417 24 month followup 

14mg transdermal E2/day for 2 years Unchanged stress incontinence 

151/208 129/209 72.60 61.80 1.18 

(1.03; 1.35) 

9 

(5; 60) 
Table 59. Comparative effectiveness of hormone therapy compared to placebo on risk of UI in females (continued) 

258

Author 

Sample 

Followup 

Active 

Treatment 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Randomized 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Randomized 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Number 

Needed to 

Treat 

(95% CI) 

Unchanged incontinence 

116/208 94/209 56.00 44.90 1.24 

(1.02; 1.50) 

9 

(4; 98) 

Unchanged urge incontinence 

178/208 162/209 85.70 77.30 1.10 

(1.01; 1.21) 

12 

(6; 182) 

Worsened urge incontinence 

5/208 21/209 2.40 10.20 0.24 

(0.09; 0.62) 

13 

(11; 26) 

Holtedahl, 1998364

N = 90 6 month followup 

Local estrogen in vagitories or jelly plus physiotherapy and electro stimulation 

10/36 27/44 28.00 61.00 0.45 

(0.25; 0.81) 

3 

(2; 8) 

Bold - significant differences in outcomes at 95% confidence level; E - number of excessive events per 1,000 treated; A - number of avoitreated; number needed to treat to benefit one patient for positive patient outcomes (continence and improvement) or to harm one patien

outcomes (incontinence) 
259 

Table 60. Clinical interventions that resulted in stress urinary continence in more than 75% of participating 

females 

Author 

Sample Treatment Followup (months) 

Rate (%) of Stress Urinary 

Continence 

Bai,2005344

N = 92 

Burch colposuspension 12 87.88 

Colombo, 1994347

N = 80 

Burch colposuspension 36 92.50 

Liapis, 2002355

N= 71 

Burch colposuspension 24 86.00 

Culligan, 2003349

N = 36 

Burch colposuspension 72.6 84.60 

Quadri, 1999357

N = 30 

Burch colposuspension 12 80.00 

Colombo,1996348

N = 36 

Burch colposuspension with placement of 

two couples of permanent polybutylatecoated polyester sutures 

12 100.00 

Sand, 2000358

N = 36 

Burch procedures with four 2-0 

polytetrafluoroethylene sutures and tension 

placed on the periurethral sutures (modified 

Tanagho method) 

3 94.74 

Gilja, 1998 37 92.86 (subjective continence) 351

N = 204 

Burch retropubic urethropexy 

39 89.29 (objective continence) 

Kammerer-Doak, 12 94.74 (subjective continence) 

1999353

N = 35 

Burch retropubic urethropexy 

12 84.21 (objective continence) 

Bergman, 1989345

N = 127 

Burch urethropexy 12 91.00 

Fathy, 2001 18 85.29 (subjective continence) 350

N = 74 

Laparoscopic Burch colposuspension 

18 82.35 (objective continence) 

Ustun, 2003360

N = 46 

Laparoscopic Burch colposuspension 18 82.60 

Persson, 2000356

N = 161 

Laparoscopic Burch colposuspension using 

two single-bite sutures of 

polytetrafluoroethylene sutures placed on 

each side of the urethra under 

transperitoneal video laparoscopy 

12 86.75 

Su, 1997359

N = 92 

Open Burch colposuspension 12 95.60 

Fathy, 2001 18 85.00 (subjective continence) 350

N = 74 

Open Burch colposuspension 

18 77.50 (objective continence) 

Cheon, 2003346

N = 90 

Open Burch colposuspension 12 86.05 

Lalos, 1993354

N = 36 

Retropubic urethrocystopexy 13 77.27 

Transperitoneal laparoscopic Burch 12 93.33 (subjective continence) 

procedure using nonabsorbable sutures 12 90.00 (objective continence) 

12 86.67 (subjective continence) 

Zullo, 2001361

N = 60 

Transperitoneal laparoscopic Burch 

procedure using Prolene mesh fixed with 

tacks or staples 

12 76.67 (objective continence) 

Gilja, 1998 36 90.91 (subjective continence) 351

N = 204 

Transvaginal Burch procedure 

38 86.36 (objective continence) 

Ishiko, 2001352

N = 73 

Combination of estriol (1mg/d) and pelvic 

floor muscle exercise 

 78.13 

Su, 1997359

N = 92 

Laparoscopic colposuspension 12 80.40 

Cheon, 2003346

N = 90 

Laparoscopic colposuspension 12 85.11 
Table 60. Clinical interventions that resulted in stress urinary continence in more than 75% of participating 

females (continued) 

260

Author 

Sample Treatment Followup 

(months) 

Rate (%) of Stress Urinary 

Continence 

Quadri, 1999 12 100.00 (subjective continence) 357

N = 30 

Marshall-Marchetti-Krantz urethropexy with 

video urethroscopic control 16 93.33 (objective continence) 

Colombo, 1994347

N = 80 

Modified Marshall-Marchetti-Krantz 

urethropexy 

36 85.00 

Choe, 2000323

N = 40 

Transvaginal antimicrobial mesh synthetic 

mesh 

6 95.00 

Gilja, 1998 36 84.78 (subjective continence) 351

N = 204 

Modified bladder neck suspension by Raz 

38 80.43 (objective continence) 

Berglund, 1996768

N = 45 

Pubococcygeal repair 12 80.00 

Lalos, 1993354

N = 36 

Pubococcygeal repair 13 78.57 

Cholhan, 2004333

N = 48 

Conventional sub urethral sling 3 92.00 

Wadie, 2005338

N = 53 

Fascial sling with free ends of flap fixed by a 

1-zero polyglactin suture and the sling is 

fixed to the underlying periurethral fascia 

using 4-zero polyglactin sutures 

0.5 92.00 

Cholhan, 2004333

N = 48 

Modified sling placed at the mid-urethra 

without tension 

3 89.00 

Abdel-Fattah, 2004332

N = 142 

Pelvic pubovaginal sling 36 75.68 

Arunkalaivanan, 2003326

N = 142 

Porcine dermal sling (pelvic implant) by 

Barrington 

12 89.19 

Pubovaginal sling procedure using 

polypropylene mesh 

Kuo, 2001 6 100.00 324

N = 50 

Pubovaginal sling procedure using rectus 

fascia 

6 95.80 

Bai, 2005344

N = 92 

Pubovaginal sling using autologous rectus 

muscle fascia 

12 92.86 

David-Montefiore, 

2006339

N = 88 

Retropubic sub urethral sling procedure 1 92.86 

Culligan, 2003349

N = 36 

Sub urethral sling (Horbach) with 

polytetrafluororthylene strip from rectum 

fascia beneath urethra under minimal tension 

72.6 100.00 

Sand, 2000358

N = 36 

Sub urethral sling with continuous 

polytetrafluororthylene strip from rectus 

fascia into retropubic space and beneath 

urethra at urethrovesical junction level 

3 100.00 

Sub urethral slingoplasty with the intravaginal 12 87.04 (subjective continence) 

sling multifilament threads 12 81.48 (objective continence) 

Sub urethral slingoplasty with the suprapubic 

arc sling macroporous monofilament threads 

12 77.59 

12 87.93 (subjective continence) 

Lim, 2005334

N = 195 

Sub urethral slingoplasty with the tensionfree vaginal tape macroporous monofilament 

threads 

12 82.76( objective continence) 

Tseng, 2005336

N = 62 

Suprapubic arch sling procedure 24 80.65 

Andonian, 2005335

N = 84 

Suprapubic arch sling procedure 12 83.00 

Lord, 2006341

N = 313 

Suprapubic urethral support sling 1.5 76.50 

David-Montefiore, 

2006339

N = 88 

Transobturator suburethral sling procedure 1 93.48 
Table 60. Clinical interventions that resulted in stress urinary continence in more than 75% of participating 

females (continued) 

261

Author 

Sample Treatment Followup 

(months) 

Rate (%) of Stress Urinary 

Continence 

deTayrac, 2004329

N = 61 

Transobturator suburethral tape 12 86.67 

Laurikainen, 2007491

N = 273 

Transobturator tension-free vaginal 

polypropylene tape procedure by de Leval 

2 94.70 

Monofilament tape inserted at the midurethra 

using the tension-free vaginal tape delivery 

instrument 

Rechberger, 2003 13.5 88.00 327

N = 100 

Multifilament tape using the Intravaginal 

slingoplasty delivery instrument 

13.5 80.00 

Laurikainen, 2007491

N = 273 

Retropubic tension-free vaginal 

polypropylene tape procedure by Ulmsten 

2 98.53 

Wadie, 2005338

N = 53 

Tension-free vaginal polypropylene tape 0.5 92.86 

Meshcia, 2004330

N = 50 

Tension-free vaginal tape procedure 92.00 

Bai, 2005344

N = 92 

Tension-free vaginal tape procedure 12 87.10 

Abdel-Fattah, 2004332

N = 142 

Tension-free vaginal tape procedure 36 77.94 

Lord, 2006 1.5 97.30 (Subjective continence) 341

N = 313 

Tension-free vaginal tape procedure 

1.5 87.10 (Objective continence) 

Ustun, 2003360

N = 46 

Tension-free vaginal tape procedure 18 82.60 

Liapis, 2002355

N = 71 

Tension-free vaginal tape procedure 24 84.00 

deTayrac, 2004329

N = 61 

Tension-free vaginal tape procedure 12 90.00 

Wang, 2003767

N = 98 

Tension-free vaginal tape procedure 12 81.63 

Adamiak, 2002325

N = 103 

Tension-free vaginal tape with spinal 

analgesia ( 0.5% bupivacaine hydrochloride 

administered at L3–L4 or L4–L5 interspace) 

6 97.14 

Adnonian, 2005335

N = 84 

Tension-free vaginal tape by Ulmsten 12 95.00 

Arunkalaivanan, 2003326

N = 142 

Tension-free vaginal tape by Ulmsten 12 85.29 

Tseng, 2005336

N = 62 

Tension-free vaginal tape by Ulmsten 24 87.10 

Meschia, 2006340

N = 190 

Tension-free vaginal tape under local or 

epidural anesthesia 

24 84.21 

Valpas, 2004331

N = 128 

Tension-free vaginal tape under local 

anesthesia with polypropylene mesh tape 

placed under the midurethra 

12 85.71 

Adamiak, 2002325

N = 103 

Tension-free vaginal tape with local 

analgesia (injection of 0.5–0.75% lidocaine 

hydrochloride in subcutaneous tissue) 

6 93.85 
262

Table 61. Clinical interventions that resulted in urinary continence in more than 75% of participating males 

Author 

Sample Treatment Followup 

(months) 

Rate (%) of Urinary 

Continence

Bales, 2000 Pelvic muscle exercises without biofeedback 6 96.00 262

N = 100 Graded pelvic muscle exercise training with 

biofeedback 2 to 4 weeks before surgery 4 

times/day until surgery and to resume exercises 

when the urethral catheter was removed following 

surgery radical retropubic prostatectomy 

6 88.00 

Extracorporeal magnetic innervation (ExMI) using 

Neocontrol system was used with 20 min 

treatment sessions, 2/week for 2 months. The 

frequency of the pulse field was 10 Hz for 10 min, 

followed by a second treatment at 50 Hz for 10 

minutes 

6 91.70 

Functional electrical stimulation (FES) using anal 

electrode and pulses of 20-Hz square waves at a 

300-μs pulse duration were used for 15 minutes 

twice daily for 1 month after retropubic radical 

prostatectomy 

6 83.30 

Yokoyama, 2004256

N = 36 

Pelvic floor muscle exercises after retropubic 

radical prostatectomy 

6 83.30 

Instructions after radical retropubic prostatectomy 12 90.50 (objective continence) 

on electrical stimulation (ES) for 15 minutes twice 

daily and biofeedback (BFB) 15 minutes twice 

daily with stimulation time of 5 seconds, and 

contracting and relaxing time of 5 and 15 seconds 

12 88.60 (subjective continence) 

Instructions after radical retropubic prostatectomy 

about postoperative pelvic muscle exercises 

12 88.00 (subjective continence) 

Instructions about postoperative after radical 

retropubic prostatectomy electrical stimulation 

(ES) for 15 minutes twice daily with frequency 27 

Hz, biphasic pulse shape with 1-sec bursts, a 5-

second pulse width and 2-second pulse trains 

12 81.00 

Wille, 2003255

N = 139 

Instructions about postoperative after radical 

retropubic prostatectomy pelvic muscle exercises 

12 76.70 

10ml of betamethasone cream 0.1% was applied 

locally to both neurovascular bundles after radical 

retropubic prostatectomy 

Deliveliotis, 2005 12 93.00 786

N = 60 

Usual neurovascular bundles with no corticoid 

cream after radical retropubic prostatectomy 

12 90.00 

Radical retropubic prostatectomy with bladder 

neck preservation according to the technique 

described by Malizia 

Srougi, 2001 6 96.77 783

N = 70 

Radical retropubic prostatectomy with bladder 

neck resection according to that of Walsh, et al. 

6 92.31 

Artificial urethral sphincter implantation after 

radical retropubic prostatectomy 

Imamoglu, 2005 48 90.90 785

N = 21 

Macroplastique injection (polydimethylslioxane 

elastomer implants as the solute component and 

hydrogel as the carrier) of 5–7.5cc above or 

around the striated sphincter region of the urethra 

submucosally after radical retropubic 

prostatectomy 

48 80.00 

Van Cangh, 1998 Radical prostatectomy alone 24 83.00 782

N = 100 60Gy external radiotherapy with 18MV photon 

beams between 12 and 16 weeks after radical 

prostatectomy 

24 77.00 

Bold - significant differences in outcomes at 95% confidence level
263 

Table 62. Clinical interventions that resulted in urinary continence at 6 or more months of followup (results from RCTs sorted bof continence after active treatments [from highest to lowest]) 

Author 

Sample 

Followup 

Active Treatment Control Treatment Continence

Cases 

(Active 

Treatment) 

[Control 

Treatment] 

% Continent 

(Active 

Treatment) 

[Control 

Treatment] 

Relative Risk 

(95% CI) 

Nu

Pelvic Floor Exercise Bo, 2005275

N = 47; 100% female 180 month followup 

Intensive PEM under the supervision of physical therapist 

Home exercise groups 

SR (13) 

[4] 

(60.00) 

[17.00] 

4.02 

(1.54; 10.53) 

PT (28) 

[21] 

(52.83) 

[42.00] 

1.26 

(0.83; 1.90) 

Mørkved, 2002815

N = 103; 100% female 6 month followup 

PEM individually supervised by a physical therapist and at home with BFB 

PEM individually supervised by a physical therapist and at home without BFB 

SR (19) 

[14] 

(35.85) 

[28.00] 

1.28 

(0.72; 2.27) 

Alewijnse, 2003271

N = 129; 100% female 14 month followup 

PEM with reminder and self-help guide 

Bladder training and PEM 

SR (17) 

[21] 

(32.70) 

[41.20] 

0.79 

(0.48; 1.32) 

Bo, 2005275

N = 47; 100% female 180 month followup 

Intensive PEM under the supervision of physical therapist 

Home exercise groups 

SR (6) 

[4] 

(28.57) 

[15.38] 

1.86 

(0.60; 5.73) 

Wells, 1991725

N = 157; 100% female 6 month followup 

PEM Phenylpropanolamine 

hydrochloride (50 mg/ day- 50 mg 2 times/day) 

SR (22) 

[11] 

(27.00) 

[14.00] 

1.85 

(0.96; 3.56) 

Wyman, 1998269

N = 204; 100% female 6 month followup 

BT+PEM BT SR (16) 

[10] 

(27.00) 

[16.00] 

1.62 

(0.79; 3.32) 

Janssen, 2001286

N = 530; 100% female 12 month followup 

Individual BT+PEM Group BT+PEM SR (28) 

[57] 

(22.00) 

[14.00] 

1.58 

(1.05; 2.36) 

Wyman, 1998269

N = 204; 100% female 6 month followup 

PEM with BFB BT SR (13) 

[10] 

(20.00) 

[16.00] 

1.28 

(0.60; 2.72) 

Pelvic Floor Exercise in Males with Urological Diseases Wille, 2003255N = 139; 0% female 12 month followup 

Postoperative (after radical prostatectomy) PEM 

Postoperative PEM+BFB, electrical stimulation 

SR (41) 

[41] 

(88.00) 

[88.60] 

0.98 

(0.84; 1.14) 
Table 62. Clinical interventions that resulted in urinary continence at 6 or more months of followup (results from RCTs sorted b

of continence after active treatments [from highest to lowest]) (continued) 

264

Author 

Sample 

Followup 

Active Treatment Control Treatment Continence

Cases 

(Active 

Treatment) 

[Control 

Treatment] 

% Continent 

(Active 

Treatment) 

[Control 

Treatment] 

Relative Risk 

(95% CI) 

Nu

Bales, 2000262

N = 100; 0% female 6 month followup 

PEM with BFB 4 weeks before and after radical prostatectomy 

PEM SR (44) 

[48] 

(88.00) 

[96.00] 

0.92 

(0.82; 1.03) 

Yokoyama, 2004256

N = 36; 0% female 6 month followup 

Functional electrical stimulation after retropubic radical prostatectomy 

PEM SR (10) 

[10] 

(83.30) 

[83.30] 

1.00 

(0.70; 1.43) 

SR (37) 

[41] 

(81.00) 

[88.60] 

0.90 

(0.76; 1.07) 

Wille, 2003255N = 139; 0% female 12 month followup 

Postoperative (after radical prostatectomy) PEM 

Postoperative PEM+BFB, electrical stimulation PT (36) 

[42] 

(76.70) 

[90.50] 

0.84 

(0.70; 1.01)

Behavioral Interventions in Pregnant WomenMeyer, 2001249

N = 107; 100% female 10 month followup 

PEM with BFB and electro stimulation 

Usual care SR (10) 

[1] 

(19.00) 

[2.00] 

10.98 

(1.46; 82.80) 

Electrical Stimulation Bo, 1999299

N = 122; 100% female 6 month followup 

Electrical stimulation Use of a continence 

guard 

PT (7) 

[2] 

(21.88) 

[6.25] 

3.50 

(0.79; 15.58) 

Smith, 1996293

N = 57; 100% female 48 month followup 

Anticholinergic propantheline bromide (7.5 to 45 mg 2-3 times/day) 

Electrical stimulation SR (3) 

[4] 

(16.67) 

[11.00] 

0.38 

(0.11; 1.33) 

Bo, 1999299

N = 122; 100% female 6 month followup 

Electrical stimulation Use of a continence 

guard 

SR (3) 

[1] 

(9.38) 

[3.13] 

3.00 

(0.33; 27.33) 

Neuromodulation Schmidt, 1999305

N = 98; 81% female 5 month followup 

Implantation of multiprogrammable neurostimulator 

Standard medical therapy 

SR (24) 

[0] 

(47.00) 

[1.00] 

43.45 

(2.72; 695.03) 

Weil, 2000306N = 44; 91% female 6 month followup 

Sacral root neuromodulation with an implantable impulse generator 

Conservative management: medications or PEM 

SR (9) 

[1] 

(42.86) 

[4.35] 

9.86 

(1.36; 71.36) 
Table 62. Clinical interventions that resulted in urinary continence at 6 or more months of followup (results from RCTs sorted b

of continence after active treatments [from highest to lowest]) (continued) 

265

Author 

Sample 

Followup 

Active Treatment Control Treatment Continence

Cases 

(Active 

Treatment) 

[Control 

Treatment] 

% Continent 

(Active 

Treatment) 

[Control 

Treatment] 

Relative Risk 

(95% CI) 

Nu

Bulking Agents Strasser, 2007308N = 63; 100% female 12 month followup 

Transurethral ultrasonographyguided injections of autologous myoblasts and fibroblasts 

Conventional endoscopic injections of collagen 

SR (38) 

[2] 

(90.48) 

[9.52] 

9.50 

(2.53; 35.63) 

Bano, 2004309

N = 50; 100% female 6 month followup 

Peri or transurethral porcine dermal implant injection (Permacol) 

Transurethral silicone injection (Macroplastique) 

PT (15) 

[9] 

(60.00) 

[36.00] 

1.67 

(0.90; 3.08) 

Corcos, 2005307

N = 133; 100% female 13 month followup 

Intraurethral collagen sub mucosal injection 

Surgery (needle bladder neck suspensions, Burch, and slings) 

PT (34) 

[37] 

(51.52) 

[55.22] 

0.93 

(0.68; 1.28) 

Schulz, 2004310

N = 40; 100% female 12 month followup 

Periurethral route of injection of bulking agent-dextran copolymer 

Transurethral route of injection of bulking agent-dextran copolymer 

PT (1) 

[3] 

(5.00) 

[15.00] 

0.33 

(0.04; 2.94) 

Devices 

PT (4) 

[2] 

(13.79) 

[6.25] 

2.21 

(0.44; 11.17) 

Bo, 1999299

N = 122; 100% female 6 month followup 

Vaginal cones of 20, 40, and 70g for 20 minutes/day 

Use of a continence guard 

SR (2) 

[1] 

(6.90) 

[3.13] 

2.21 

(0.21; 23.08) 

PT - negative pad test; SR - self-reported continence; Bold - significant relative risk at 95% confidence level; E - number of excessive ev
266 

Table 63. Surgical interventions that resulted in significant difference in urinary continence at 6 or more months of followup (re

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Continence

Cases 

(Active) 

[Control] 

Treatment 

% Continent 

(Active) 

[Control] 

Treatment 

Relative Risk 

(95% CI) 

N

Be

o

Gynecologic Surgery Kaya, 2004319

N = 90; 100% female 12 month followup 

Extrafascial total abdominal hysterectomy 

Intrafascial total abdominal hysterectomy 

SR (4) 

[14] 

(8.89) 

[31.11] 

0.29 

(0.10; 0.80) 

Surgery for Prolapse and UIColombo, 1996348

N = 36; 100% female 12 month followup 

Burch colposuspension 

Abdominal paravaginal defect repair 

U (18) 

[13] 

(100.00) 

[72.22] 

1.37 

(1.02; 1.84) 

Kammerer-Doak, 1999353N = 35; 100% female 12 month followup 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

SR (18) 

[3] 

(94.74) 

[18.75] 

5.05 

(1.81; 14.09) 

Meshcia, 2004330

N = 50; 100% female 6 month followup 

Tension-free vaginal tape 

Plication of the endopelvic fascia 

U (23) 

[14] 

(92.00) 

[56.00] 

1.64 

(1.14; 2.37) 

Anterior colporrhaphy with Kelly plication 

U (35) 

[23] 

(91.00) 

[65.00] 

1.40 

(1.08; 1.81) 

Bergman, 1989345

N = 127; 100% female 12 month followup 

Burch urethropexy 

Modified Pereyra needle urethropexy 

U (35) 

[24] 

(91.00) 

[72.00] 

1.30 

(1.03; 1.65) 

Valpas, 2004331

N = 128; 100% female 12 month followup 

Tension-free vaginal tape under local anesthesia 

Laparoscopic mesh colposuspension under general anesthesia 

U (60) 

[29] 

(85.71) 

[56.86] 

1.51 

(1.17; 1.95) 

Meschia, 2006340

N = 190; 100% female24 month followup 

Tension-free vaginal tape 

Intravaginal slingplasty 

SR+U (80) 

[68] 

(84.21) 

[71.58] 

1.18 

(1.01; 1.37) 

Kammerer-Doak, 1999353N = 35; 100% female 12 month followup 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

U (16) 

[5] 

(84.21) 

[31.25] 

2.69 

(1.27; 5.72) 

Meschia, 2006340

N = 190; 100% female 24 month followup 

Tension-free vaginal tape 

Intravaginal slingplasty 

U (79) 

[65] 

(83.16) 

[68.42] 

1.22 

(1.03; 1.43) 
Table 63. Surgical interventions that resulted in significant difference in urinary continence at 6 or more months of followup (re

(continued) 

267

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Continence

Cases 

(Active) 

[Control] 

Treatment 

% Continent 

(Active) 

[Control] 

Treatment 

Relative Risk 

(95% CI) 

N

Be

o

Meschia, 2006340

N = 190; 100% female 24 month followup 

Tension-free vaginal tape 

Intravaginal slingplasty 

PT (78) 

[63] 

(82.11) 

[66.32] 

1.24 

(1.04; 1.47) 

Colombo, 2000362

N = 71; 100% female 168 month followup 

Burch colposuspension with abdominal hysterectomy 

Anterior colporrhaphy with vaginal hysterectomy 

SR (30) 

[17] 

(81.08) 

[50.00] 

1.62 

(1.12; 2.35) 

Osman, 2003769N = 75; 100% female 6 month followup 

Burch retropubic suspension or pubovaginal sling 

Oxybutynin hydrochloride 5 mg 3 times/day 

SR (40) 

[0] 

(80.00) 

[0.00] 

41.29 

(2.64; 645.03) 

Anterior colporrhaphy with Kelly plication 

U (27) 

[11] 

(71.05) 

[31.43] 

2.26 

(1.33; 3.84) 

Bergman, 1995774

N = 127; 100% female 60 month followup 

Burch urethropexy 

Modified Pereyra needle urethropexy 

U (27) 

[13] 

(71.05) 

[37.14] 

1.91 

(1.19; 3.08) 

Ankardal, 2004776

N = 240; 100% female 12 month followup 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

SR (85) 

[64] 

(70.83) 

[53.33] 

1.33 

(1.08; 1.63) 

Colombo, 2000362

N = 71; 100% female 168 month followup 

Burch colposuspension with abdominal hysterectomy 

Anterior colporrhaphy with vaginal hysterectomy 

U (26) 

[14] 

(70.27) 

[41.18] 

1.71 

(1.08; 2.68) 

Quadri, 1999357

N = 30; 100% female 15 month followup 

Burch colposuspensions 

Marshall-MarchettiKrantz urethropexy with video urethroscopic control 

SR (10) 

[15] 

(66.67) 

[100.00] 

0.68 

(0.47; 0.98) 

Colombo, 2000362

N = 71; 100% female 168 month followup 

Burch colposuspension with abdominal hysterectomy 

Anterior colporrhaphy with vaginal hysterectomy 

CST (24) 

[7] 

(64.86) 

[20.59] 

3.15 

(1.56; 6.35) 

Persson, 2000356

N = 161; 100% female 12 month followup 

Laparoscopic Burch colposuspension using one doublebite of sutures 

Laparoscopic Burch colposuspension using two singlebite sutures of sutures 

SR (50) 

[72] 

(64.10) 

[86.75] 

0.74 

(0.61; 0.89) 
Table 63. Surgical interventions that resulted in significant difference in urinary continence at 6 or more months of followup (re

(continued) 

268

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Continence

Cases 

(Active) 

[Control] 

Treatment 

% Continent 

(Active) 

[Control] 

Treatment 

Relative Risk 

(95% CI) 

N

Be

o

Ward, 2004816

N = 344; 100% female 24 month followup 

Tension-free tape procedure 

Colposuspension PT (111) 

[86] 

(63.43) 

[50.89] 

1.25 

(1.03; 1.50) 

Colombo, 1997486

N = 109; 100% female 6 month followup 

Posterior pubourethral ligament plication 

Pereyra suspension CST (34) 

[46] 

(61.82) 

[85.19] 

0.73 

(0.57; 0.92) 

Persson, 2000356

N = 161; 100% female 12 month followup 

Laparoscopic Burch colposuspension using one doublebite of sutures 

Laparoscopic Burch colposuspension using two singlebite sutures of sutures 

PT (43) 

[62] 

(55.13) 

[74.70] 

0.74 

(0.58; 0.93) 

Quadri, 1999357

N = 30; 100% female 16 month followup 

Burch colposuspensions 

Marshall-MarchettiKrantz urethropexy with video urethroscopic control 

U (8) 

[14] 

(53.33) 

[93.33] 

0.57 

(0.35; 0.93) 

Colombo, 1997486

N = 109; 100% female 6 month followup 

Posterior pubourethral ligament placation 

Pereyra suspension U (24) 

[37] 

(44.00) 

[68.00] 

0.64 

(0.45; 0.90) 

Ankardal, 2004776

N = 240; 100% female 12 month followup 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

SR (52) 

[26] 

(43.33) 

[21.67] 

2.00 

(1.34; 2.97) 

Albo, 2007343

N = 655; 100% female 24 month followup 

Burch colposuspension 

Pubovaginal sling, using autologous rectus fascia 

SR+U+PT (141) 

[187] 

(42.86) 

[57.36] 

0.75 

(0.64; 0.87) 

Maher, 2005337

N = 45; 100% female 12 month followup 

Pubovaginal sling Transurethral 

macroplastique 

U (2) 

[17] 

(9.09) 

[73.91] 

0.12 

(0.03; 0.47) 

CST - negative cotton swab test; PT - negative pad test; U - urodynamic continence; SR - self-reported continence; Bold - significant rela

confidence level; E - number of excessive events per 1,000 treated; A - number of avoided events per 1,000 treated
269 

Table 64. Clinical interventions that resulted in a larger number of attributable events of urinary continence in 

adults from the community (number of additional continence cases >300 per 1,000 treated) 

Author 

Sample 

Followup 

Active Treatment Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Number of 

Attributable 

Events/1,000 

Treated 

(95% CI) 

Stress Continence

Aksac, 2003288

N = 50; 100% female 

2 month followup 

Pelvic floor muscle exercise 

(contractions for 10 seconds 

and relaxation for 20 

seconds) via biofeedback 

(vaginal probe in EMG 

pressure mode) 3 

times/week 

Usual care 80.00 0.10 799 

(0; 261)E 

Bo, 1999299

N = 122; 100% female 

6 month followup 

Pelvic floor exercise with 8-

12 contractions 3 times/day 

and in groups with skilled 

physical therapists 1/week 

Untreated control 

group offered the 

use of a 

continence guard 

48.28 3.13 452 

(36; 3,415)E 

Bo, 2005275

N = 47; 100% female 

Acute 

Intensive pelvic floor 

exercise with 8-12 maximum 

contractions for 6-8 seconds 

3 series/day under the 

supervision of physical 

therapist for 6 months 

Home exercise 

groups 

60.00 17.00 430 

(91; 1,620)E 

Kammerer-Doak, 

1999353

N = 35; 100% female 

12 month followup 

Burch retropubic 

urethropexy 

Modified anterior 

colporrhaphy 

94.74 18.75 760 

(152; 2,454)E 

Klarskov, 1986778

N = 40; 100% female 

4 month followup 

Surgery: Burch 

colposuspension when 

patients had anterior 

suspension defect. Vaginal 

repair when patients had 

posterior bladder descent 

Pelvic floor 

training program 

5 times in weekly 

lessons guided 

by trained 

physiotherapists 

61.54 12.50 490 

(80; 1,726)E 

Anterior 

colporrhaphy 

with Kelly 

plication 

71.05 31.43 396 

(104; 893)E 

Bergman, 1995774

N = 127; 100% female 

60 month followup 

Burch urethropexy 

Modified Pereyra 

needle 

urethropexy 

71.05 37.14 339 

(70; 773)E 

Meshcia, 2004330

N = 50; 100% female 

6 month followup 

Tension-free vaginal tape Plication of the 

endopelvic fascia 

92.00 56.00 360 

(78; 767)E 

Quadri, 1999357

N = 30; 100% female 

12 month followup 

Burch colposuspensions MarshallMarchetti-Krantz 

urethropexy with 

video 

urethroscopic 

control 

66.67 100.00 333 

(24; 530)A 

Urinary Continence

Akhila, 2006368

N = 116; 100% female 

12 month followup 

Conjugated equine estrogen 

0.625mg/day orally 

Transdermal 

patch with 

50mg/day 

estrogen 

40.00 100.00 600 

(420; 708)A 

Colombo, 2000362

N = 71; 100% female 

12 month followup 

Burch colposuspension with 

abdominal hysterectomy 

Anterior 

colporrhaphy 

with vaginal 

hysterectomy 

64.86 20.59 443 

(116; 1,102)E 
Table 64. Clinical interventions that resulted in a larger number of attributable events of urinary continence in 

adults from the community (number of additional continence cases >300 per 1,000 treated) (continued) 

270

Author 

Sample 

Followup 

Active Treatment Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Number of 

Attributable 

Events/1,000 

Treated 

(95% CI) 

Maher, 2005337

N = 45; 100% female 

60 month followup 

Pubovaginal sling Transurethral 

Macroplastique 

9.09 73.91 648 

(391; 715)A 

Urge Continence

But, 2003298

N = 52; 100% female 

2 month followup 

Functional magnetic 

stimulation with Pulsegen 

device, which produced a 

pulsating magnetic field of B 

= 10 microT intensity and a 

frequency of 10Hz. 

Placebo 

treatment with 

sham inactive 

device 

79.00 22.00 570 

(131; 1,488)E 

Schmidt, 1999305

N = 98; 81% female 

5 month followup 

Implantation of 

multiprogrammable 

neurostimulator 

subcutaneously in lower 

quadrant of the abdomen 

with lead positioned to target 

sacral nerve and anchored 

in place 

Standard medical 

therapy 

47.00 1.00 460 

(17; 6,940)E 

Weil, 2000306

N = 44; 91% female 

6 month followup 

Sacral root neuromodulation 

with an implantable impulse 

generator 

Prior 

conservative 

management: 

medications or 

pelvic floor 

exercise 

42.86 4.35 385 

(16; 3,059)E 

E - number of excessive events per 1,000 treated; A - number of avoided events per 1,000 treated
271

Table 65. Effects of adrenergic drugs on self-reported urinary continence in females (results from RCTs)813

Author* Active Treatment Control Treatment 

Cases After 

(Active) 

[Control] 

Treatment 

Rate (%) After 

(Active) 

[Control] 

Treatment 

Relative Risk 

(95% CI) 

Numbe

Needed 

Treat 

Yasuda, 1993 Clenbuterol Placebo (8) 

[2] 

(2.27) 

[10.39] 

4.57 

(1.00; 20.88)

12 

Lose, 1988 Norepinephrine Placebo (6) 

[3] 

(14.29) 

[26.09] 

1.83 

(0.52; 6.39) 

8 

Hilton, 1990 Phenylpropanolamine Placebo (0) 

[2] 

(18.18) 

[0.00] 

0.24 

(0.01; 4.44) 

6 

Lehtonen, 1986 Phenylpropanolamine Placebo (15) 

[8] 

(36.36) 

[71.43] 

1.96 

(1.06; 3.63) 

3 

Yasuda, 1993 Clenbuterol Placebo (36) 

[21] 

(23.86) 

[46.75] 

1.96 

(1.26; 3.05) 

4 

Wells, 1991 Phenylpropanolamine PFMT (54) 

[42] 

(51.22) 

[72.00] 

1.41 

(1.09; 1.81) 

5 

PFMT (10) 

[10] 

(52.63) 

[66.67] 

1.27 

(0.73; 2.21) 

Ishiko, 2000 Clenbuterol 7 

Clenbuterol + PFMT (10) 

[17] 

(77.27) 

[66.67] 

0.86 

(0.56; 1.32) 

9 

(2) 

[9] 

(26.47) 

[3.85] 

0.15 

(0.03;, 0.63) 

4 

Wells, 1991 Phenylpropanolamine PFMT 

(22) 

[16] 

(47.06) 

[42.31] 

0.90 

(0.56; 1.45 ) 

21 

Walter, 1990 Phenylpropanolamine 

+ estrogen 

Estrogen (2) 

[2] 

(14.29) 

[13.33] 

0.93 

(0.15; 5.76) 

105 

Hilton, 1990 Phenylpropanolamine 

+ estrogen 

Estrogen (13) 

[3] 

(15.79) 

[44.83] 

2.84 

(0.93; 8.65) 

3 

Walter, 1990 Phenylpropanolamine 

+ estrogen 

Estrogen (4) 

[6] 

(42.86) 

[26.67] 

0.62 

(0.22; 1.75) 

6 

(13) 

[2] 

(18.18) 

[44.83] 

2.47 

(0.66; 9.20) 

Phenylpropanolamine 4 + estrogen 

Placebo 

(12) 

[2] 

(18.18) 

[60.00] 

3.30 

(0.90; 12.15) 

2 

Hilton, 1990 

Phenylpropanolamine Estrogen (12) 

[0] 

(0.00) 

[60.00] 

11.90 

(0.78; 181.54) 

2 

* These studies were part of the systematic review; PFMT- pelvic floor muscle training; Bold - significant relative risk at 95% confidence 

excessive events per 1,000 treated; A - number of avoided events per 1,000 treated; number needed to treat to benefit one patient for po(continence and improvement) or to harm one patient for negative patient outcomes (incontinence)
272

Table 66. Effects of anticholinergic drugs compared to placebo on self-reported urinary continence or improvement in UI in adubladder (results from RCTs)812

Author* Active Treatment 

Cases After 

(Active) 

[Control] 

Treatment 

Rate (%) After 

(Active) 

[Control] 

Treatment 

Relative 

Risk(95% CI) 

Number 

Needed to 

Treat 

Numb

Attribu

Events p

Treated (

Abrams, 1998 Tolterodine 2mg bid or 

oxybutynin 5mg tid 

(117) 

[27] 

(47.37) 

[49.58] 

1.05 

(0.77; 1.42) 

Burgio, 1998 Oxybutynin 2.5-5mg tid (45) 

[34] 

(65.38) 

[81.82] 

1.25 

(0.99; 1.58) 

Dorschner, 2000 Propiverine 15mg tid (43) 

[26] 

(53.06) 

[87.76] 

1.65 

(1.25; 2.20) 

3 34

(130; 6

Freeman, 2003 Tolteradine ER 4 mg once a 

day 

(173) 

[118] 

(31.55) 

[43.47] 

1.38 

(1.14; 1.66) 

8 11

(45; 2

Halaska, 1994 Propiverine 15mg tid (34) 

[18] 

(47.37) 

[89.47] 

1.89 

(1.33; 2.69) 

2 42

(155; 7

Millard,, 1999 Tolterodine 1- 2mg bid (126) 

[24] 

(37.50) 

[50.00] 

1.33 

(0.95; 1.87) 

Szonyi 1995 Oxybutynin 2.5mg bid (22) 

[16] 

(55.17) 

[78.57] 

1.42 

(0.97; 2.08) 

VanKerrebroeck, 2001 

Tolterodine extended release 2- 4mg qid 

(313) 

[218] 

(42.83) 

[60.89] 

1.42 

(1.26; 1.61) 

6 18

(111; 2

* These studies were part of the systematic review; Bold - significant relative risk at 95% confidence level; number needed to treat to benpositive patient outcomes (continence and improvement) or to harm one patient for negative patient outcomes (incontinence); E - numbe

1,000 treated; A - number of avoided events per 1,000 treated 
273 

Table 67. Effects of serotonin and noradrenaline reuptake inhibitor duloxetine on stress UI (results from RCTs)642

Author* Daily Dose of Duloxetine Control Treatment Outcomes 

Cases After 

(Active) 

[Control] 

Treatment 

Rate (%) After 

(Active) 

[Control] 

Treatment 

Relative 

Risk 

(95% CI) 

N

Dmochowski, 2003 

80mg Placebo NT Failure to cure (308) 

[319] 

94.10 89.53 

0.95 

(0.91; 1.00) 

Millard, 2003 80mg Placebo or 

NT 

Failure to cure (211) 

[217] 

93.94 92.95 

0.99 

(0.94; 1.04) 

80mg Placebo or 

NT 

Failure to cure (100) 

[112] 

84.85 81.30 

0.96 

 0.86; 1.07) 

40mg Placebo or 

NT 

Failure to cure (93) 

[112] 

84.85 75.61 

0.89 

(0.79; 1.01) 

Norton, 2002 

20mg Placebo or 

NT 

Failure to cure (107) 

[112] 

84.85 83.59 

0.99 

(0.89; 1.09) 

Cardozo, 2004 0mg Placebo or 

NT 

Failure to improve (16) 

[45] 

86.54 34.78 

0.40 

(0.27; 0.61)

Dmochowski, 2003 

80mg Placebo or 

NT 

Failure to improve (167) 

[225] 

66.37 48.55 

0.73 

(0.64; 0.84)

Millard, 2003 80mg Placebo or 

NT 

Failure to improve (92) 

[100] 

43.29 40.53 

0.94 

(0.75; 1.16)

Van Kerrebroeck, 2004 

80mg Placebo or 

NT 

Failure to improve (119) 

[164] 

66.40 48.18 

0.73 

(0.62; 0.85)

Zinner, 1998 40mg Placebo or 

NT 

Failure to improve (18) 

[29] 

85.29 54.55 

0.64 

(0.45; 0.90)

Mulcahy, 1996 20mg Placebo or 

NT 

Failure to improve (13) 

[19] 

51.35 23.64 

0.46 

(0.26; 0.81)

20mg Placebo or 

NT 

Failure to improve (18) 

[29] 

85.29 52.94 

0.62 

(0.44; 0.88)

Zinner, 1998 

30mg Placebo or 

NT 

Failure to improve (10) 

[29] 

85.29 38.46 

0;45 

(0.27, 0.75) 

80mg Placebo or 

NT 

Failure to cure (objective - SPT) 

(69) 

[72] 

63.16 61.06 

0.97 

(0.79; 1.18) 

40mg Placebo or 

NT 

Failure to cure (objective - SPT) 

(63) 

[72] 

63.16 56.76 

0.90 

(0.73; 1.11) 

20mg Placebo or 

NT 

Failure to cure (objective - SPT) 

(75) 

[72] 

63.16 68.18 

1.08 

(0.89; 1.30) 

80mg Placebo or 

NT 

Failure to cure (objective - CST) 

(96) 

[103] 

87.29 84.21 

0.96 

(0.87; 1.07) 

Norton, 2002 

40mg Placebo or 

NT 

Failure to cure (objective - SPT) 

(86) 

[103] 

87.29 76.79 

0.88 

(0.78; 0.99)
Table 67. Effects of serotonin and noradrenaline reuptake inhibitor duloxetine on stress UI (results from RCTs){Mariappan, 200

274

Author* Daily Dose of Duloxetine Control Treatment Outcomes 

Cases After 

(Active) 

[Control] 

Treatment 

Rate (%) After 

(Active) 

[Control] 

Treatment 

Relative 

Risk 

(95% CI) 

N

20mg Placebo or 

NT 

Failure to cure (objective - CST) 

(101) 

[103] 

87.29 90.18 

1.03 

(0.94,;1.13) 

Dmochowski, 2003 

80mg Placebo or 

NT 

Failure to cure (objective - diary) 

(308) 

[319] 

94.10 89.53 

0.95 

(0.91; 1.00) 

Millard, 2003 80mg Placebo or 

NT 

Failure to cure (objective - diary) 

(211) 

[217] 

93.94 92.95 

0.99 

(0.94; 1.04) 

80mg Placebo or 

NT 

Failure to cure (objective - diary) 

(100) 

[112] 

84.85 81.30 

0.96 

(0.86; 1.07) 

40mg Placebo or 

NT 

Failure to cure (objective - diary) 

(93) 

[112] 

84.85 75.61 

0.89 

(0.79; 1.01) 

Norton, 2002 

20mg Placebo or 

NT 

Failure to cure (objective - diary) 

(107) 

[112] 

84.85 83.59 

0.99 

(0.89; 1.09) 

Cardozo, 2004 80mg Placebo or 

NT 

Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(17) 

[4] 

7.69 

33.33 

4.33 

(1.57; 12.00)

Kinchen, 2005 80mg Placebo or 

NT 

Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(110) 

[93] 

40.97 49.11 

1.20 

(0.98; 1.47) 

Millard, 2003 80mg Placebo or 

NT 

Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(167) 

[148] 

64.07 73.57 

1.15 

(1.01; 1.30) 

Norton, 2002 80mg Placebo or 

NT 

Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(62) 

[37] 

26.81 44.29 

1.65 

(1.18; 2.30) 

Van Kerrebroeck, 2004 

80mg Placebo or 

NT 

Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(139) 

[119] 

48.18 56.28 

1.17 

(0.99; 1.38) 

40mg Placebo or 

NT 

Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(51) 

[37] 

26.81 37.23 

1.39 

(0.98; 1.97) 

Norton, 2002 

20mg Placebo or 

NT 

Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(43) 

[37] 

26.81 31.16 

1.16 

(0.80; 1.68) 
Table 67. Effects of serotonin and noradrenaline reuptake inhibitor duloxetine on stress UI (results from RCTs){Mariappan, 200

275

Author* Daily Dose of Duloxetine Control Treatment Outcomes 

Cases After 

(Active) 

[Control] 

Treatment 

Rate (%) After 

(Active) 

[Control] 

Treatment 

Relative 

Risk 

(95% CI) 

N

80mg Duloxetine 40 

mg 

Failure to cure (quantification of symptoms) 

(100) 

[93] 

75.61 81.30 

1.08 

(0.94; 1.23) 

80mg Duloxetine 20 

mg 

Failure to cure (quantification of symptoms) 

(100) 

[107] 

83.59 81.30 

1.08 

(0.94; 1.23) 

80mg Duloxetine 20 

mg 

Failure to cure (quantification of symptoms) 

(100) 

[107] 

83.59 81.30 

0.97 

(0.87; 1.09) 

40mg Duloxetine 20 

mg 

Failure to cure (quantification of symptoms) 

(93) 

[107] 

83.59 75.61 

0.90 

(0.80; 1.03) 

30mg Duloxetine 20 

mg 

Failure to cure (quantification of symptoms) 

(10) 

[18] 

52.94 38.46 

0.73 

(0.41; 1.30) 

40mg Duloxetine 20 

mg 

Failure to cure (quantification of symptoms) 

(18) 

[18] 

(52.94) 

[54.55] 

1.03 

0.66; 1.61 ) 

Zinner, 1998 

40mg Duloxetine 30 

mg 

Failure to cure (quantification of symptoms) 

(18) 

[10] 

(38.46) 

[54.55] 

1.42 

(0.80; 2.53) 

80mg Duloxetine 40 

mg 

Failure to cure (objective - SPT) 

(6) 

[63] 

(56.76) 

[5.31] 

1.08 

(0.86; 1.34) 

80mg Duloxetine 20 

mg 

Failure to cure (objective - SPT) 

(69) 

[75] 

(68.18) 

[61.06] 

0.90 

(0.74; 1.09) 

40mg Duloxetine 20 

mg 

Failure to cure (objective - SPT) 

(63) 

[75] 

(68.18) 

[56.76] 

0.83 

(0.68; 1.02) 

80mg Duloxetine 40 

mg 

Failure to cure (objective - CST) 

(96) 

[86] 

(76.79) 

[84.21] 

1.10 

(0.96; 1.25) 

80mg Duloxetine 20 

mg 

Failure to cure (objective - CST) 

(96) 

[101] 

(90.18) 

[84.21] 

0.93 

(0.84; 1.03) 

40mg Duloxetine 20 

mg 

Failure to cure (objective - CST) 

(86) 

[101] 

(90.18) 

[76.79] 

0.85 

(0.76; 0.96) 

80mg Duloxetine 40 

mg 

Failure to cure (objective - diary) 

(100) 

[93] 

(75.61) 

[81.30] 

1.08 

(0.94; 1.23) 

80mg Duloxetine 20 

mg 

Failure to cure (objective - diary) 

(100) 

[107] 

(83.59) 

[81.30] 

0.97 

(0.87; 1.09) 

Norton, 2002 

40mg Duloxetine 20 

mg 

Failure to cure (objective - diary) 

(93) 

[107] 

(83.59) 

[75.61] 

0.90 

(0.80; 1.03) 
Table 67. Effects of serotonin and noradrenaline reuptake inhibitor duloxetine on stress UI (results from RCTs){Mariappan, 200

276

Author* Daily Dose of Duloxetine Control Treatment Outcomes 

Cases After 

(Active) 

[Control] 

Treatment 

Rate (%) After 

(Active) 

[Control] 

Treatment 

Relative 

Risk 

(95% CI) 

N

80mg Duloxetine 40 

mg 

General Health Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(62) 

[51] 

(37.23) 

[44.29] 

1.19 

(0.89; 1.58) 

80mg Duloxetine 20 

mg 

General Health Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(62) 

[43] 

(31.16) 

[44.29] 

1.42 

(1.04; 1.94)

40mg Duloxetine 20 

mg 

General Health Status ('very much better,' 'much better,' or 'a little better' from PGI-I) 

(51) 

[43] 

(31.16) 

[37.23] 

1.19 

(0.86; 1.66) 

* These studies were part of the systematic review; Bold - significant relative risk at 95% confidence level; NT- no treatment; SPT - stres

cough stress test; PGI-I - Patient Global Impression of Improvement; number needed to treat to benefit one patient for positive patient ouimprovement) or to harm one patient for negative patient outcomes (incontinence); E - number of excessive events per 1,000 treated; A 

events per 1,000 treated 
277

Effects of Clinical Interventions on FI 

 Baseline mechanisms of FI comprise loss of structural and functional integrity of pudendal 

nerve activity, of pelvic floor muscles, of rectal compliance and of the anal sphincter and loss of 

rectal sensation.17,20,23,24 Disposition of the rectum into the anus (rectal prolapse) or protrusion of 

the rectum through the vagina (rectocele) also can result in FI. Clinical types of FI include urge 

incontinence (discharge of feces despite active attempts to retain bowel contents), passive 

incontinence (involuntary discharge of stool or flatus without awareness), and fecal seepage 

(leakage of small amount of stool without awareness or staining of undergarments following an 

otherwise normal evacuation). The aim of effective clinical intervention is to restore the structure 

and function of these mechanisms, improve the strength and coordination between the pelvic 

floor and the anal sphincter muscles during voluntary squeeze and following rectal perception, 

enhance anorectal sensory perception and control, regulate pudendal nerve activity, and provide 

normal anatomical positioning of the rectum. 

Clinical Interventions to Reduce Progression of FI in Adults in 

Nursing Homes and LTC Settings 

Conservative management of FI in nursing homes. Consistent benefits of combined nurse 

led interventions on the severity of incontinence were reported in three RCTs that examined the 

effects of conservative management of FI in nursing homes (Appendix Table F151).233-235 The 

largest improvement (10 percent increase in appropriate toileting) was achieved after prompted 

voiding treatment, including checks for incontinence, offering toileting assistance, prompted 

voiding, and social reinforcement of appropriate toileting (Appendix Table F152).233 The 

percentage of incontinent wet checks among total checks by nurses was reduced by 3 percent.233

Integrated incontinence care and frequent exercises showed a significant reduction of 6 percent 

in the proportion of wet episodes.235 Functional incidental training that included prompted 

voiding combined with individualized endurance and strength-training exercises reduced the 

number of wet stool checks among total checks by 1.2 percent.234

Pharmacological interventions on FI in LTC settings. One RCT examined the effects of 

laxative agents in elderly patients with FI associated with chronic fecal impaction (Appendix 

Table F151).817 The number of FI episodes per patient day did not differ when an osmotic agent 

with a rectal stimulant and weekly tap-water enemas were compared to single osmotic laxative 

(Appendix Table F153).817

Evidence-based conservative management of FI included the assessment of patient history 

and rectal examination, patient education on regular toilet habits, pelvic floor and sphincterstrengthening exercises, and individualized doses of laxatives.509 Implementation of this program 

did not reduce the frequency of self-reported fecal episodes (Appendix Table F154) and did not 

improve quality of life (Appendix Table 155) in stroke patients with constipation and FI 

(Appendix Tables F156 and F157). 

Summary. In conclusion, very few well-designed RCTs examined the clinical interventions 

on FI in nursing homes and LTC settings. A small improvement in severity of FI was reported 

after integrated care in nursing homes that included prompted toileting and exercise. The effects 

of conservative management of FI in subgroups by gender, race, and ethnicity remain unknown. 

Clinical interventions that can reduce the risk of incidence and progression of FI in LTC settings 

have not beet tested in RCTs. 
278

Dietary Interventions on FI in Community Dwelling Adults 

 One small placebo-controlled RCT examined the effects of fiber supplements on FI. A usual 

diet supplemented with 7.1g of soluble fiber psyllium reduced the rate of incontinent stools to 17 

percent compared to 50 percent after placebo treatments, but the relative risk was not significant 

(RR 0.3, 95 percent CI 0.1; 1.2) (Appendix Table F158).371 

Supplementation with 25g of gum Arabic increased stool weight by 3 percent compared to 

placebo with no difference in water content and holding capacity (Appendix Table F159). The 

effects of dietary fiber on FI need future investigation in a large clinical trial. 

Effects of Conservative Management of Postnatal FI in Females 

In an RCT of 747 women with postnatal UI (Appendix Table F151)251,252 intensive pelvic 

floor muscle training reinforced by visiting nurses within 9 months after delivery significantly 

reduced the rate of any FI to 4.4 percent compared to 10.5 percent after standard care (RR 0.5, 95 

percent CI 0.3; 1.0) at 1 year but not 6 years of followup (Appendix Table F159 and F160). 

However, severe FI did not differ between groups either at 1 or at 6 years. 

Summary. The effects of behavioral changes supervised by health care providers that would 

provide long-term protection from postnatal FI require further investigation. 

Behavioral Interventions on FI in Females

 Self-administered behavioral interventions in females were examined in three RCTs.250,372,511 

 Patient outcomes. 

Continence. Sensory biofeedback training with a vaginal perineometer and standard Kegel 

pelvic floor muscle training produced continence twice as often in women with FI after obstetric 

and sphincter trauma as augmented biofeedback pelvic floor muscle training with audiovisual 

feedback and electric stimulation (RR 2.0, 95 percent CI 1.1; 3.9) (Appendix Table F161).372 We 

estimated that 382 cases of FI would be prevented per 1,000 women with FI after obstetric and 

sphincter trauma treated with augmented biofeedback and electrostimulation (95 percent CI 27; 

1,055). Pelvic floor muscle training with visual and verbal biofeedback therapy using a radial 

catheter with a latex balloon cured no more women with frequent idiopathic FI than pelvic floor 

muscle training (Appendix Table F162).511

FI. In an RCT of 493 pregnant women with and 1,034 women without previous vaginal birth, 

self-administered perineal massage during pregnancy until delivery did not improve postnatal FI 

at 3 months postpartum (Appendix Table F163).250

Surrogate outcome - Objectively measured mean maximum resting pressure was increased 

by 5 percent and squeeze pressure by 3 percent compared to the control intervention (Appendix 

Table F164).372
279

Effects of Behavioral Interventions on FI in Community Dwelling 

Adults 

 The effects of behavioral interventions on FI in Community dwelling adults (secondary 

prevention) were examined in six RCTs373-376,502,818 and one nonrandomized controlled trial501

(Appendix Table F151). 

Patient outcomes. 

 Continence. Continence was reported in one large RCT of 171 patients with FI of different 

causes.376 Bowel training with instructions on sphincter exercises with and without biofeedback 

was no better than standard care (Appendix Table F165). 

Improvement of FI. A nonrandomized controlled clinical trial examined the effects of 

telephone-assisted biofeedback treatment for patients with refractory FI living in rural areas.501

Improvement in self-reported Pascatori and St Mark scores and in anal manometry outcomes was 

not greater compared to the standard face-to-face protocol (Appendix Table F166).Rates of 

improvement in FI (45 to 55 percent) were the same after hospital-based computer-assisted 

sphincter pressure biofeedback with and without electrostimulation, as well as after receiving 

advice on diet, fluid intake, and bowel training (Appendix Table F167).376 Education and 

biofeedback therapy using a radial catheter resulted in nonsignificant improvement in FI in 50 

percent of patients with idiopathic FI.511 Standard care combined with pelvic floor muscle 

training improved symptoms of FI in 45 percent of the patients.511 Pelvic floor muscle training 

with manometry and ultrasound improved FI in 43 percent of the patients.

501 

 In conclusion, a few tested behavioral interventions cured 5 to 10 percent and improved FI in 

more than 40 percent of the patients but with no statistically significant differences compared to 

standard care. 

FI. The effects of behavioral clinical interventions were examined on self-reported frequency 

of incontinent episodes and severity scores as well as on objective instrumental outcomes 

(Appendix Table F168). Progression of FI was three times more frequent after telephone-assisted 

biofeedback compared to individualized biofeedback.501

Surrogate outcome - Subjectively measure severity of FI and quality of life with FI. 

Hospital-based training and biofeedback services combined with sphincter exercises and 

electromyelogram biofeedback devices significantly reduced the number of fecal accidents per 

week by 47 percent.376 The same intervention without the device reduced fecal episodes by 52 

percent.376 In a small crossover RCT of 23 patients with idiopathic FI associated with abnormal 

perineal descent and frequent irritable bowel syndrome, pelvic floor muscle training with active 

sensory retraining reduced FI episodes by 37 percent compared to exercises with no 

instructions.373 One RCT reported a significant reduction in weekly pad use for FI by 78 percent 

after hospital biofeedback in combination with an electromyelogram device, by 61 percent after 

hospital-based computer-assisted sphincter pressure biofeedback, and by 89 percent after 

lifestyle changes and sphincter exercises.376 

 Behavioral interventions did not improve total FI scores in the majority of the 

trials.375,376,502,818 Only one RCT reported a small significant improvement in St Mark FI scores 

by 9 percent.375 One RCT showed significant improvement in quality of life after pelvic floor 

muscle training and biofeedback compared to baseline levels by 4 percent in Pescatori scores of 

family and relationship and by 16 percent in Pescatori scores of travel restriction.374

Summary. In conclusion, four RCTs of behavioral treatments of FI reported small (<40 

percent) improvement in severity and quality of life (Appendix Table F169).372-375 Limited 
280

evidence suggested a significant reduction in FI after complex behavioral interventions, 

including lifestyle changes and exercises augmented with biofeedback (Appendix Table 

F170).376 

Effects of Electrical Stimulation and Neuromodulation on FI 

 Several RCTs examined the effects of electrical stimulation or neuromodulation on FI 

(Appendix Table F151).377,819-821 

 Patient outcomes. 

Continence. Active anal stimulation did not produce better cure (Appendix Table F171), 

significant, or small improvement in FI compared to sham stimulation (Appendix Table F172).819 

Improvement. Individualized sacral nerve continuous stimulation improved FI in 89 percent 

of patients with severe baseline FI compared to 17 percent after sham stimulation.377 We 

estimated that 720 additional patients among 1,000 treated would experience an improvement in 

symptoms of FI after individualized sacral nerve stimulation. 

 Surrogate outcomes. 

Subjective measures of quality of life. However, the treatments did not improve quality of life 

with random differences after active and sham stimulation (Appendix Table F173). Electrical 

stimulation of the anal sphincter in addition to intra-anal EMG biofeedback did not change FI 

compared to standard training of the pelvic floor.821 Active stimulation therapy using an anal 

plug with a pulse generator did not improve patient satisfaction with bowel habits of the 

incomplete evacuation score.820 

Objective measures of severity of FI. All RCTs reported small inconsistent differences in anal 

manometry outcomes after active stimulation compared to the control (Appendix Table F174). 

Summary. In conclusion, electrical stimulation did not improve FI in the majority of the 

RCTs. The significant relative improvement after sacral nerve stimulation in patients with severe 

baseline FI requires future confirmation in a large well designed RCT with long-term followup. 

Effects of Massage on FI 

One RCT did not show significant differences in risk of FI 3 months postpartum from 

massage and stretching of the perineum during the second stage of labor with a water soluble 

lubricant.514

Effects of Pharmacological Agents on FI in Community Dwelling 

Adults 

 Pharmacological agents on FI in community dwelling adults were examined in 12 RCTs 

(Appendix Table F151).378-380,403-405,822-827

 Botulinum toxin. 

Outcome - FI. Four RCTs examined the effects of botulinum toxin in patients with 

constipation and symptoms of outlet obstruction.380,822,826,827 The incidence of FI was not 

significantly higher after Botox compared to lateral internal anal sphincterotomy.380 All patients 

were continent after local injection of Botox to the each side of the puborectalis or to the 

posterior aspect of this muscle (Appendix Table F175).822 
281

Surrogate outcome - Subjective measures of severity of FI. Self-reported modified Wexner 

Fecal Continence scores826 were not improved after Botox administration (Appendix Table 

F176). 

Surrogate outcome - Objective measure of severity of FI. Anal manometry outcomes827 were 

not improved after Botox administration (Appendix Table F176). 

Loperamide. 

 Two RCTs examined the effects of loperamide in patients after restorative proctocolectomy for 

ulcerative colitis378 and in patients with chronic diarrhea and FI.823 

Surrogate outcome - Subjective measure of severity of UI. Neither treatment resulted in better 

outcomes. Frequency of FI episodes and use of pads at night were the same after loperamide or 

placebo (Appendix Table F177).378 Loperamide reduced fecal urgency in patients with chronic 

diarrhea and FI (mean difference -1.0, 95 percent CI -1.9; -0.1)823 

Surrogate outcome - Objective measures of severity of FI. Loperamide in patients after 

restorative proctocolectomy for ulcerative colitis378 and in patients with chronic diarrhea and FI823

did not improve anal manometry outcomes378,823 (Appendix Table F176). 

 Synthesizing the evidence from all available clinical trials, few interventions378-380 resulted in 

fecal continence in more than 50 percent of patients but were not statistically better than 

placebo378,379or surgery380 (Appendix Tables F178-F180). Chemical sphincterotomy with 

isosorbide-5-mononitrate,404 glycerine trinitrate, and Botox resulted in 100 percent continence 

rate.405 Chemical sphincterotomy with phenylephrine demonstrated significant efficacy 

compared to placebo.824 Reproducibility of the significant effects of chemical sphincterotomy 

using different agents should be confirmed in the large RCTs. 

Effects of Chemical Sphincterotomy 

 Three RCTs analyzed the effects of chemical sphincterotomy (primary prevention) in 

patients with chronic anal fissure.403-405 

 Patient outcomes - Continence. All patients were continent after rectal administration of 

isosorbide-5-mononitrate404 and after glycerine trinitrate ointment405 (Appendix Table F177). 

Healing of anal fissures was observed four times more often after isosorbide-5-mononitrate 

compared to placebo (RR 4, 95 percent CI 1; 13).404 We estimated that rectal administration of 

isosorbide-5-mononitrate would result in 580 healed patients among 1,000 treated. 

 Surrogate outcome - Subjective and objective measures of severity of FI. Chemical 

sphincterotomy with oral nifedipine403 or rectal administration of isosorbide-5-mononitrate404 did 

not result in consistent improvement in the Wexner scores and anal manometry outcomes 

(Appendix Table F176). 

Effects of Alpha-Adrenergic Agonist on FI

 Patient outcome - Improvement in FI. Topical 10 percent phenylephrine, alpha-adrenergic 

agonist increasing anal sphincter pressure, applied to the anus improved FI symptoms three times 

more often than placebo in patients with dysfunctional anal sphincter (RR 3, 95 percent CI 1; 

13).824 

 Surrogate outcome - Subjective measures of severity of FI. Anal administration of 

phenylephrine significantly improved FI scores and FI symptom scores503 but not the Wexner 

scale scores824 (Appendix Table F176). 
282

Effects of Nonabsorbable Basic Aluminum Salt on Late Rectal Injury 

Related to Radiotherapy 

Patient outcome - FI. Oral sucralfate did not prevent FI in prostate cancer patients treated 

with radiotherapy at a 3 month followup.379 

Effects of Medical Bowel Confinement on FI

 Patient outcome - Improvement in FI. Medical bowel confinement and regular diet did not 

improve FI after anorectal reconstructive surgery at 13 months of followup.825

Summary. Synthesizing the evidence from all available clinical trials, a few interventions378-

380 resulted in fecal continence in more than 50 percent of patients but were not statistically better 

than placebo378,379 or surgery380 (Appendix Tables F158 and F159s). Chemical sphincterotomy 

with isosorbide-5-mononitrate,404 glycerine trinitrate, and Botox resulted in 100 percent 

continence rate.405 Administration of phenylephrine to improve sphincter function in patients 

with FI after ileoanal pouch construction demonstrated significant efficacy compared to 

placebo.824 Reproducibility of the significant effects of chemical sphincterotomy using different 

agents should be confirmed in the large RCTs. 

Effects of Different Techniques to Repair External Anal Sphincter after 

Acute Obstetric Trauma 

 Four RCTs compared end-to-end technique to overlapping repair of obstetric anal sphincter 

lacerations (Appendix Table F151).381-384 

 Patient outcome - FI. Defects of internal or external sphincter did not differ after two 

techniques (Appendix Table F181).383 The rates of self-reported fecal and flatus incontinence 

were the same after both interventions.382 Only one RCT reported a significant reduction in fecal 

urgency at 6 and 12 months postpartum after end-to-end technique compared to overlapping 

repair.381 We estimated that 250 per 1,000 treated women would not experience fecal urgency at 

6 months and 283 at 12 months postpartum. 

 Surrogate outcome - Subjective and objective measures of FI. Self-reported symptoms of FI 

and anal manometry were comparable after overlap or end-to-end anal sphincter repair 

(Appendix Tables F182 and F183).828 FI scores and instrumental outcomes did not differ after 

two interventions (Appendix Table F184).383,384

Effects of Clinical Interventions to Prevent FI after Delivery 

 The effects of episiotomy were examined in two RCTs,386,387 the effects of Cesarean or 

vaginal delivery were compared in two RCTs,388,389 the effects of delayed or immediate pushing 

in the second stage of labor with epidural analgesia in one RCT,390 and the effects of delivery by 

forceps or vacuum extractor in three RCTs391-393 (Appendix Table F151). 

 Patient outcome - FI. Self-reported FI 18 months postpartum was the same after restrictive 

or liberal episiotomy.386 The same proportion of women after mediolateral episiotomy or vaginal 

birth experienced FI (Appendix Table F185).387 
283

 Cesarean vs. vaginal delivery resulted in the same rates of fecal and flatus incontinence at 3 

months and 2 years postpartum.388,389 However, only 43 percent of women randomized to 

vaginal delivery underwent Cesarean section. 

 Delayed or immediate pushing in the second stage of labor with epidural analgesia 

demonstrated the same rates of FI and sphincter defects in ultrasound at 3 months postpartum.390 

 Delivery with a vacuum extractor tended to increase the risk of anal (RR 3.5, 95 percent CI 

1.0; 12.2) 393 or FI (RR 1.8) 391 compared to forceps delivery with borderline significance of the 

differences (Appendix Table F185). 

 Surrogate outcome - Subjective and objective measures of FI. Self-reported FI scores and 

instrumental outcomes did not differ after all tested treatments.(Appendix Table F186) 

Summary. No evidence suggested that Cesarean section or instrumental delivery can prevent 

FI postpartum compared to vaginal delivery. 

Effects of Early Ultrasound Diagnosis of Anal Obstetric Trauma 

 Clinical and ultrasound examination of the anal sphincter to diagnose tears followed by 

immediate surgical repair were examined in one well-designed RCT of 752 nulliparous women 

with second-degree perineal tear (Appendix Table F187).385 

 Patient outcomes - FI. Self-reported FI and fecal urgency at 3 months and 1 year of 

followup did not differ among women who underwent ultrasound examinations compared to 

clinical examinations alone. Severe FI was reduced by 60 percent after ultrasound examination at 

3 months (RR 0.4, 95 percent CI 0.2; 0.7) with no differences at 1 year of followup. 

 In conclusion, effective clinical interventions to reduce the risk of FI related to obstetric 

trauma are not well known and require future investigation. 

Effects of Surgical Interventions on FI in Females with Rectal 

Prolapse

 The effects of surgical procedures on FI in women with full-thickness rectal prolapse were 

evaluated in two small and underpowered RCTs.413,414 Abdominal resection rectopexy was 

compared to perineal rectosigmoidectomy and pelvic floor repair in 20 elderly female patients 

with FI who were followed up for 17 months.413 

 Patient outcome - Continence. Both treatments resulted in continence rate of 40 percent 

(Appendix Table F188). Marlex mesh posterior rectopexy alone cured 56 percent and 

sigmoidectomy combined with a sutured posterior rectopexy cured 46 percent of 29 women with 

full-thickness rectal prolapse with no significant differences between treatments.414 

Effects of Surgical Interventions on Females with FI 

 The effects of surgical interventions on neuropathic FI in community dwelling women were 

examined in several RCTs.428,829-831 

 Patient outcome - Continence. Gluteus maximus transposition failed to cure 33 percent and 

total pelvic floor postanal repair with anterior levatoroplasty failed to cure 42 percent of women 

with post obstetric FI (Appendix Table F189).428 Total pelvic floor repair cured 75 percent, 

postanal repair cured 33 percent, and anterior levatoroplasty and sphincter plication cured 33 

percent of 36 women 28-75 years with neuropathic FI with no statistically significant differences 
284

between groups.829 Adjuvant biofeedback following anal sphincter repair and anterior 

overlapping sphincter repair cured <6 percent of 38 females with persistent FI and external anal 

sphincter defect with no statistically significant differences between groups.830 

 Surrogate outcome - Subjective and objective measures of severity of FI. Self-reported FI 

scores, patient satisfaction, and quality of life were comparable after the tested interventions 

(Appendix Table F190).385,428 Surgeries resulted in random differences in instrumental outcomes 

inconsistent in the direction and effect size (Appendix Table F191). Small changes in maximum 

resting pressure were observed after adjuvant internal anal sphincter plication in pelvic floor 

repair compared to pelvic floor repair alone in 33 women with severe neuropathic FI related to 

vaginal delivery.831

 Patient outcome - FI. FI did not differ at 12 months after total abdominal or subtotal 

abdominal hysterectomy in a well-designed RCT of 279 women with benign uterine diseases.754 

 Summary. Overall, limited evidence from small RCTs suggested that surgical procedures 

result in comparable risk of FI and quality of life. The effect size varied depending on the 

definition of FI and baseline cause and severity of FI. The effectiveness of the interventions in 

the subgroups of different age and severity categories require future investigation. 

Effects of Clinical Interventions in Men with Prostate Diseases on the 

Risk of FI 

 Patient outcomes. 

Continence. The effects of radiotherapy on FI in men with prostate diseases were examined 

in three RCTs (Appendix Table F151).780,788,790 Both regimes of radiation resulted in more than 

an 80 percent continence rate.780

FI. Three-dimensional conformal radiotherapy with a dose of 68Gy reduced rates of FI with 

frequent pad use in 7 percent compared to 12 percent after a dose of radiation of 78Gy at 4 years 

(RR 0.5, 95 percent CI 0.3; 0.9) but not at 5 years of followup (Appendix Table F192).788

Patients with prostate cancer reported the same use of sanitary shields for stool leakage after 

radiotherapy or active surveillance.790

 Surrogate outcome - Subjective measure of severity of FI. Self-reported stool leakage 

tended to be greater after radiotherapy compared to active surveillance (Appendix Table 

F193).790

Effects of Bowel Management on FI in Patients with Spinal Cord Injury

Surrogate outcomes - Subjective measures of severity of FI. Transanal irrigation showed a 

small positive effect compared to conservative bowel management in 87 patients after spinal 

cord injury and symptoms of neurogenic bowel dysfunction (Appendix Table F194).832

Neurogenic bowel dysfunction scores were reduced by 3 percent, St Mark’s FI scores by 7 

percent, and Cleveland Clinic constipation scores by 6 percent. The other incontinence 

outcomes, including the American Society of Colon and Rectal Surgeons FI scores, influence of 

FI on daily activities, and the number of episodes of clothes change, however, showed no 

differences (Appendix Table F194). 
285

Effects of Different Techniques of Hemorrhoidectomy on FI 

 The effects of hemorrhoidectomy on FI in adults were examined in nine RCTs (Appendix 

Table F151).394-402

Patient outcomes. 

Continence. Several interventions resulted in fecal continence in all patients, including 

stapled and excision hemorrhoidectomy,394 ligature and open diathermy hemorrhoidectomy,396

submucosal hemorrhoidectomy with radiofrequency bistouries and Conventional Parks' 

hemorrhoidectomy,399 excisional hemorrhoidectomy with ultrasonically activated scalpel, and 

closed excisional hemorrhoidectomy assisted by electrocautery401 (Appendix Table F195). The 

rates of continence were not consistent across RCTs; for example, all patients were continent 

after ligature haemorrhoidectomy in one,396 but only 67 percent in another trial.398 The rates of FI 

after open haemorrhoidectomy varied from 0.1 percent in a small RCT (N=42)397 to 7 percent in 

an RCT with 250 patients.400 

Improvement in FI. Improvement in FI did not differ after open or closed 

hemorrhoidectomy.400 However, no statistical differences in outcomes after the tested procedures 

were shown. Self-reported increase in FI was observed in 15 percent of patients after ligature and 

in 25 percent of patients after open diathermy haemorrhoidectomy (RR not significant) 

(Appendix Table F196).396 

Surrogate outcome - Objective measure of severity of FI. Anorectal outcomes demonstrated 

inconsistent changes across four RCTs,397,400-402 with significant differences in one.397 (Appendix 

Table F197). 

Effects of Clinical Interventions in Patients with Colorectal 

Diseases on FI (FI-Secondary Outcome)

 The effects of surgical interventions on FI were compared in patients with anorectal 

abscesses,415 fistula-in-ano,416-418 anal fissure,419-423 and adenocarcinoma of the rectum424-426

(Appendix Table F151). 

Patient outcome - FI. Incision, drainage, and fistulectomy with primary partial internal 

sphincterectomy compared to incision and drainage alone did not reduce the risk of flatus 

incontinence and soiling in patients with anorectal abscesses (Appendix Table F198).415 Special 

fibrin sealant combined with intra-adhesive cefoxitin, surgical closure of primary opening, or 

both modifications resulted in fecal continence in all patients with chronic anal fistula.416

Adjuvant radiotherapy before total excision in patients with rectal cancer consistently increased 

the risk of FI in three RCTs, by 60 percent during the day (RR 1.6, 95 percent CI 1.4; 1.9), by 90 

percent during the night (RR 1.9, 95 percent CI 1.4; 2.6), by 70 percent in utilization of pads (RR 

1.7, 95 percent CI 1.4; 2.1) compared to mesorectal excision,424 and by 220 percent (RR 2.2, 95 

percent CI 1.2; 4.2) compared to the low anterior resection.424 The harm of adjuvant radiotherapy 

reported in an RCT of 171 patients who survived for a minimum of 5 years after treatment with 

an increased relative risk of incontinence of liquid stool (RR 2.1, 95 percent CI 1.3; 3.2), 

incontinence of solid stool (RR 4.1, 95 percent CI 1.2; 14.2), and utilization of pads (RR 2.2, 95 

percent CI 1.4; 3.5) 425 was larger. We estimated that surgery without adjuvant radiation would 

avoid 240 cases of daytime FI per 1,000 treated,424 310 cases of self-reported FI,424 260 cases of 
286

loose stool, and 110 cases of loose solids.425 Adjuvant radiation also restricted social activities 

almost three time more often compared to surgery (RR 2.9, 95 percent CI 1.4; 5.8).425 

Surrogate outcome - Subjective measures of severity of FI. Postoperative radiotherapy, in 

addition to intensive daily pelvic floor muscle training with intra-anal biofeedback, improved the 

modified Cleveland Incontinence Scores at 1 year by 5.6 percent (mean difference -0.6, 95 

percent CI -1.0; -0.2) compared to behavioral treatments without radiation (Appendix Table 

F199).426 

 The clinical effects of glyceril trinitrate application were compared to lateral sphincterotomy 

with no significant difference in FI among patients with chronic anal fissure.

419-423 Quality of life 

was the same after both treatments.422 

 The trial that compared dermal island flap anoplasty with cutaneous advancement flap into 

the rectum to conventional open fistulotomy or seton insertion in 20 patients with fistula-in-ano 

reported comparable FI scores (Appendix Table F199).418 Another RCT did not show difference 

in FI Wexner scores after internal sphincterotomy compared to the application of 0.25 percent 

nitroglycerin tid to perianal area in 90 patients with symptomatic chronic anal fissures (Appendix 

Table F199).422 

 A trial that compared dermal island flap anoplasty with cutaneous advancement flap into the 

rectum with conventional open fistulotomy or section in 20 patients with fistula-in-ano reported 

comparable FI scores.418 Another RCT did not show differences in FI. Wexner scores after 

internal sphincterotomy compared the application of 0.25 percent nitroglycerin tid to the perineal 

area in 90 patients with symptomatic chronic anal fissures422 (Appendix Table F199). 

Effects of Clinical Interventions in Patients with Rectal Prolapse on FI 

 The effects of clinical interventions in patients with rectal prolapse on FI were examined in 

seven RCTs (Appendix Table F151).406-412 

Patient outcome - FI. The risk of complete FI was reduced by 60 percent (RR 0.4, 95 

percent CI 0.2; 0.7) after posterior sutured abdominal rectopexy combined with sigmoidectomy 

and end-to-end stapled anastomosis compared to polyglycolic acid mesh rectopexy without 

sigmoidectomy (Appendix Table F200).406 

Surrogate outcome - Subjective and objective measures of severity of FI. Surgical 

procedures did not reduce the risk of FI, self-reported severity scores, or instrumental outcomes 

(Appendix Table F201). 

Effects of Surgical Treatments of Anal Sphincter on FI 

 The effects of surgical treatments of anal sphincter on FI related to chronic anal fissure, 

fistulas, or neurogenic causes were examined in several RCTs (Appendix Table F151).427,833-839 

 Patient outcomes. 

Continence. Open lateral internal sphincterotomy, as well as the anal administration of 

isosorbide dinitrate, resulted in fecal continence in all 63 patients with chronic anal fissure

(Appendix Table F202).834

FI. Implantation of artificial bowel sphincter reduced urge FI by 80 percent (RR 0.2, 95 

percent CI 0.2; 0.3), pad utilization by 40 percent (RR 0.6, 95 percent CI 0.5; 0.7), and 

restrictions in physical activities by 60 percent (RR 0.4, 95 percent CI 0.3; 0.5) compared to 

baseline levels (Table 68 and Appendix Table F202).427 
287

 Progression of FI was reduced by 80 percent (RR 0.2, 95 percent CI 0.1; 0.9) after closed 

compared to open lateral sphincterotomy.833 Improvement in FI was increased by 40-50 percent 

after anterior levatorplasty with mobilization of external sphincter compared to anal (and vaginal 

in women) plug electrostimulation of the pelvic floor837 in patients with idiopathic severe 

refractory FI. Physical restrictions were reduced by 50 percent (RR 0.5, 95 percent CI 0.2;0.9). 

Surrogate outcome - Subjective and objective measures of severity of FI. Artificial bowel 

sphincter reduced FI scores (0-120 for complete FI) from 106 to 48 (mean difference -1.7, 95 

percent CI -1.4;-2.0) or by 2 percent compared to the baseline condition.427 Artificial bowel 

sphincters reduced the Cleveland Clinic Scoring and the American Medical Systems quality of 

life questionnaire specific to FI compared to usual supportive care.839(Appendix Table F203). 

 Guidance by endoanal ultrasound of injections of silicon biomaterial into inter-sphincteric 

space and internal anal sphincter improved the Wexner and visual analog scores and FI Quality 

of Life Index compared to injections without a guide (Appendix Table F204).838 

 All procedures resulted in small inconsistent changes in anal manometry outcomes 

(Appendix Table F204). 

Surrogate outcome - Dynamic graciloplasty. One multicenter noncontrolled 

nonramdomized clinical trial (Dynamic Graciloplasty Therapy Study Group) reported significant 

improvements quality of life (Medical Outcomes Study Short Form 36 physical function and 

social functioning). The majority of nonstoma patients (56 to 62 percent) at 12-24 months had 

continent stools/total number of stools ≥50 percent. In the stoma patients 37.5 percent at 12 

months to 43 percent at 24 months reported having continent stools.429,430

Summary. In conclusion, implanting an artificial bowel sphincter demonstrated some 

consistent effects to reduce the risk of FI. Adjuvant radiation in patients with prostate cancer 

resulted in a consistent significant increase in FI compared to surgery alone. The protective 

effects on FI of surgeries for hemorrhoids, rectal prolapse, rectal cancer, and anal fissures are not 

replicable across RCTs and require future confirmation in well-designed long-term RCTs. 

Surgical Interventions (Restorative Proctocolectomy) on FI in Adults 

(FI as Secondary Outcome) 

 Surgical interventions (restorative proctocolectomy) on FI in adults (FI as secondary 

outcome) were examined in patients with cancer in 13 RCTs,840-852 in patients with ulcerative 

colitis in four RCTs,431-434and one retrospective cohort,853 in patients with rectal prolapse in one 

RCT,854 and in patients with sphincter damage in one RCT855 (Appendix Table F151). 

Patient outcome - Continence. The majority of patients with cancer were continent after 

standardized resection with J pouch anastomosis or straight coloanal anastomosis across RCTs 

(Table 69). Rates of FI did not differ between treatment groups. Abdominal colectomy with hand 

sewing or double stapling the pouch to the anal canal provided the highest rates of continence in 

patients with ulcerative colitis with no differences between the two surgeries.431 All patients were 

continent after duplicated or quadruplicated ileal reservoirs in restorative proctocolectomy with 

no differences between them.432,433 Abdominal rectopexy with or without sigmoidectomy 

resulted in the same continence rates in patients with rectal prolapse.854

 Fecal continence was reported in 75 percent of 1,885 patients operated for chronic ulcerative 

colitis at 1 year and gradually decreased to 59 percent after 20 years of followup (Appendix 

Table F205).853 The proportion of patients continent after surgery increased during the last 

decades from 57 percent in 1981-1985 to 70 percent from 1996-2000 (Appendix Table F206).853
288

Surrogate outcome - Subjective and objective measures of severity of FI. Severity of FI 

differed between types of surgical anastomosis in patients with cancer (Appendix Table F207). 

Low anterior resection with straight anastomosis increased FI scores by 61 percent compared to J 

pouch anastomosis (mean difference in a scale from 0 to18 for complete FI, 1.2, 95 percent CI 

0.8; 1.7).844 In contrast, another RCT showed a significant increase in the Wexner FI scores after 

J anastomosis (mean difference 1.3, 95 percent CI 0.5; 2.0),841 The Fecal Incontinence Severity 

Index decreased after J anastomosis (mean difference -4.6, 95 percent CI -5.6; -3.5) and the FI 

quality of life scale improved (mean difference 0.7, 95 percent CI 0.1; 1.3).856 Severity of FI did 

not differ after the tested interventions in patients with ulcerative colitis or rectal prolapse. 

 Anal manometry outcomes demonstrated random changes after surgical interventions with 

inconsistent direction and effect size. Smaller RCTs reported greater differences (Appendix 

Table F208). 

Summary. In conclusion, different types of anastomosis (J-pouch-anal or straight) combined 

with resection of cancer resulted in comparable fecal continence rates across the RCTs. Surgical 

interventions in patients with ulcerative colitis were comparable between active treatments for 

fecal continence in the majority of the patients during the first 10 years after surgery with an 

increased risk of FI during longer period of followup. The effects of treatments on quality of life 

were inconsistent in direction and effect size. 

 Clinical interventions resulted in comparable incidence and progression of FI in the majority 

of the RCTs. Significant relative benefits on fecal continence were reported in small trials of 

<100 subjects (Table 70). Definite harm of adjuvant radiotherapy compared to surgery alone was 

shown in RCTs of 597 patients424 and 171 patients425 with rectal cancer. Short-term benefits of 

pelvic floor muscle training supplemented with bladder training and supervised by nurses was 

reported in RCTs of 747 pregnant women.251 Early detection of anal sphincter tears after vaginal 

delivery, followed by immediate surgical repair, significantly reduced the risk of FI 3 months 

and 1 year postpartum in RCTs of 752 pregnant women.385 The significant results of small RCTs 

need future confirmation in well-designed long-term trials. 
289 

Table 68. Comparative effectiveness of surgical interventions in anal sphincter on FI in adults (events) 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI

Wiley, 2004833

N = 79 54% female 12 month followup 

Closed lateral internal sphincterotomy (Hoffman and Goligher) using a short stab incision and blind division of internal sphincter guided by the surgeon finger 

Open lateral sphincterotomy (Parks) via a 1cm radial incision with division of internal sphincter under direct vision 

Self-reported deterioration in FI 

2/38 10/41 5.3 24.4 0.2 

(0.1; 0.9

Using pad for FI 60/112 99/112 54.0 88.0 0.6 

(0.5; 0.7

Using diapers for FI 

19/112 57/112 17.0 51.0 0.3 

(0.2; 0.5

Wong, 2002427

N = 112 75% female 12 month followup 

Implantation of Acticon trade mark artificial bowel sphincter - solid silicone elastomer device 

Baseline condition 

Avoiding physical activities due to FI 

32/112 91/112 29.0 81.0 0.4 

(0.3; 0.5

Self-reported improvement in FI at 3 months 

28/35 19/35 80.0 54.3 1.5 

(1.0; 2.1

Self-reported improvement in FI at 24 months

26/35 19/35 74.3 54.3 1.4 

(1.0; 2.0

Use of pads for FI at 1 year 

10/35 15/35 28.6 42.9 0.7 

(0.3; 1.3

Osterberg, 2004837N = 70 79% female 12 month followup 

Anterior levatorplasty with mobilization of external sphincter 

Anal (and vaginal in women) plug electrostimulation of the pelvic floor with stimulation frequency was 25 Hz and the duration 1.5 seconds, with a pulse-train interval of 3 seconds 

Physical handicap due to FI at 1 year 

9/35 19/35 25.7 54.3 0.5 

(0.2; 0.9

Bold - significant difference in outcomes at 95% confidence level; E - number of excessive events per 1,000 treated; A - number of avoided 

number needed to treat to benefit one patient for positive patient outcomes (continence and improvement) or to harm one patient for negati

(incontinence)
290 

Table 69. Effects of restorative proctocolectomy on FI in adults (events) 

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Patients with Cancer 

Seow-Choen, 1995840N = 40 35% female 12 month followup 

Ultra-low anterior resection with total mesorectal excision and 8cm J colonic pouch-anal anastomosis (median distance of anastomosis from the anal verge 3cm) 

Ultra-low anterior resection with total mesorectal excision and straight coloanal anastomosis (median distance of anastomosis from the anal verge 3.25cm) 

Fecal continence 

19/20 14/20 95.0 70.0 1.4 

(1.0; 1.8) 

FI 0/16 1/19 0 5.0 0.4 

(0.0; 9.0) 

Ho, 2001841

N = 42 60% female 24 month followup 

Standardized ultra-low anterior

resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6cm in length 

Standardized ultra-low anterior resection with straight coloanal anastomosis, the descending colon was connected to the anorectal stump 

Incontinence to gas 

0/16 3/19 0 16.0 0.2 

(0.0l; 3.0) 
Table 69. Surgical interventions (diversion) on FI in adults (events) (continued) 

291

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Ho, 2002842

N = 12 17% female 12 month followup 

Standardized ultra-low anterior resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6cm in length 

Standardized ultra-low anterior resection with straight coloanalanastomosis, the descending colon was connected to the anorectal stump 

Self-reported fecal continence 

6/6 6/6 100.0 100.0 

Soliani, 1992843

N = 57 32% female .5 months followup 

Conceal Colostomy Plug fit with a twopiece Conceal system 

Conceal Colostomy Plug fit with a one-piece Conceal system 

Improved fecal continence 

5/36 7/57 13.9 12.3 1.1 

(0.4; 3.3) 

Symptomatic anastomotic fecal leakage 

8/52 1/45 15.0 2.0 6.9 

(0.9; 53.3) 

Proportion with frequent nocturnal bowel movements 

12/52 3/45 24.0 7.0 3.5 

(1.0; 11.5) 

Ability to always defer defecation >30 minutes (%) 

8/52 22/45 15.0 49.0 0.3 

(0.2; 0.6) 

Hallbook, 1996844

N = 100 45% female 12 month followup 

Low anterior resection with total mesorectal excision with straight anastomosis 6 to 8cm in length 

Low anterior resection with total mesorectal excision colonic J pouch anastomosis 6 to 8cm in length 

Ability to always evacuate the bowel <15 minutes (%) 

29/52 15/45 55.0 34.0 1.7 

(1.0; 2.7) 
Table 69. Surgical interventions (diversion) on FI in adults (events) (continued) 

292

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Never a sensation of incomplete evacuation (%) 

5/52 10/45 9.0 22.0 0.4 

(0.2; 1.2) 

Bowel function does not affect wellbeing at all 

14/52 29/45 26.0 65.0 0.4 

(0.3; 0.7) 

Bowel urgency < 15 minutes 

2/20 4/20 10.0 20.0 0.5 

(0.1; 2.4) 

Bowel urgency > 15 minutes 

17/20 16/20 85.0 80.0 1.1 

(0.8; 1.4) 

Nocturnal fecal leakage 

1/20 5/20 5.0 25.0 0.2 

(0.0; 1.6) 

Seow-Choen, 1995840N = 40 35% female 12 month followup 

Ultra-low anterior resection with total mesorectal excision and 8cm J colonic pouch-anal anastomosis (median distance of anastomosis from the anal verge 3cm) 

Ultra-low anterior resection with total mesorectal excision and straight coloanal anastomosis (median distance of anastomosis from the anal verge 3.25cm) 

Use of pads for FI 

1/20 3/20 5.0 15.0 0.3 

(0.0; 2.9) 

FI - need to wear pad 

0/16 3/19 0 16.0 0.2 

(0.0; 3.0) 

FI with alterations in life style 

4/16 5/19 25.0 26.3 1.0 

(0.3; 3.0) 

Ho, 2001841

N = 42 60% female 24 month followup 

Standardized ultra-low anterior

resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6 cm in length 

Standardized ultra-low anterior resection with straight coloanalanastomosis. Descending colon was anastomosed tothe anorectal stump 

Nocturnal fecal leakage 

0/16 1/19 0 5.0 0.4 

(0.0; 9.0) 

Ho, 2002842

N = 12 17% female 

Standardized ultra-low anterior

resection with J pouch 

Standardized ultra-low anterior resection with 

Rectosphincteric inhibitory reflex present, % 

2/6 3/6 33.3 50.0 0.7 

(0.2; 2.7) 
Table 69. Surgical interventions (diversion) on FI in adults (events) (continued) 

293

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

12 month followup anastomosis by 

folding the descending colon to the form of a `J', 6cm in length 

straight coloanal anastomosis, the descending colon was anastomosed to the anorectal stump 

Presence of technetium TC 99m tincolloid liquid in descending colon 56 hours after the test 

3/6 2/6 50.0 33.3 1.5 

(0.4; 6.0) 

Nocturnal fecal leak 

7/44 4/44 15.6 8.3 1.8 

(0.6; 5.6) 

Soiling at passing flatus

8/44 5/44 18.8 11.1 1.6 

(0.6; 4.5) 

Toilet dependency 

4/44 6/44 9.4 13.9 0.7 

(0.2; 2.2) 

Incomplete evacuation 

21/44 17/44 46.9 38.9 1.2 

(0.8; 2.0) 

Ho, 2005845

N = 88 40% female 12 month followup 

Standardized total mesorectal excision with at least 2cm of distal tumor clearance. Jpouch was constructed from descending colon 6cm in length using an Autosuture ILA 75 linear cutting stapler 

Standardized total mesorectal excision with at least 2cm of distal tumor clearance. Coloplasty pouch was anastomosed to stapled anorectal stump 

Internal anal sphincter fragmentation

3/44 4/44 6.3 8.3 0.8 

(0.2; 3.2) 

Defer defections for >30 minutes 

25/36 16/35 69.0 46.0 1.5 

(1.0; 2.3) 

Sensation of incomplete evacuation 

8/36 11/35 21.0 31.0 0.7 

(0.3; 1.5) 

Machado, 2005846

N = 71 22% female 24 month followup 

Low anterior resection and total mesorectal excision with a colonic J-pouch anastomosis 

Low anterior resection and total mesorectal excision with a colonic Jpouch or a side-to-end anastomosis. 

Regular use of pad for FI 

12/36 14/35 33.0 40.0 0.8 

(0.5; 1.5) 

Laurent, 2005847 Total mesorectal 

excision and 

Total mesorectal 

Fecal urgency 1/16 3/20 6.0 15.0 0.4 

(0.0; 3.6) 
Table 69. Surgical interventions (diversion) on FI in adults (events) (continued) 

294

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

N = 37 19% female 24 month followup 

hand sewn colonic J-pouchanal anastomosis (6cm) 

excision and stapled colonic J-pouch-anal anastomosis (6cm) using PI-30 stapling instrument 

No pad requirement for FI 

16/16 17/20 100.0 85.0 1.2 

(0.9; 1.4) 

Lazorthes, 1997848

N = 47 60% female 24 month followup 

Complete rectal excision with coloanal anastomosis 6cm J-pouch group 

Complete rectal excision with coloanal anastomosis 10cm J-pouch group 

Bowel urgency 

1/23 2/24 4.3 8.3 0.5 

(0.1; 5.4) 

Urgency 1/24 1/24 4.2 4.2 1.0 

(0.1; 15.1) 

Fecal leakage 2/24 2/24 8.3 8.3 1.0 

(0.2; 6.5) 

Jiang, 2005849

N=48\44% female 24 month followup 

Side-to-end anastomosis after low anteriorresection 

Colonic Jpouch reconstruction after low anterior resection 

Use of pad for FI 

1/24 2/24 4.2 8.3 0.5 

(0; 5.2) 

Patients with Ulcerative Colitis 

Reilly, 1997431

N = 41 34% female 6 month followup 

Abdominal colectomy excising anal transition zone and hand sewing the pouch to the anal canal (Ileal Pouch-Anal Anastomosis) 

Abdominal colectomy preserving anal transition zone and double stapling the pouch to the anal canal (Ileal PouchAnal Anastomosis) 

Complete fecal continence during days 

12/15 14/17 77.0 84.0 1.0 

(0.7; 1.4) 
Table 69. Surgical interventions (diversion) on FI in adults (events) (continued) 

295

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Bowel frequency at night 

4/31 5/29 12.9 17.2 0.7 

(0.2; 2.5) 

Leakage of mucus (no patients reported fecal loss or pad use) 

4/31 4/29 12.9 13.8 0.9 

(0.3; 3.4) 

Ability to defer defecation >30 minutes 

27/31 25/29 87.1 86.2 1.0 

(0.8; 1.2) 

Johnston, 1996432

N = 60 57% female 12 month followup 

Duplicated (J) pelvic ileal reservoirs in restorative proctocolectomy constructed with 30-40cm of ileum 

Quadruplicated (W) reservoir pelvic ileal reservoirs in restorative proctocolectomy, constructed with 30-40cm of ileum 

Ability to defer defecation >15 minutes 

28/31 29/29 90.3 100.0 0.9 

(0.8; 1.0) 

Number with scores <11 in fecal continence scale from 0-continence to 24 - complete incontinence 

10/11 12/13 90.9 92.3 1.0 

(0.8; 1.3) 

Selvaggi, 2000433

N = 24 58% female 12 month followup 

Ileal pouch-anal anastomosis including total colectomy, total rectal excision, and two-limb J reservoir 

Ileal pouchanal anastomosis including total colectomy, total rectal excision, and four-limb W reservoir Absence of 

rectoanal inhibitory reflex 

1/11 1/13 9.1 7.7 1.2 

(0.1; 16.8) 
Table 69. Surgical interventions (diversion) on FI in adults (events) (continued) 

296

Author 

Sample 

Followup 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/ 

Number 

Treated 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Complete fecal continence during nights 

5/15 11/17 36.0 62.0 0.5 

(0.2; 1.1) 

Reilly, 1997431

N = 41 34% female 6 month followup 

Abdominal colectomy excising anal transition zone and hand sewing the pouch to the anal canal (Ileal Pouch-Anal Anastomosis) 

Abdominal colectomy preserving anal transition zone and double stapling the pouch to the anal canal (Ileal PouchAnal Anastomosis) 

Wearing a pad for FI 

1/15 4/17 7.0 26.0 0.3 

(0.0; 2.3) 

Patients with Rectal Prolapse 

McKee, 1992854

N = 18 50% female 20 month followup 

Abdominal rectopexy without sigmoidectomy 

Abdominal rectopexy with sigmoidectomy of redundant sigmoid colon and end-to-end anastomosis of colon and rectum made in pelvic brim 

FI using saline solution infusion test 

1/9 3/9 11.1 33.3 0.3 

(0.0; 2.6) 

Bold - significant difference in outcomes at 95% confidence level; E - number of excessive events per 1,000 treated; A - number of avoided e

number needed to treat to benefit one patient for positive patient outcomes (continence and improvement) or to harm one patient for negative 

(incontinence) 
297 

Table 70. Comparative effectiveness of clinical interventions on FI in community dwelling adults (significant differences only s

Author 

Sample 

Followup 

Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/

Number 

Treated 

Relative Risk

(95% CI) 

Num

Nee

to T

(95% 

Fecal ContinenceFynes, 1999372

N = 40 100% female 3 month followup 

Augmented biofeedback training of pelvic floor with audiovisual feedback and electric stimulation of slow and fast twitch fibers for 12 weeks 

Sensory biofeedback training with a vaginal perineometer and standard Kegel pelvic floor exercise for 12 weeks 

Cured (became asymptomatic) 

15/20 7/19 2.04 

(1.07; 3.86) 

3 

(1; 

Seow-Choen, 1995840N = 40 35% female 12 month followup 

Ultra-low anterior resection with total mesorectal excision and 8cm J colonic pouch-anal anastomosis (median distance of anastomosis from the anal verge 3cm) 

Ultra-low anterior resection with total mesorectal excision and straight coloanal anastomosis (median distance of anastomosis from the anal verge 3.25cm) 

Fecal continence 

19/20 14/20 1.36 

(1.00; 1.84) 

4 

(2; 1

Complete fecal continent (fecal incontinent at baseline) 

116/306 180/291 0.61 

(0.52; 0.73) 

4 

(3; 

Peeters, 2005424

N = 597 38% female 60 month followup 

Radiotherapy with total dose of 25Gy administered in 5 fractions over 5 to 7 days before total mesorectal excision 

Total mesorectal excision 

Always fecal incontinent 

43/306 15/291 2.73 

(1.55; 4.80) 

1

(5; 
Table 70. Comparative effectiveness of clinical interventions on FI in community dwelling adults (significant differences only s

298

Author 

Sample 

Followup 

Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/

Number 

Treated 

Relative Risk

(95% CI) 

Num

Nee

to T

(95% 

Fernando, 2006381N = 64 100% female 12 month followup 

Primary overlap. 1st row of sutures inserted ~1.5cm from one side of torn edge of external anal sphincter and carried through to within 0.5cm of other edge. 2nd row of sutures inserted to attach loose end of overlapped muscle 

End-to-end repair of the external anal sphincter 

Fecal continence 

32/32 24/32 1.33 

(1.08; 1.63) 

4 

(2; 

Luukkonen, 1992406N = 30 33% female 22 month followup 

Posterior sutured abdominal rectopexy combined with sigmoidectomy complete rectal prolapse and endto-end anastomosis made with a circular stapler 

Polyglycolic acid mesh rectopexy without sigmoidectomy for complete rectal prolapse anterior rectal wall free 

Complete anal continence 

9/33 11/15 0.37 

(0.20; 0.70) 

2 

(2; 

Improvement in Fecal ContinenceLeroi, 2005377

N = 34 91% female 1 month followup 

Active sacral nerve continuous stimulation with pulse width of 210 microseconds, frequency 14 pulses/second, and amplitude adapted to the patient’s perception of perineal and anal sphincter muscle contraction 

Sham sacral nerve stimulation with lead turned off 

Improvement in FI 

30/34 6/34 5.00 

(2.39; 10.44) 

1 

(1; 
Table 70. Comparative effectiveness of clinical interventions on FI in community dwelling adults (significant differences only s

299

Author 

Sample 

Followup 

Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/

Number 

Treated 

Relative Risk

(95% CI) 

Num

Nee

to T

(95% 

Osterberg, 2004837N = 70 79% female 12 month followup 

Anterior levatorplasty with mobilization of external sphincter 

Anal (and vaginal in women) plug electrostimulation of the pelvic floor with stimulation frequency was 25Hz and the duration 1.5 seconds, with a pulse-train interval of 3 seconds 

Self-reported improvement in FI Improvement in Incontinence at 3 months 

28/35 19/35 1.47 

(1.04; 2.08) 

4 

(2; 

Davis, 2004830

N = 38 100% female 12 month followup 

Anterior overlapping sphincter repair using interrupted nonabsorbable sutures and levatorplasty using absorbable sutures 

Anterior overlapping sphincter repair plus visual or auditory biofeedback with dual-balloon pressure system during pelvic floor exercise 2 times/day 

Symptomatic improvement in FI 

13/20 17/18 0.69 

(0.49; 0.97) 

4 

(2; 

Tjandra, 2004838

N – 82 78% female 3 month followup 

PTP injection into intersphincteric space and internal anal sphincter with guidance by endoanal ultrasound 

PTP injection into intersphincteric space and internal anal sphincter without guidance by endoanal ultrasound 

>50 percent improvement in Wexner’s continence score 

29/12 16/11 1.73 

(1.12; 2.65) 

3 

(2; 

Dahlberg, 1998425

N = 171 51% female 60 month followup 

Preoperative highdose radiotherapy with 25Gy given in 5 fractions for 5-7 days followed by anterior resection of rectal cancer 

Anterior resection of rectal cancer alone 

Excellent operation with respect to bowel function 

12/84 28/87 0.44 

(0.24; 0.81) 

6 

(4; 
Table 70. Comparative effectiveness of clinical interventions on FI in community dwelling adults (significant differences only s

300

Author 

Sample 

Followup 

Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/

Number 

Treated 

Relative Risk

(95% CI) 

Num

Nee

to T

(95% 

Risk of FIGlazener, 2001251

N = 747 100% female 12 month followup 

Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises supplemented with bladder training 

Usual peripartum preparation 

Any FI (to motions) 

12/371 25/376 0.49 

(0.25; 0.95) 

1

(13; 

Fecal urgency, toilet dependence 

25/84 5/87 5.18 

(2.08; 12.89) 

4 

(1; 

Bowel emptying difficulties 

44/84 31/87 1.47 

(1.04; 2.08) 

6 

(3; 

Incontinence of gas 

57/84 44/87 1.34 

(1.04; 1.73) 

6 

(3; 

Incontinence of loose stool 

42/84 21/87 2.07 

(1.35; 3.18) 

4 

(2; 

Dahlberg, 1998425

N = 171 51% female 60 month followup 

Preoperative highdose radiotherapy with 25Gy given in 5 fractions for 5-7 days followed by anterior resection of rectal cancer 

Anterior resection of rectal cancer alone 

Incontinence of solid stool 

12/84 3/87 4.14 

(1.21; 14.16) 

9 

(3; 1

FI during day 190/306 111/291 1.63 

(1.37; 1.93) 

4 

(3; 

Peeters, 2005424

N = 597 38% female 60 month followup 

Radiotherapy with total dose of 25Gy administered in 5 fractions over 5 to 7 days before total mesorectal excision 

Total mesorectal excision 

FI during night 98/306 49/291 1.90 

(1.40; 2.58) 

7 

(4; 

Self-reported FI 12/21 11/43 2.23 

(1.19; 4.19) 

3 

(1; 

Peeters, 2005424

N = 64 50% female 60 month followup 

Radiotherapy with total dose of 25Gy was administered with 5Gy fractions to rectum, perirectal tissues, anal sphincters, and regional lymph nodes before low anterior resection of rectal cancer 

Low anterior resection of rectal cancer without preoperative radiotherapy 

Self-reported gas incontinence 

15/21 20/43 1.54 

(1.01; 2.34) 

4 

(2; 2
Table 70. Comparative effectiveness of clinical interventions on FI in community dwelling adults (significant differences only s

301

Author 

Sample 

Followup 

Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/

Number 

Treated 

Relative Risk

(95% CI) 

Num

Nee

to T

(95% 

Primary overlap. 1st row of sutures inserted ~1.5cm from one side of torn edge of external anal sphincter and carried through to within 0.5cm of other edge. 2nd row of sutures inserted to attach loose end of overlapped muscle. 

End-to-end repair of the external anal sphincter 

Fecal urgency 1/32 10/32 0.10 

(0.01; 0.74) 

4 

(3; 

Fecal urgency 12 months postpartum 

8/32 1/32 8.00 

(1.06; 60.32) 

4 

(0; 4

Fernando, 2006381N = 64 100% female 12 month followup 

End-to-end technique to repair obstetric anal sphincter 

Overlap technique to repair obstetric anal sphincter 

Fecal urgency 6 months postpartum 

9/32 2/32 4.50 

(1.05; 19.22) 

4 

(1; 2

Parellada, 2004834

N = 63 96% female 24 month followup 

Surgical: open lateral internal sphincterotomy and mucose closure with chromic catgut. 

Chemical: local 0.2% isosorbide dinitrate - pea-size quantity applied manually at the entrance of the anus, 3 times/day immediately after a warm bath, for 6 weeks. 

Self-reported gas incontinence and fecal soiling 

9/30 0/33 20.84 

(1.26; 343.32)

3 

Wong, 2002427

N = 112 75% female 12 month followup 

Implantation of Acticon trade mark artificial bowel sphincter - solid silicone elastomer device 

Baseline condition Urge fecal 

incontinence 

22/112 100/112 0.22 

(0.15; 0.32) 

1 

(1; 

Johanson, 1999391N = 607 100% female 60 month followup 

Delivery with vacuum extractor 

Forceps delivery Self-reported 

FI, sometimes 

28/296 16/311 1.84 

(1.02; 3.33) 

2

(8; 1
Table 70. Comparative effectiveness of clinical interventions on FI in community dwelling adults (significant differences only s

302

Author 

Sample 

Followup 

Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/

Number 

Treated 

Relative Risk

(95% CI) 

Num

Nee

to T

(95% 

Self-reported severe fecal incontinence 3 months postpartum (Wexner scores >4) 

12/376 31/376 0.39 

(0.20; 0.74) 

1

(14; 

Faltin, 2005385

N = 752 100% female 12 month followup 

Clinical and ultrasound examination of the anal sphincter 

Clinical examination alone 

Self-reported severe fecal incontinence 1 year postpartum (Wexner scores >4) 

11/376 23/376 0.48 

(0.24; 0.97) 

2

(20; 

Lundby, 2005857

N = 494 50% female 15-20 year followup 

Postoperative radiotherapy after anterior resection 

Anterior resection alone 

FI 9/244 1/250 9.22 

(1.18; 72.24) 

3

(4; 1

Severity of FIOsterberg, 2004837N = 70 90% female 12 month followup 

Anterior levatorplasty with mobilization of external sphincter 

Anal (and vaginal in women) plug electrostimulation of the pelvic floor with stimulation frequency was 25Hz and the duration 1.5 seconds, with a pulse-train interval of 3 seconds 

Physical handicap due to FI at 1 year 

9/35 19/35 0.47 

(0.25; 0.90) 

4 

(2; 

Use of pad for FI 

41/84 19/87 2.23 

(1.42; 3.52) 

4 

(2; 

Dahlberg, 1998425

N = 171 51% female 60 month followup 

Preoperative highdose radiotherapy with 25Gy given in 5 fractions for 5-7 days followed by anterior resection of rectal cancer 

Anterior resection of rectal cancer alone 

Restriction in social life because FI 

25/84 9/87 2.88 

(1.43; 5.80) 

5 

(2; 
Table 70. Comparative effectiveness of clinical interventions on FI in community dwelling adults (significant differences only s

303

Author 

Sample 

Followup 

Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment/ 

Number 

Treated 

Number of 

Cases After 

Control 

Treatment/

Number 

Treated 

Relative Risk

(95% CI) 

Num

Nee

to T

(95% 

Peeters, 2005424

N = 597 38% female 60 month followup 

Radiotherapy with total dose of 25Gy administered in 5 fractions over 5 to 7 days before total mesorectal excision 

Total mesorectal excision 

Use of pads for fecal incontinence 

171/306 96/291 1.69 

(1.40; 2.05) 

4 

(3; 

Wiley, 2004833

N = 79 54% female 12 month followup 

Closed lateral internal sphincterotomy (Hoffman and Goligher) using a short stab incision and blind division of the internal sphincter guided by surgeon’s finger 

Open lateral sphincterotomy (Parks) via a 1cm radial incision with division of the internal sphincter under direct vision 

Self-reported deterioration in FI 

2/38 10/41 0.22 

(0.05; 0.92) 

5 

(4; 

Self reported using pad for FI 

60/112 99/112 0.61 

(0.50; 0.73) 

3 

(2; 

Self reported using diapers for FI 

19/112 57/112 0.33 

(0.21; 0.52) 

3 

(2; 

Wong, 2002427

N = 112 75% female 12 month followup 

Implantation of Acticon trade mark artificial bowel sphincter - solid silicone elastomer device 

Baseline condition 

Avoiding physician activities due to FI 

32/112 91/112 0.35 

(0.26; 0.48) 

2 

(2; 

Peeters, 2006788

N = 669 0% female 12 month followup 

Three-dimensional conformal radiotherapy 68Gy 

Three-dimensional conformal radiotherapy 78Gy 

FI as use of incontinence pads for rectal loss of blood, mucus, or stools (requiring use of pads more than twice a week) 

21/326 40/330 0.53 

(0.32; 0.88) 

1

(12; 

Bold - significant differences at 95% confidence level; number needed to treat to benefit one patient for positive patient outcomes (continto harm one patient for negative patient outcomes (incontinence); A - number of avoided events per 1,000 treated; E - number of excess

treated 
304

Question 4. What are the Strategies to Improve the 

Identification of Persons at Risk and Patients who have UI 

and FI? 

Strategies to Improve the Identification of Persons at Risk and 

Patients who have UI 

 Evidence from large observational studies suggests that a substantial proportion of 

community dwelling adults have undiagnosed UI. Prevalence varied across gender and age 

groups. The majority (66.2 percent) of women with UI after pregnancy did not report the 

symptoms to their nurses or doctors.858 Healthcare professionals did not assess bladder control in 

77 percent and did not examine pelvic floor muscles during routine vaginal examination in 94 

percent of pregnant women.859 The majority of young women 18-23 years old (77 percent) with 

symptoms of UI never sought medical help, and only 11.5 percent received care they were 

satisfied with.860 The prevalence of undiagnosed UI was consistent across Western countries: 55 

percent for mid-age and older women from a large Australian Longitudinal Study on Women's 

Health,860 56 percent in an Austrian cohort,139 62 percent in the Netherlands,122 and higher in 

Turkey (85 percent)861 and in the United Arab Emirates (69.1 percent).862 The prevalence of 

undiagnosed UI is higher in recent studies. For example, 75 percent of Swedish women with UI 

had not sought professional help,155 75 percent in Spain, 67 percent in France, 60 percent in 

Germany,112 and 75 percent112 to 86 percent478 in the United Kingdom. 

 The prevalence of undiagnosed UI is also high in men; only one third of American men863

and 46 percent of Swedish men583 with UI received professional care for UI, and only 33 percent 

obtained information about UI from the health service.61 Only 55 percent of men 45-75 years old 

with bothersome urinary symptoms contacted general practitioners, and only 40 percent of those 

were referred to a urologist for a specialized exam and advice.598 Specialized care was given to 

11 percent of adults with UI in Belgium.587 Among males with overactive bladder symptoms 

living in 11 Asian countries, only 6 percent discussed this condition with a physician.864 

 The proportion of older community dwelling adults with undiagnosed UI varied from 25 

percent of men and 40 percent of women in Spain,35 to 91 percent in Thailand,865 and 82 percent 

in Japan.63 Primary care providers in the United States assessed UI in 21 percent of older 

incontinent women and 10 percent of older incontinent men.521 The prevalence of undiagnosed 

UI was highest in Black women and in Hispanic men.146 

 The diagnostic pathway to detect persons at risk and patients with UI includes populationbased epidemiologic surveys with validated questionnaires and scales,866 clinical history, and 

simple self-administered diagnostic tests. Treatment decisions are made based on instrumental 

methods, including ultrasound and multi-channel urodynamics, considered as a “gold standard,” 

essential to decide the most effective intervention.867

 Valid questionnaires to assess UI (Appendix Table F209). The Symptom and Quality of 

Life Committee of the International Consultation on Incontinence (ICI) systematically reviewed 

available questionnaires and scales to diagnose UI and evaluate quality of life in patients with 

UI.866 The committee highly recommended the questionnaires with rigorous validity, reliability, 

and responsiveness in several clinical studies graded with the highest level of evidence (level A) 

(Appendix Table F210).866 The ICI Questionnaire combined symptoms of UI and impact on life 

for both genders.868 The Bristol Female Lower Urinary Tract Symptoms Questionnaire869 and the 
305

Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ)870 are recommended to 

estimate the severity and impact on life of stress and urge UI in women (Appendix Table 

F211).866 The ICS male questionnaire measures voiding patterns, stress, urge UI, and impact on 

quality of life related to UI.871 The overactive bladder questionnaire demonstrated validity and 

reliability to measure symptoms of overactive bladder in males and females.872 Most of the 

questionnaires are gender specific and include UI and other symptoms of lower urinary tract 

problems in females (Urogenital Distress Inventory;873 Urogenital Distress Inventory-6;874

Incontinence Severity Index;875 Bristol Female Lower Urinary Tract Symptoms Questionnaire876

and in males ICS Male, Lower Urinary Tract Symptoms877 and Danish Prostatic Symptom Score, 

Lower Urinary Tract Symptoms878). The questionnaires on Quality of Life in Persons with UI879

and the Incontinence Classification System880 estimate perceived UI, social interactions, personal 

strain, impact on sexual life, and overall health in both genders. Several scales are recognized as 

valid tools to measure quality of life in incontinent women: King’s Health Questionnaire;881

Incontinence Impact Questionnaire;882 Incontinence Impact Questionnaire-7; UI Severity Score 

(UISS);883,884 and CONTILIFE-Urinary Incontinence-Specific Measure of Quality of Life.885 The 

committee did not find good evidence to recommend scales of quality of life in males. Standard 

recommendations developed by the Symptom and Quality of Life Committee of the ICI did not 

include sensitivity, specificity, and positive predictive likelihood of different questionnaires 

compared to objective physician diagnosis or instrumental methods. The assessment of validity 

based on significant correlation coefficients can be biased by the sample size of the studies and 

the distribution of the responses. 

Diagnostic value of questionnaires and scales for UI. Several studies examined the 

diagnostic value of questionnaires and validated scales compared to multichannel video 

urodynamic testing,452,480,506,886-889 physician diagnosis based on medical history, urine analysis, 

and micturition charts and diaries and urodynamics,447,890-892 detailed interviews with nurses,893

or other objective tests including the pad test,894 provocative cough stress test, and computerized 

urethra-cystometrogram (Table 71).895 One study tested a simple screening tool to detect 

common geriatric problems in community dwelling adults including UI.479 The scales included 

questions on the presence and severity of symptoms of UI and quality of life. The majority of 

studies examined females only; three studies included both males and females.479,480,892 An 

epidemiologic survey could identify only 56 percent of women who had urge UI and 66 percent 

of women who had stress UI.447 Survey questions for geriatric UI could identify only 60 percent 

of incontinent adults.480 The highest sensitivity of 98 percent was reported in a nonrandomized 

multicenter study of 531 patients with overactive bladder and urge UI detected with a simple, 

five-item questionnaire.892

 The sample size of the studies was not associated with the sensitivity of the scales to detect 

UI (Appendix Table F212). The specificity of the scales varied from 21 percent480 to 100 

percent.895 The lowest specificity was demonstrated for a survey in elderly patients to detect urge 

UI.480 The Medical, Epidemiologic, and Social Aspects of Aging Urinary Incontinence 

Questionnaire did not provide any false positive results of stress UI.895 Such large variability in 

specificity of the scales could not be explained by differences in sample size (Appendix Table 

F212). The scales had comparable specificity for different types of UI; 95 percent for mixed 

UI,479 96 percent for stress UI,480 and 96 percent for urge UI.447

 Three scales suggested a greater likelihood of UI compared to urodynamic evaluations480,895

and physician diagnosis447,479 (Appendix Table F213). The same scale resulted in larger positive 

likelihood ratios for urge (positive LR 14) and lower for stress UI (positive LR 5.5).447 The 
306

majority of scales resulted in only a small (positive LR <4) probability of UI diagnosed with 

multichannel urodynamics,452,480,506,887-889 pad test,894 or physician diagnosis.890,891 The moderate 

diagnostic value of the Urogenital Distress Inventory was reported in a systematic review with a 

pooled likelihood ratio of 2.2, 95 percent CI 1.5; 2.9.452,888 Larger studies tended to report lower 

likelihood ratios, but the sample size could explain only small proportions of differences in ratios 

(Appendix Table F212). Across the studies, the consistent number needed to screen to detect one 

case of UI was two to three patients (Table 71). 

 Several studies estimated the validity of the questionnaires with correlation coefficients. One 

study of 384 older women reported a significant correlation (correlation coefficient ratio 0.2-0.7) 

between the Incontinence Impact Questionnaire and the Urogenital Distress Inventory with the 

clinical diagnosis of UI.896 The Incontinence Severity Index was correlated with the 48-hour 

"pad weighing" test (correlation coefficient 0.6-0.6).875,897

 A large RCT reported a significant correlation between the Incontinence Quality of Life 

Questionnaire, Patient Global Impression of Improvement and Severity Questionnaire, and stress 

pad test results.507 Secondary analyses of three clinical drug trials reported a significant 

correlation between the Urgency Perception Scale and patient voiding diary variables and other 

patient assessments, including perception of bladder condition, perception of treatment benefit, 

the Medical Outcomes Study Short-Form 36 health survey, the King's Health Questionnaire, the 

OAB Questionnaire, and the Overall Treatment Effect scale.898 The significance of correlation 

coefficients depends on the sample size of the studies. For example, a large RCT reported a 

correlation coefficient ratio of 0.2-0.4 as significant.507

In conclusion, two questionnaires demonstrated good diagnostic value compared to 

multichannel urodynamics to detect UI in epidemiologic surveys.447,895 Two screening 

questionnaires may accurately detect UI in older adults.479,480 Several questionnaires of severity 

and quality of life of UI that demonstrated rigorous validity and reliability were recommended 

for clinical practice and research. The clinical and economical value of self-reported perceived 

UI needs future research. 

Diagnostic value of clinical history compared to multichannel urodynamic for stress UI 

in community dwelling adults. The diagnostic value of clinical history to detect stress UI 

compared to a “gold standard” multichannel urodynamics was examined in 24 studies with 

inconsistent results.435-455,899 Most of the studies included females; one evaluated stress UI in 

men after radical prostatectomy899 (Table 72). The authors used ICS criteria to define 

urodynamic UI, noted during filling cystometry as the involuntary leakage of urine during 

increased abdominal pressure, in the absence of a detrusor contraction.483 Clinical history 

assessments varied but were poorly reported. The common assessment included duration and 

severity of involuntary urine leakage, exacerbating factors, baseline diseases, self management, 

and impact on quality of life. 

 The sensitivity of the clinical history compared to multichannel urodynamics varied from 44 

percent in the largest study437 to 100 percent in several studies in females435,443,446 and males.899

The larger study tended to report lower sensitivity; 20 percent of the variation in sensitivity was 

attributable to sample size (Appendix Figure F2). 

 Specificity also varied substantially from 13 percent in a study with elderly women455 to 95 

percent in the smallest study of 46 patients with complaints of UI or voiding disorders.435 The 

largest study of 1,455 women reported specificity of 87 percent.437 Clinical history resulted in 50 

percent false positive results in males.899 The variability in specificity could not be explained by 

the sample size of the studies; only 3 percent was attributable to the number of subjects 
307

(Appendix Table F212). Positive predictive values as the proportion of true positives among all 

positives also varied from 66 percent in a study of 66 females445 to 92 percent in a study of 566 

patients.453 Larger studies tended to report greater positive predictive values of clinical history 

(Appendix Figure F3); 22 percent of the differences in positive predictive values were 

attributable to the sample size of the study. Only one study of 46 women showed that clinical 

history was associated with a definite increase in the likelihood of disease (positive likelihood 

ratio of 20).435 One study of 198 Japanese women reported a moderate increase in the likelihood 

of stress UI identified with clinical history compared to multichannel urodynamics (positive 

likelihood ratio of 7.7).436 The majority of the studies found only small increases (positive 

likelihood ratios >2) in the likelihood of stress UI identified with clinical history440-447,899 or 

minimal (positive likelihood ratios >1).442,448-455 The differences in sample size could not explain 

the variability in positive likelihood ratios (Appendix Table F212). One systematic review 

reported a small positive likelihood ratio (2.09, 95 percent CI 1.83; 2.35) associated with the 

pooled sensitivity and specificity in females using studies published before 2003.867 The review 

reported highly significant heterogeneity between studies (p<0.0001) in sensitivity and 

specificity with no clear explanations for substantial variability in diagnostic values of clinical 

history to detect stress UI. 

Diagnostic value of clinical history compared to multichannel urodynamics for urge UI 

in community dwelling adults. The diagnostic value of clinical history to detect urge UI and 

detrusor overactivity compared to a “gold standard” multichannel urodynamic, was examined in 

18 studies.436,437,440-443,447,450,452,454,455,899-905 The majority of studies included females; two studies 

evaluated urge UI in men after radical prostatectomy899 and in older males with persistent lower 

urinary tract symptoms.904 The authors used the ICS criteria to define urodynamic urge UI during 

filling cystometry.483 The sensitivity of clinical history to detect urge UI varied: it was 14 percent 

in one study of older women,455 less than 50 percent in seven studies437,443,450,452,454,905 to 50 to 80 

percent in eight studies,440-442,447,899,901,903,904 and more than 80 percent in two studies.436,902 Large 

trials reported sensitivity of 28 percent905 to 41 percent.437 The sample size of the studies could 

explain only 7 percent of the differences in sensitivity (Appendix Table F212). 

 The specificity of clinical history varied from 13 percent in one comparative study of 1,000 

females with lower urinary tract symptoms442 to 45-80 percent in six studies, including two 

studies in men,440,899-902,904 while the majority of the studies reported specificities greater than 85 

percent.436,437,441,443,447,450,452,454,455,903,905 Inconsistency in diagnostic values varied by study 

design to reduce bias in estimations. RCTs reported a specificity of 96 percent,437 while a 

nonrandomized clinical trial of 4,500 women showed a lower specificity of 86 percent.905

Substantial variability in specificity was not attributable to differences in sample size. Full crosstabulations of the results were available in eight studies to calculate positive predictive values as 

the proportion of true positives among all positives that were detected with clinical history. One 

study in males reported the lowest positive predictive value (PPV) of 33 percent;452 six studies 

showed PPV as 62 to 77 percent.440,441,443,447,450,902 The highest PPV of 81 percent was reported in 

a comparative study of 198 Japanese women.436 The sample size of the studies was not 

associated with differences in PPV. Several studies found that clinical history could increase the 

likelihood of urge UI with positive likelihood ratios between 10 and 22.436,437,441,443,447,450 Two 

studies reported moderate probability of urge UI detected with clinical history with positive 

likelihood ratios between 5 and 9.455,903 The majority of the studies showed only a small increase 

in likelihood of urge UI detected with clinical history.440,452,454,899-902,904,905 One study of 1,000 

women with symptoms of lower urinary tract dysfunction demonstrated a very low positive 
308

likelihood ratio of clinical history (<1) to diagnose urge UI.442 Larger studies tended to report 

lower positive predictive likelihood, but only 2 percent of the variability was attributable to the 

sample size of the studies. A systematic review of eight studies reported a small positive 

likelihood ratio of 4.69, 95 percent CI 4.05 to 5.33 associated with the pooled sensitivity and 

specificity to detect detrusor overactivity and urge UI in females.867 Heterogeneity between 

studies was significant (p<0.0001) with no well defined reasons for such variability in diagnostic 

value of clinical history. 

 Two studies examined the diagnostic value of clinical history to detect mixed UI and 

reported sensitivity from 68 percent437 to 91 percent,442 specificity from 47 percent to 24 percent 

respectively, and a small positive predictive likelihood of 1.3 or 1.2 respectively. 

Diagnostic values of different tests to detect persons at risk and patients with UI were 

examined in 23 studies with sample sizes varying from 20906 to 981 adults907 (Appendix Table 

F214). The diagnostic value of the tests varied substantially, depending on index methods, 

populations, and type of UI. Sensitivity differed from a low of 25 percent to detect outlet 

obstruction in males with ambulatory compared to conventional urodynamic testing908 to 100 

percent to detect female urge UI with cystometry by fetal cardiotocographic monitor for pressure 

recording909 or stress UI by the fluid bridge test.910 Specificity was the lowest (7 percent) for 

ambulatory urodynamic monitoring compared to multichannel urodynamics to detect stress UI in 

female soldiers.911 The majority of studies demonstrated specificity of the index tests less than 90 

percent. The fluid bridge test had a 76 percent probability (specificity of 24 percent) of false 

positive results. Urethral pressure profile examination had a specificity of more than 90 percent 

in two studies.912,913 Cough stress test and single-channel medium-fill cystometry914 and 

cystometry using a fetal monitor909 also had a low probability of false positive results for urge UI 

compared to multichannel urodynamics (specificity 96 percent). The Resident Assessment 

Protocol included in the MDS demonstrated a specificity of 97 percent to detect stress UI in 123 

randomly selected residents of 13 nursing homes in five states compared to multichannel 

urodynamics with definitions adjusted for impaired contractility in elderly patients.481 The 

positive likelihood ratio was defined as the ratio of the probability of a patient with UI having a 

positive test to the probability of an individual without UI having a positive test was 25.3 to 

diagnose significant stress leakage in residents of these nursing homes.481 Several studies 

examined diagnostic values of the urethral pressure profile; one nonrandomized clinical trial of 

108 women reported a large predictive likelihood of 24.5 to detect stress UI.913 Results were 

inconsistent across the same comparisons in other studies with small915-917 or moderate positive 

likelihood907,912 to diagnose UI. The majority of studies showed that tested diagnostic methods 

provided only a small likelihood of UI in adults (Appendix Table F214). 

 The majority of the studies that examined the diagnostic value of x-ray compared to 

multichannel urodynamics reported a small positive likelihood ratio to detect UI (Appendix 

Table F215).456-459,461 One large study of 1,584 males and females showed a likelihood ratio of 

10.11 for micturating cystourethrography to detect UI.460 The full bladder clinical stress test had 

a conclusive diagnostic value with a likelihood ratio of 33.5 in one study464 and moderate 

likelihood ratios between 5 and 10 in three studies.465,918,919 Single channel urodynamics 

demonstrated inconsistent diagnostic value for stress and urge UI with likelihood ratios varying 

from 1.9 in the geriatric population463 to 24.5 in younger women.462

Diagnostic value of ultrasound compared to UI in community dwelling adults. The 

diagnostic values of ultrasound exams to detect UI compared to multichannel urodynamics were 

examined in ten studies in community dwelling females to detect mixed470,473 or stress 
309

UI471,472,474-477,920,921 with no studies conducted in males (Table 73). One study of 201 incontinent 

nursing home residents, which examined a portable ultrasound device to diagnose post-void 

residual volume confirmed with catheterization, showed the lowest sensitivity of 59 percent to 

detect post-void residual volume >150ml.922 The same study reported a high sensitivity of 95 

percent to detect low post-void residual volume (<100ml).922

 The studies used different ultrasound techniques and definitions of UI including transrectal 

ultrasound475,921 to detect a drop in urethrovesical junction pressure during stress as a criterion 

for stress UI; translabial470,923 or vaginal471 ultrasound to observe urine leakage during the stress 

test; or perineal ultrasound to examine the opening of bladder neck and rotational angle.474,476,477 

 Bladder neck funneling on ultrasonography had 60 percent sensitivity to detect low leak 

point pressure in a study of 320 women.477 The highest sensitivity (>90 percent) was reported in 

two studies to observe urine leakage using translabial470 or vaginal ultrasound.471 Specificity 

ranged from 69 to 99 percent, depending on definitions of UI922 and ultrasound 

techniques.470,471,474,475,921,923 The PPV was lowest (19.8 percent) in a study to detect low leak 

point pressure in women with stress UI.477 Three studies reported PPV >93 percent to detect 

urine leakage470,471 or a drop in urethrovesical junction pressure.475 An ultrasound exam with a 

portable device provided a definite diagnosis of post-void residual urine volume >200ml in 

nursing home residents with a positive likelihood ratio of 69.922 Transrectal ultrasound 

conclusively detected a drop in urethrovesical junction pressure during stress tests in women 

with stress UI with a positive likelihood ratio of 21.5475 and in women undergoing surgery for 

stress urinary incontinence of 9.4.921 Ultrasound findings of urine leakage were associated with a 

moderate probability of UI in two studies with positive likelihood ratios >5.470,471 The 

differences in sample size could explain only 2 percent of the variability in likelihood ratios. 

 In conclusion, clinical history of UI results in a small likelihood of urodynamic UI and in a 

moderate likelihood of urodynamic urge UI in females. Very limited evidence in males suggests 

that clinical history of UI is not accurate to predict urodynamic UI. Inconsistent evidence implied 

that diagnostic values of x-ray, single channel urodynamic, full bladder clinical test, and Q-tip 

test are similar to multichannel urodynamics. Ultrasound diagnosis of urinary leakage and 

bladder neck anatomy was comparable to urodynamic UI and urinary retention in community 

dwelling adults and residents of nursing homes. MDS algorithms accurately diagnosed UI in 

LTC settings. 

 To assess the effectiveness of diagnostic methods to detect UI in adults, we estimated the 

number needed to screen to detect one case of UI and the number of diagnostic tests needed to 

detect one case of UI using the recently published prevalence of undiagnosed UI in age, gender, 

race, and socioeconomic status categories.146 The cost of different procedures was obtained from 

the systematic review and cost-effectiveness analysis of diagnostic tests of UI.867 Despite 

substantial differences in positive predictive likelihood ratios, the number needed to screen and 

the number of needed tests was similar and consistent among the studies (Table 74). 

Epidemiologic surveys with self-completed scales and questionnaires would cost less than $70 to 

detect one case of UI. The professional assessment of clinical history would cost from $175 in 

males after radical prostatectomy899 to nearly $400 in women with stress UI.437 Health care 

providers would need to collect clinical history in five to 15 patients to detect one case of 

urodynamic UI; the cost would not be more than $250. Clinical history had the lowest cost to 

diagnose urge UI in males with persistent lower urinary tract symptoms904 and the highest cost to 

detect detrusor overactivity in elderly women.455 The detection of urge UI with professional 

assessment of clinical history would cost more than $300 in the majority of the studies. The cost 
310

of ultrasound exams to detect one case of urodynamic UI varied from $600 to $900. The 

effectiveness of self-reported scales, professional assessment of clinical history, and ultrasound 

to detect UI in women was comparable and consistent across race, age, and socioeconomic 

groups; one to four women should be examined to detect one case of UI (Table 75). The number 

needed to screen males to detect one case of UI was also consistent in population groups 

(Appendix Table F216). The cost of different treatment options was beyond present analysis but 

may affect the cost of diagnostic pathways. One of the most expensive diagnostic methods, 

multichannel urodynamic evaluation, is an important step to diagnose intrinsic sphincter 

deficiency (urodynamic urinary incontinence and a maximum urethral closure pressure ≤20cm 

H2O ) in combination with hypermobility in women planning surgery for stress UI.924 However, 

this costly invasive examination may not be necessary for women who prefer behavioral 

treatments including lifestyle changes, bladder training, and pelvic floor muscle training. The 

effects of population-based screening and educational programs on clinical outcomes, quality of 

life, and cost of available treatments need future investigations in well designed RCTs. 
311 

Table 71. Diagnostic value of validated questionnaires and scales to detect persons at risk and patients with UI 

Author 

Sample 

Level of 

Evidence UI Type Index Test (Scale) Gold Standard Sensitivity (%) Specificity (%) 

Moore, 1996479

N = 109; 66% female 

II-2 Mixed "Screen" Blinded geriatricians' 

assessments 

89 95 

Kirschner-Hermanns, 1998480N = 132; 80% female 

II-2 Stress Questionnaire Multichannel video urodynamic 

testing 

60 96 

Urge Questionnaire Physicians' diagnosis based on 

medical history, urine analysis, and micturition chart 

Sandvik, 1995 56 96 

447

N = 250; 100% female 

II-2 

Stress Questionnaire Physicians' diagnosis based on 

medical history, urine analysis, and micturition chart 

66 88 

Seim, 2004892

N = 531; 59% female 

II-1 Overactive 

bladder 

Questionnaire Physicians' diagnosis based on 

medical history, urine analysis, and micturition chart 

98 90 

Rohr, 2004 Stress Questionnaire Open interview 91 86 

893

N = 421; 100% female 

II-2 

Urge Questionnaire Open interview 91 86 

Contreras Ortiz, 1993886N = 217; 100% female 

II-2 All Bladder Instability 

Discriminant Index 

Multichannel video urodynamic testing 

88 83 

Urge Questionnaire for 

Urinary Incontinence Diagnosis 

Physicians' diagnosis based on medical history, urine analysis, a cough stress test, postvoid residual volume assessment, and multichannel urodynamic testing 

Bradley, 2005 79 79 

891

N = 117; 100% female 

II-2 

Stress Questionnaire for 

Urinary Incontinence Diagnosis 

Physicians' diagnosis based on medical history, urine analysis, a cough stress test, postvoid residual volume assessment, and multichannel urodynamic testing 

85 71 

Urge 3 incontinence 

questions 

Physicians' diagnosis based on medical history, urine analysis, a cough stress test, postvoid residual volume assessment, and 3-day voiding diary 

Brown, 2006 75 77 

890

N = 301; 100% female 

II-2 

Stress 3 Incontinence 

questions 

Physicians' diagnosis based on medical history, urine analysis, a cough stress test, postvoid residual volume assessment, and 3-day voiding diary 

86 60 
Table 71. Diagnostic value of validated questionnaires and scales to detect persons at risk and patients with UI (continued) 

312 

Author 

Sample 

Level of 

Evidence UI Type Index Test (Scale) Gold Standard Sensitivity (%) Specificity (%) 

Gunthorpe, 2000894

N = 89; 100% female 

II-2 Stress Incontinence 

screening questionnaire 

Pad test 65 80 

Klovning, 1996887

N = 250; 100% female 

II-2 Stress Detrusor instability 

score 

Multichannel video urodynamic testing 

60 77 

Lemack, 1999888N = 128; 100% female 

II-1 Stress The Urogenital 

Distress Inventory (UDI-6) 

Multichannel video urodynamic testing 

85 63 

Fitzgerald, 2002452

N = 293; 100% female 

II-2 All The Urogenital 

Distress Inventory (UDI-6) 

Multichannel video urodynamic testing 

88 55 

Urge Questionnaire Multichannel video urodynamic 

testing 

Matharu, 2005 63.1 65.1 

506

N = 490; 100% female 

I 

Stress Questionnaire Multichannel video urodynamic 

testing 

76.9 56.3 

Lemack, 1999888N = 128; 100% female 

II-2 Urge The Urogenital 

Distress Inventory (UDI-6) 

Multichannel video urodynamic testing 

83 50 

Roongruangslip, 2005889N = 129; 100% female 

II-2 All Questionnaire Multichannel video urodynamic 

testing 

96 25 

Kirschner-Hermanns, 1998480N = 132; 80% female 

II-2 Urge Questionnaire Multichannel video urodynamic 

testing 

84 21 

Diokno, 1999895

N = 118; 100% female 

II-2 Stress MESA Provocative cough stress test, 

post-void residual urine measurement, and computerized urethrocystometrogram 

62 100 

NNS - number needed to screen or detect one case of UI
313 

Table 72. Diagnostic value of clinical history compared to multichannel urodynamics – “gold standard” to detect persons at ris

Author 

Sample 

True 

Positive 

False 

Positive 

False 

Negative 

True 

Negative 

Sensitivity 

(%) 

Specificity 

(%) 

Positive 

Predictive 

Value 

Stress UI Porru, 1994435

N = 46; 100% female 

 100 95 

Ishiko, 2000436

N = 198; 100% female 

152 4 14 28 92 88 97 

Yalcin, 2004437

N = 1,455; 100% female 

 44 87 

Diokno, 1990438

N = 456; 100% female 

65 14 30 52 68 79 82 

Ramsay, 1993439

N = 200; 100% female 

72 28 19 81 79 74 72 

Muylder, 1992440

N = 408; 100% female 

228 58 14 108 94.2 65.1 80 

Lagro-Janssen, 1991441

N = 103; 100% female 

76 9 3 15 96 63 89 

96 63 

96.1 23.4 

Clarke, 1997442N = 1,000; 100% female 

70 35 

Sand, 1988443

N = 218; 100% female 

114 43 0 66 100 61 73 

Kujansuu, 1982444

N = 121; 100% female 

46 20 11 43 81 68 70 

Niecestro, 1992445

N = 66; 100% female 

13 17 3 32 81 65 43 

Sunshine, 1989446

N = 109; 100% female 

73 14 0 15 100 52 84 

Sandvik, 1995447

N = 785; 100% female 

179 26 4 27 98 51 87 

Ficazzola, 1998899

N = 60; 0% female 

 100 50 

Bergman, 1990448

N = 154; 100% female 

 56 70 

Weidner, 2001449

N = 950; 100% female 

 66 63 

Cundiff, 1997450

N = 535; 100% female 

416 60 17 42 96 41 87 
Table 72. Diagnostic value of clinical history compared to multichannel urodynamics to detect persons at risk and patients with 

314 

Author 

Sample 

True 

Positive 

False 

Positive 

False 

Negative 

True 

Negative 

Sensitivity 

(%) 

Specificity 

(%) 

Positive 

Predictive 

Value 

Le Coutour, 1990451

N = 154; 100% female 

 92 39 

Fitzgerald, 2002452

N = 293; 100% female 

187 51 22 33 90 39 79 

Korda, 1987453

N = 566; 100% female 

451 39 52 24 90 38 92 

Ouslander, 1987454

N = 135; 100% female 

82 31 5 17 94 35 73 

Diokno, 1987455

N = 200; 100% female 

145 40 9 6 94 13 78 

Urge UIIshiko, 2000436

N = 198; 100% female 

25 6 4 154 86 96 81 

Sand, 1988443

N = 218; 100% female 

10 3 20 185 33 98 77 

Sandvik, 1995447

N = 785; 100% female 

23 8 18 187 56 96 74 

Lagro-Janssen, 1991441

N = 103; 100% female 

11 4 7 81 61 95 73 

Cundiff. 1997450

N = 242; 100 % female 

42 17 60 416 41 96 71 

Yalcin, 2004437

N = 1,455; 100% female 

 41 96 

van Waalwijk van Doorn, 1997903

N = 228; 100% female 

 53 94 

Diokno, 1987455

N = 200; 100% female 

 14 97 

Fitzgerald, 2002452

N = 293; 100% female 

10 21 27 235 27 92 32 

Ouslander, 1987454

N = 135; 100% female 

 32 90 

Ficazzola, 1998899

N = 60; 0% female 

 50 77 

Digesu, 2003905

N = 4,500; 100% female 

 28 86 

Ding, 1997904

N = 126; 0% female 

 73 60 

Cantor, 1980902

N = 214; 100% female 

107 53 11 43 91 45 67 
Table 72. Diagnostic value of clinical history compared to multichannel urodynamics to detect persons at risk and patients with 

315 

Author 

Sample 

True 

Positive 

False 

Positive 

False 

Negative 

True 

Negative 

Sensitivity 

(%) 

Specificity 

(%) 

Positive 

Predictive 

Value 

Kong, 1990901

N = 269; 100% female 

 79 49 

Petros, 1992900N = 113; 100% female 

 40 74 

Muylder, 1992440

N = 408; 100% female 

147 91 89 81 62.3 47.1 62 

Clarke, 1997442N = 1,000; 100% female 

 68 12.9 

Mixed UIYalcin, 2004437

N =1455; 100% female 

 68 47 

Clarke, 1997442N = 1,000; 100% female 

 91 23.8 
316 

Table 73. Diagnostic value of ultrasound exam compared to multichannel urodynamics - “gold standard” to detect persons at r

Author 

Sample 

Ultrasound Criteria to Detect Risk of 

Incontinence 

Sensitivity 

(%) 

Specificity 

(%) 

Positive 

Predictive 

Value 

(%) 

Positive 

Predictiv

Likelihoo

Vaginal probe <22mm 63 Vaginal probe <10mm 72 

Jolic, 1997920

N = 66; 100% female 

Abdominal probe 93 

Post-void residual urine volume <50ml 90 71 3.10 Post-void residual urine volume <100ml 95 63 2.57 Post-void residual urine volume ≥50ml 63 95 12.60 Post-void residual urine volume ≥150ml 59 97 19.67 

Ouslander, 1994922

N = 201; 74% female 

Post-void residual urine volume >200ml 69 99 69.00 

Dietz, 1999923

N = 37; 100% female 

Fluid leakage 63 86 77 4.50 

Kuo, 1994472

N = 102; 100% female 

Bladder neck anatomy 

Dietz, 1998473

N = 125; 100% female 

Bladder neck anatomy 84 76 88 3.50 

Dietz, 2001470

N = 52; 100% female 

Fluid leakage 94 88 94 7.83 

Quinn, 1989471

N = 124; 100% female 

Fluid leakage 97 82 94 5.39 

Chen, 1997474

N = 65; 100% female 

Bladder neck anatomy 73 77 64 3.17 

Bergman, 1988475

N = 91; 100% female 

Bladder neck anatomy 86 96 95 21.50 

Bergman, 1988921

N = 61; 100% female 

Bladder neck anatomy 94 90 91 9.40 

Kiilhoma, 1994476

N = 38; 100% female 

Bladder neck anatomy 72 

Huang, 2003477

N = 320; 100% female 

Bladder neck anatomy 59.5 68.6 19.8 1.89 
317 

Table 74. Number needed to screen to detect one case of UI, number of tests to detect one case of UI, and cost to detect one ca

undiagnosed UI146 and cost of diagnostic tests867) 

Cost to Detect One Case 

Author 

Positive 

Likelihood 

Ratio 

Number Needed to 

Screen to Detect 

One Case of UI 

Number of Tests to 

Detect One Case of 

UI 

Cost of Screening to 

Detect One Case of 

UI

Costs of T

One C

Scales to Diagnose UIMoore, 1996479 17.8 5 2 40.63 1Kirschner-Hermanns, 1998 15.0 8 2 60.27 1

480

1.1 8 6 60.02 4

Sandvik, 1995 14.0 9 2 64.58 1

447

5.5 9 2 67.53 1

Seim, 2004892 9.8 5 2 36.90 1Rohr, 2004893 6.5 5 3 39.74 1Contreras Ortiz, 1993886 5.2 5 3 37.52 1Bradley, 2005 3.8 6 3 45.02 2

891

2.9 6 3 45.02 2

Brown, 2006 3.3 6 3 45.02 2

890

2.2 6 3 45.02 2

Gunthorpe, 2000894 3.3 7 4 52.52 2Klovning, 1996887 2.6 8 4 60.02 2Lemack, 1999 2.3 6 4 45.02 3

888

1.7 6 4 45.02 3

Fitzgerald, 2002452 2.0 5 4 37.52 3Matharu, 2005 1.8 8 4 60.02 3

506

1.8 6 4 45.02 3

Roongruangslip, 2005889 1.3 5 5 37.52 3Diokno, 1999895 62.0 8 2 60.02 1Clinical History to Diagnose Stress UIPorru, 1994435 20.0 5 2 175.22 7Ishiko, 2000436 7.7 5 2 190.46 8Yalcin, 2004437 3.4 11 3 398.23 10Diokno, 1990438 3.2 7 3 257.68 10Diokno, 1987455 1.1 5 5 186.40 16Ramsay ,1993439l 3.0 6 3 221.80 10DeMuylder, 1992440 2.7 5 3 186.01 10Lagro-Janssen, 1991441 2.6 5 3 182.52 1

2.6 5 3 182.52 11.3 5 4 182.33 15

Clarke, 1997442

1.1 7 5 250.31 16
Table 74. Number needed to screen to detect one case of UI, number of tests to detect one case of UI, and cost to detect one ca

undiagnosed UI{Harris, 2007 #11264} and cost of diagnostic tests{Versi, 1996 #11105}) (continued) 

318 

Cost to Detect One Case 

Author 

Positive 

Likelihood 

Ratio 

Number Needed to 

Screen to Detect 

One Case of UI 

Number of Tests to 

Detect One Case of 

UI 

Cost of Screening to 

Detect One Case of 

UI

Costs of T

One C

Sand, 1988443 2.6 5 3 175.22 1Kujansuu, 1982444 2.5 6 3 216.32 1Niecestro, 1992445 2.3 6 3 216.32 1Sunshine 1989446 2.1 5 3 175.22 12Sandvik, 1995447 2.0 5 3 178.80 12Ficazzola, 1998899 2.0 5 3 175.22 12Bergman, 1990448 1.9 9 3 312.89 12Weidner, 2001449 1.8 7 4 265.48 12Cundiff, 1997450 1.6 5 4 182.52 13Le Coutour, 1990451 1.5 5 4 190.46 13Fitzgerald, 2002452 1.5 5 4 194.69 14Korda, 1987453 1.5 5 4 194.69 14Ouslander, 1987454 1.4 5 4 186.40 14Clinical History to Diagnose Urge UIIshiko, 2000436 21.5 6 2 203.74 7Sand, 1988443 16.5 15 2 530.97 7Sandvik, 1995447 14.0 9 2 312.89 7Lagro-Janssen, 1991441 12.2 8 2 287.25 8Cundiff, 1997450 10.3 12 2 427.36 8Yalcin, 2004437 10.3 12 2 427.36 8Van Waalwijk van Doorn, 1997903

8.8 9 2 330.60 8

Diokno, 1987455 4.7 34 3 1251.57 9Fitzgerald, 2002452 3.4 18 3 648.96 10Ouslander, 1987454 3.2 15 3 547.56 10Ficazzola, 1998899 2.2 10 3 350.44 1Digesu, 2003905 2.0 17 3 625.78 12Ding, 1997904 1.8 7 4 240.03 12Cantor, 1980902 1.7 5 4 192.55 13Kong, 1990901 1.5 6 4 221.80 13Petros, 1992900 1.5 12 4 438.05 13DeMuylder, 1992440 1.2 8 4 281.25 15Clarke, 1997442 0.8 7 6 257.68 20
Table 74. Number needed to screen to detect one case of UI, number of tests to detect one case of UI, and cost to detect one ca

undiagnosed UI{Harris, 2007 #11264} and cost of diagnostic tests{Versi, 1996 #11105}) (continued) 

319 

Cost to Detect One Case 

Author 

Positive 

Likelihood 

Ratio 

Number Needed to 

Screen to Detect 

One Case of UI 

Number of Tests to 

Detect One Case of 

UI 

Cost of Screening to 

Detect One Case of 

UI

Costs of T

One C

Clinical History to Diagnose Mixed UIYalcin, 2004437 1.3 7 4 257.68 15Clarke, 1997442 1.2 5 4 192.55 15Ultrasound to Diagnose UI

3 5 3 602.39 323 5 3 570.68 34

13 8 2 860.55 2420 8 2 918.90 24

Ouslander, 1994922

69 7 2 785.72 22

Dietz, 1999923 5 8 3 860.55 29Dietz, 1998473 4 6 3 645.42 3Dietz, 2001470 8 5 2 576.75 26Quinn ,1989471 5 5 3 558.92 28Chen, 1997474 3 7 3 742.67 32Bergman, 1988475 22 6 2 630.41 23Bergman, 1988921 9 5 2 576.75 25Kiilhoma, 1994476 7 6 752.98 65Huang, 2003477 2 8 3 911.17 38

Number needed to screen to identify one undiagnosed incontinence case = [(prevalence of undiagnosed incontinence) (sensitivity of the 

Number of diagnostic tests to identify one undiagnosed incontinence case = 2 + number needed to screen (1 - prevalence of undiagnos

specificity of the diagnostic test)925. 
320 

Table 75. Number needed to screen and number of tests to detect one case of UI in women (pooled sensitivity and sensitivity o

with multichannel urodynamic867) 

Prevalence of 

Undiagnosed UI 

Clinical History to Diagnose 

Stress UI 

Clinical History to Diagnose 

Urge UI 

Ultrasound to Diagnose 

Stress UI 

Sc

Population Categories Number Needed to Screen Number of Tests Number Needed to Screen Number of Tests Number Needed to Screen Number of Tests Num

t

All 0.55 5 4 8 3 5 3 Race/Ethnicity Black 0.66 4 3 7 3 4 3 Hispanic 0.41 7 5 11 3 7 3 White 0.52 6 4 8 3 6 3 Age Group 30–39 0.84 7 5 10 3 7 3 40–49 0.46 10 6 15 4 10 4 50–59 0.43 10 6 16 4 11 4 60–79 0.50 8 5 12 3 8 3 Socioeconomic Status Low 0.44 7 4 10 3 7 3 Middle 0.56 5 4 8 3 5 3 High 0.57 5 4 8 3 5 3 Medical Insurance Any private 0.57 5 4 8 3 5 3 Public only 0.52 6 4 8 3 6 3 None 0.55 5 4 8 3 5 3 

Number needed to screen to identify one undiagnosed incontinence case = [(prevalence of undiagnosed incontinence) (sensitivity of the Number of diagnostic tests to identify one undiagnosed incontinence case = 2 + number needed to screen (1 - prevalence of undiagnose

specificity of the diagnostic test)925
321 

Strategies to Improve the Identification of Persons at Risk and 

Patients who have FI 

 The diagnostic pathway to detect persons at risk and patients with FI includes self-reported 

symptoms using questionnaires and scales,866 clinical history of patients seeking help, anal 

manometry, sensory testing, anal endosonography, magnetic resonance imaging, and 

colonoscopy to detect baseline causes for FI.17 Treatment decisions are made based on 

instrumental methods including ultrasound and anal manometry, but no consensus exists about 

which test is a “gold standard,” essential to estimate the diagnostic values of other tests.926

Treatment decisions are made based on clinical assessments and functional and anatomical 

evaluations of the anorectum.17

 The Symptom and Quality of Life Committee of the International Consultation on 

Incontinence could not find sufficient evidence of psychometric properties to attain grade A 

status for the questionnaires and scales for FI and related quality of life (Appendix Table 

F217).866 However, three questionnaires were recommended for evaluation of patients with FI, 

including the Fecal Incontinence Quality of Life Scale;484 the Manchester Health 

Questionnaire,927 and the Birmingham Bowel and Urinary Symptoms Questionnaire928

(Appendix Table F218) The questionnaires assess the presence and severity of FI and the 

perceived quality of life including role and physical limitations, emotional impact of FI, personal 

relationships, and sexual restrictions related to FI. The American College of Gastroenterology 

Practice Parameters Committee advised using the Cleveland Clinic Grading system to evaluate 

the degree of incontinence and the efficacy of therapy,17 but this was not recommended by the 

ICI committee. These guidelines do not provide sensitivity, specificity, or likelihood of FI as 

criteria to grade scales or to recommended questionnaires for research. 

 Very few studies examined the diagnostic values of scales to detect FI compared to physician 

diagnosis. The Epidemiology of Prolapse and Incontinence Questionnaire demonstrated 87 

percent sensitivity, 70 percent specificity, 61 percent positive predictive value, and a small 

predictive likelihood ratio (2.9) to diagnose FI in 294 enrolled women with pelvic floor prolapse 

compared to examiner diagnosis.929 The Bowel Symptom Questionnaire had a 48.5 percent 

sensitivity, a 79.2 percent specificity, a 43.2 percent positive predictive value, and a small 

likelihood ratio (2.3) to identify anal sphincter trauma related to vaginal delivery in 156 

women.930 The Bowel Symptom Questionnaire detected 57.1 percent of the cases of external 

anal sphincter disruption with specificity of 75.8 percent, positive predictive value of 21.6 

percent, and positive likelihood ratio of 2.4.930

 The American College of Gastroenterology Practice Parameters Committee described a 

detailed algorithm to evaluate patients with FI or risk factors of FI. However, diagnostic values 

of the recommended tests were not well documented. For example, when health care 

professionals did not actively ask questions about continence status, routine clinical history and 

physical examination identified only 8 percent of patients with constipation and 11 percent with 

FI, compared to complex diagnostic methods including anal manometry, cinedefecography, 

electromyography of the anal sphincter, and assessment of terminal motor latency of the 

pudendal nerve.931 Self reported and professional evaluations of severity and quality of life 

related to FI showed agreement in a study of 118 patients with FI.515 However, surgeons defined 

solid incontinence as more severe, while patients assigned more severity scores to liquid FI. 

Clinical values and the economical cost of self-reported questionnaires to detect patients with 

undiagnosed incontinence require future research. 
322 

 Anal manometry with an asymmetry index >25 percent had an 81 percent sensitivity, 71 

percent specificity, and only a 2.8 positive likelihood ratio to predict combined anal sphincter 

defect detected with ultrasonography in 61 women with previous vaginal delivery and no past 

anoperineal surgery.932 Anal manometry compared to endoanal ultrasonography in patients with 

idiopathic FI with intact sphincters had different diagnostic value for manometry outcomes. 

Abnormal resting pressure gradient (<1.78) had 89 percent sensitivity, 96.3 percent specificity, 

and a large predictive likelihood ratio of 24 to identify FI; maximal mean resting pressure 

(<40mmHg) had 55 percent sensitivity, 98 percent specificity, and a predictive likelihood ratio of 

22, while vector volume (<11.8) had 53 percent sensitivity, 88 percent specificity, and a small 

predictive ratio of 4.3.933 A combination of anal manometry and the strength-duration curve had 

better diagnostic values than tests alone with sensitivity of 95 percent and specificity of 100 

percent to predict female FI due to sphincter weakness.934 Abnormal anal pressure identified only 

70 percent of incontinent patients with 68 percent specificity and a 2.5 predictive ratio. Strength 

duration data demonstrated 77 percent sensitivity and 84 percent specificity with a predictive 

value of 4.8.934 Anal manometry with low squeeze sphincter pressure had 52 percent sensitivity 

to detect FI, impaired rectal sensation could identify only 36 percent incontinent patients; 

pudendal neuropathy was present in 50 percent of patients with FI diagnosed by colonoscopy or 

sigmoidoscopy.935 Anal manometry, rectal capacity measurement, and saline-infusion tests did 

not demonstrate significant association with FI and could not differentiate 350 incontinent and 

80 continent patients.936

 Endoanal ultrasound had 100 percent specificity and sensitivity to detect external sphincter 

defects and 100 percent sensitivity, 95 percent specificity, and a 20 predictive likelihood ratio to 

identify internal sphincter defects compared to morphological surgical findings in 40 women 26-

80 years old with FI undergoing pelvic floor repair.482

 Endoanal magnetic resonance had 56 percent sensitivity, 69 percent specificity, 71 percent 

predictive positive value, and a 1.8 predictive likelihood ratio to detect defects of anal sphincter 

compared to endoanal ultrasonography in 237 patients with FI undergoing anal sphincter 

repair.937 Endoanal ultrasonography identified 90 percent of external anal sphincter defects with 

an 85 percent positive predictive value compared to surgical findings. Endoanal magnetic 

resonance detected 81 percent of external anal sphincter defects with 40 percent specificity, 89 

percent positive predictive value, and a small 1.3 positive likelihood ratio.937

 In conclusion, self-reported questionnaires and scales have unsatisfactory diagnostic clinical 

validity to diagnose anatomical or physiological causes of FI in adults. For tools using summary 

scores or scales, different ones are needed for FI and AI since these problems are defined 

differently. Anal ultrasonography has the highest diagnostic value to detect anal trauma in 

patients with FI. Patient complaints about FI assessed with a clinical history should be followed 

by the diagnostic procedures to diagnose primary conditions that may result in FI. Future 

research is needed to determine effective strategies to identify patients at risk of FI, including 

residents of LTC facilities. 
323 

Chapter 4. Discussion 

 The present report synthesizes the evidence following the clinical pathway of detection, 

clinical diagnosis, treatment, and prevention of incontinence in community dwelling adults in 

and in LTC settings. 

Detection of UI 

 The first big challenge is to define what we call UI. Physiological and clinical self reports 

yield different results. A person with substantial symptoms despite no urodynamic signs of UI 

still has a substantial problem. The diagnostic detection rates from scales and clinical history for 

UI do not correlate closely to multichannel urodynamics.16 The question is which should take 

precedence. Most of the evidence comes from women, with few studies for men.899,904 The yield 

from screening is high, on average: two to four subjects should be screened to detect one case of 

UI.146 A previous systematic review showed that in primary care settings clinical history and 

diaries are the most cost-effective methods to detect UI in women.16 However, less than half the 

incontinent patients who actively sought health care for UI could provide clinical histories or use 

diaries.112,155,478 Population-based surveys using validated scales447,479,480 yielded predictive 

likelihood ratios and the number needed to screen to detect one case of UI comparable to clinical 

history435,436 but at a lower cost ($36-$67 vs. $175-$255 respectively). Such population-based 

surveys can yield nationally representative valid estimations of prevalent and “bothersome” UI. 

Routine clinical examinations in high risk groups, including pregnant women and frail adults, 

should include assessment of UI. 

 The diagnostic value of the tests among different age, race, and socioeconomic status 

subgroups has not been well established; however, the prevalence of undiagnosed UI differed by 

10-20 percent in such groups.146 Therefore, screening programs should target patients at high risk 

of UI including aging and frail adults with functional dependency and cognitive impairment, 

patients with stroke, diabetes, obesity, poor general health, and comorbidities, pregnant females 

and women after vaginal birth or with vaginal prolapse, and males after urological surgery and 

radiation for prostate cancer. Limited evidence suggests that the Resident Assessment Protocol 

included in the MDS had a definitive predictive likelihood ratio to diagnose UI in nursing home 

residents.481 Systematic evaluations of functional status of residents, including noninvasive 

examinations of incontinence without multichannel urodynamics, would be the preferable 

screening method in LTC settings. 

Detection of FI 

 Few validated questionnaires866 and instrumental methods were examined to detect the 

presence and baseline of causes for FI17 with no consensus on which test is the “gold standard,” 

essential to estimate the diagnostic values of other tests,926 despite the tremendous impact of FI 

on quality of life and health care cost. 17 523 Patient reports do not correlate well with anatomical 

and physiological measures. Anal manometry does not correlate well with ultrasonography932 or 

sigmoidoscopy.935 Endoanal ultrasound demonstrated the highest predictive likelihood 

ratio,482,937 but the use of this method is restricted to adults seeking medical treatment.522,524 The 

severity and impact of incontinence on quality of life can be estimated from self-reported 
324 

frequency, amount of leakage, and restrictions on daily activities8,9,32 but not from instrumental 

methods.483 However, treatment decisions are made based on objective measures of 

incontinence.17,21 Instrumental physiological measurements that are associated with patient 

outcomes and may reflect better effects of different interventions should be analyzed in well 

designed experiments. 

Treatment

 The present report confirmed the significant diversity of interventions used, sampling 

strategies and definitions, and measurement of outcomes.17,21,25 

Sampling

Studies of UI and FI in LTC facilities were limited to those that agreed to participate in clinical 

trials.233,234,238,708 Recruitment of residents was restricted by cognitive function or 

comorbidities.709,710 The loss of followup was substantial in most studies in LTC.233-235 Studies of 

behavioral interventions among community dwelling adults relied largely on patients in 

clinics,250,372,501,510,712,714,716 with few studies that reported population based recruitment.240,242,245

Clinic-based sampling was used for most RCTs of surgical treatments of UI and FI among 

patients who decided to undergo surgery. Selection criteria varied for the same interventions. For 

example, only women with intact uteri were included in some,366,794,796,797 but not all, RCTs367 of 

hormone therapy. Studies that included continent subjects reported baseline leakage243,244 and 

previous surgery for incontinence;761 few excluded patients with a positive stress test.321,322

Baseline characteristics of the patients were balanced with stratified randomization in several 

RCTs.379,400,712,771,788,800,803,808,837,938 However, some clinical trials reported significant differences 

at baseline among treatment groups despite randomization.274,276,303,710,787,789 Pooling analysis 

was questionable due to sampling differences in the present report and previous systematic 

reviews.529,536,539,546 Applicability of clinical interventions that demonstrated significant 

improvement in incontinence was restricted to the sampled population groups. Whether these 

effective interventions would result in the same clinical benefit in other populations requires 

future research. 

Definitions of Incontinence and Measures of Success 

 Despite extensive efforts to standardize the definitions of incontinence,483 the original studies 

measured self-reported symptoms and signs of incontinence, severity, and quality of life related 

to incontinence, and objective instrumental evidence of leakage inconsistently within and across 

the studies.The prevalence of stress (68.9 percent) was higher than the prevalence of any UI 

(45.5 percent) in the one report.122 The Women's Health In the Lund Area study reported an 

increase in self-reported UI from 32 percent to an estimated 66 percent when the authors 

removed the restriction that the UI had to represent hygienic bother.131 Another study estimated 

20 cases of stress UI but 89 women answered positively to the question of urine leakges during 

coughing or sneezing.61 Ratings of success including improvement in incontinence and in 

quality of life by doctors and patients were also different.484 Objective measures of UI showed 

random changes in most RCTs. The objective improvements in selected physiological measures 

were not consistent after the same interventions and did not correlate with self-reported 
325 

continence and reduction in severity of UI.322,330,485-491 A small proportion of RCTs reported 

significant improvements in quality of life284 and social adaptation288,299 after behavioral 

interventions. Severity of UI and discomfort due to UI were reduced after pelvic floor muscle 

training with biofeedback in one RCT.729 One RCT of a complex behavioral program supervised 

by nurse advisors and a consulting urogynecologist demonstrated improvement in quality of life 

using several scales.510 Sacrocolpopexy with Burch colposuspension compared to other active 

treatments resulted in a small improvement in medical, epidemiological, and social aspects of 

aging scores for stress incontinence761 and overall quality of life.353 The effects of treatments on 

quantitative measures of incontinence, including frequency and amount of leakage, were less 

compared to qualitative improvements in symptoms. 

 Other systematic reviews analyzed predominantly self-reported cure and improvement in UI, 

omitting objective measures of incontinence.492-494 One review of two clinical trials with 

urodynamic tests concluded that the data is not sufficient to propose this invasive and costly 

testing as a measure of success.495 

 Previous reviews did not find anal manometry a good measure of success in reducing FI.496-

500 Anal manometry showed random changes between active and control 

interventions.372,375,376,403,501-503 Improvement in self-reported FI was inconsistent with changes in 

anal manometry.373,376,378,503 Few trials demonstrated the same direction and effect of treatment 

on improvement in FI and objective measures of FI.372 Composite outcomes, including both selfreported changes in severity of incontinence and physiologic parameters in a common scale may 

offer a better choice to measure success of clinical interventions.504,505

Clinical Effectiveness to Reduce the Risk of Incontinence

Primary Prevention

 Few studies that reported inclusion of continent women at baseline also reported baseline 

urinary leakage243,244 or previous surgery for UI in some participants;761 only two RCTs excluded 

patients with a positive stress test.321,322 The RCTs with primary prevention of incontinence did 

not always assess the continence status of the subjects at baseline and therefore, they cannot 

provide valid estimations of the preventive effects of the treatments. In many cases baseline 

conditions (prostate diseases in males and pregnancy in females), as well as examined 

interventions including delivery modes or prostate surgery, were associated with higher risks of 

incontinence. Without objective assessment of baseline incontinence we assumed that some of 

the participants may have had incontinence at baseline. To avoid bias at baseline status, we 

reviewed RCTs that equally distributed patients with diagnosed or undiagnosed (not reported in 

the articles) incontinence between active and control groups and thus provide valid estimates of 

the treatment effects. We also emphasized the effects of the treatments on continence, where 

continence was a well defined outcome and there was a clear goal to reduce the risk of 

incontinence in patients with either diagnosed or undetected (and hence not reported) 

incontinence. 

 Many surgical interventions reviewed here aimed to treat baseline conditions, including 

rectal cancer, anal fissures, ulcerative colitis, and hemorrhoids, reported incontinence as a 

secondary outcome to complications of surgery. We focused on the continence status only, rather 

than the primary therapeutic outcomes and surgical complications previously analyzed.557,939,940

Therefore, we had to estimate the relative benefits attributable to these surgical procedures on 
326 

reducing the risk of incontinence and improving quality of life. All clinically relevant outcomes 

should be taken into account when comparing the effectiveness of surgical procedures to treat 

cancer and other baseline diseases. 

Secondary Prevention

Clinical effectiveness to reduce the risk of incontinence included self-managed behavioral 

changes (especially pelvic floor muscle exercises), physiotherapy, pharmacological 

administration, use of medical devices, and surgery for UI and FI. Considerable variations in 

dose and length of interventions and followup periods and modifications of surgical techniques 

made overall comparisons across trials difficult and imprecise. The present report found a 

significant increase in continence after pelvic floor muscle training by 250 percent (RR 2.5, 95 

percent CI 1.2; 5.3). Substantial heterogeneity between RCTs of biofeedback assisted pelvic 

floor muscle training and pelvic floor muscle training combined with bladder training was 

demonstrated in both the present and previous reviews.539,552 Implemented behavioral changes 

did not show significant improvement in UI among residents in LTC settings in the analyzed 

trials and in previous assessments.528,529 

 Despite substantial heterogeneity among studies, attributable benefit for public health can be 

estimated from individual RCTs. Compared to regular care, behavioral interventions could avoid 

170-749 cases of stress UI per 1,000 treated.249,288 Weight reduction would result in improved 

stress UI in 990 adults per 1,000 treated.714 Intensive lifestyle changes would avoid 54 cases of 

stress UI per 1,000 treated.245 Intensive supervised pelvic floor muscle training among pregnant 

women would prevent 390 cases of UI per 1,000 treated.246

 The largest attributable benefit on stress UI was demonstrated from small RCTs of 40-127 

participants (Table 64). The effect size of pelvic floor muscle training on continence was smaller 

but still significantly better compared to usual care in the pooled analysis. The Cochrane 

systematic review reported better effects from pelvic floor muscle training on cure from single 

studies with no overall estimation.539

 This report confirms previous reviews of consistent significant benefits on female stress UI 

of laparoscopic and open colposuspension,492,494,535 but inconsistent effects from containment 

products or mechanical devices to prevent urine leakage 493,941 and suburethral slings.343,546

Future research may demonstrate more valid estimation of long-term benefits and harms after 

invasive treatments compared to early behavioral interventions when incontinence is minimal 

and does not affect the quality of life. We also attempted to review clinical interventions that 

could achieve total urinary continence (free from stress and urge UI) (Table 61). Limited 

evidence suggested that tension free vaginal tapes,328,340,770 sling procedures,334,342 and local 

estrogen therapy368 can result in comparable benefits to colposuspension continence rates.486,775

Not surprisingly, behavioral interventions provided the largest number of avoided cases of UI per 

1,000 treated (Table 64). The role of early behavioral interventions to reduce the risk of 

incontinence in community dwelling adults has been intensively discussed in the medical 

literature.483,942

 The role of self-motivation to manage UI was beyond the scope of this review; however, 

some evidence suggests that individualized focus group interviews,943 self-confidence in 

treatment benefits944 and personal efficacy945 may be associated with better outcomes. 

 We uncovered few well-designed RCTs among case series of clinical interventions for FI 

that demonstrated significant improvements, with conclusions similar to previous systematic 
327 

analyses of evidence.496-500,549-557 Conservative management of FI was effective in LTC.233-235

Limited evidence suggests possible benefits from anal sphincter exercises and biofeedback 

therapy for women with obstetrically related FI.497 Very few pharmacological interventions378-380

resulted in fecal continence in more than 50 percent of patients and were not statistically better 

than placebo378,379or surgery.380 Chemical sphincterotomy in patients with chronic anal 

fissure404,405 resulted in a 100 percent continence rate. Different delivery modes and surgical 

techniques to repair obstetric anal sphincter lacerations demonstrated low clinical efficacy and 

comparable effectiveness. Surgeries for rectal prolapse achieved fecal continence in 40-56 

percent with no significant differences between treatments.413,414 The effect size of surgical 

procedures to treat FI varied depending on the definition of FI and baseline cause and severity of 

FI with no good evidence of the superior effectiveness of alternative surgical procedures.945

Future well-designed research is necessary to examine surgical treatments of FI in different 

population groups.496

Strength of the Evidence 

Studies of diagnostic methods had the lowest quality with few RCTs conducted.437,462,506,507

Large-population-based surveys reported prevalence of incontinence in age, gender, and race 

subgroups.8,9,50,67,508 The independent contribution of risk factors on UI and FI were analyzed 

with adjusted odds ratios in cross-sectional and retrospective cohort studies. Care must be taken 

to distinguish associations from actual risks. Moreover, many of the risks are immutable (e.g., 

age and gender) The temporality between these diseases and UI can be estimated from 

prospective cohort studies measuring the incidence of UI. Such studies have not yet been 

conducted. Observational studies cannot establish causality between comorbidities and UI. 

Adjusted odds ratio estimated probability of having incontinence among people with particular 

diseases compared to those without such diseases. The estimations are still valuable because they 

identify subgroups at higher probability of UI. However, multivariate models included different 

sets of risk factors. Since causality between risk factors and incontinence could not be 

determined from such studies, and the majority of risk factors are not modifiable, we hesitated to 

estimate events attributable to risk factors. 

 Efficacy and comparative effectiveness of clinical interventions to reduce the risk and 

progression of incontinence were analyzed from 365 RCTs. The quality of the RCTs was 

evaluated in terms of the preplanned intention to treat principle, masking of the treatment status, 

adequate allocation concealment, randomization scheme and adequacy, and justification for 

sample size. The majority of the RCTs showed good quality; did not exclude subjects from the 

analysis of the outcomes, and provided adequate randomization. However, allocation 

concealment was not adequate in a large proportion of RCTs.258,261,266,277,286,372,375,376,502,509-512

The RCTs of interventions that are regulated by the FDA, including hormone replacement 

therapy, had the best quality.240,245,253,304,365,366,389,513,514 Large RCTs, including the Diabetes 

Prevention Program,245 complex conservative management of UI,240 delivery management,388,389

and early prevention of UI in postnatal care253 had high quality. 

 RCTs remain a “gold standard” to establish causality of the treatments on the outcomes. 

Inadequate randomization and allocation concealment, exclusion of subjects from the analysis, 

and inadequate power to detect differences all threaten the validity of the results and waste time 

and resources. Central randomization, randomization of the clinics rather than patients, adequate 

allocation concealment, and preplanned intention to treat analysis are possible for all tested 
328 

treatments. Variations in populations, interventions, and measures of outcomes, rather than 

quality of RCTs, resulted in heterogeneity between studies. 

 We did not include case series that described the experience of individual institutions to treat 

UI and FI (Chapter 25).21 Such publications may be useful to generate hypotheses for welldesigned trials but have poor internal and external validity and do not provide good evidence 

about comparative effectiveness of different treatments. 

Policy Implications 

 Public awareness of incontinence, its risk factors, and possible treatment options may reduce 

the burden on incontinence. The behavioral risk factor surveillance system may assess 

prevalence and annual incidence of incontinence in large nationally representative population 

groups. Routinely collected clinical history should include evaluation of the risk factors, 

symptoms, and signs of incontinence. Pregnant, obese, and aging women, males with prostate 

diseases, patients with vaginal and rectal prolapse, and frail elderly should be actively screened 

for incontinence. Quality indicators for nursing homes, including access to toilets and wet status 

of the residents, should be continuously monitored and analyzed. Instrumental methods, 

including multichannel urodynamics and anal manometry, cannot be recommended as outcomes 

to examine effectiveness of clinical interventions on incontinence. Early behavioral changes in 

weight, physical activity, and pelvic floor muscle training may reduce the incidence of 

incontinence in adults. Preventive strategies might include assessment and reduction of 

modifiable risk factors in early stages of incontinence when incontinence is minimal and does 

not affect the quality of life. 

Question 5. What are the Research Priorities for Identifying 

Effective Strategies to Reduce the Burden of Illness in these 

Conditions? 

 Future research should examine the reproducibility of effective clinical interventions, 

including local estrogen therapy, weight reduction combined with increased physical activity, 

individualized electrical and magnetic stimulation, sphincteric stents, penile compression 

devices, and artificial bowel sphincter. Several of these interventions are being tested in ongoing 

clinical trials registered in www.clinicaltrials.gov (Table 76). Consistency in long-term results 

would provide a better basis for clinical and policy decisions. 

 Further investigation is needed on the long-term curative effects of self-reported continence 

of combined behavioral and drug therapies on clinical outcomes at 6 months or more followup 

rather than surrogate tests. The balance between the curative effects of surgical procedures for 

incontinence and adverse effects and costs should be further examined in well-designed RCTs. 

Administrative databases can provide useful information on comparative treatment effectiveness, 

but the results can be biased if provider characteristics are ignored. 

 The effectiveness of clinical interventions should be tested in subgroups of patients by race, 

comorbidities and concomitant treatments, and baseline functional conditions of the pelvic floor, 

including trauma and pelvic floor muscle strength. Better preplanned randomization schemes 

could yield sufficient numbers of patients among treatment groups to support subgroup analysis 

that would give valid estimations of treatment effects in different patient populations. The choice 
329 

of outcomes should reflect patient perception of cure and quality of life rather than solely 

provider evaluation and instrumental testing. 

 The effects of early behavioral interventions in high risk populations on incidence of 

incontinence should be examined in well-designed RCTs. Pregnant and pre-menopausal 

continent women should be the target population for future preventive RCTs of complex lifestyle 

modification. The large proportion of incontinent adults who do not seek care requires changes 

in the public perception of incontinence as an embarrassing condition with no cure.946-949 Clinical 

examination of pregnant women should include assessment of continence status. Pregnancy and 

postpartum care should include a quality indicator for continence evaluation. Continence service 

should be a quality indicator for health care during pregnancy and postpartum. Early detection of 

incontinence in annual population-based surveys (the Behavioral Risk Factor Surveillance 

System) may improve public awareness of incontinence. Several ongoing studies will test 

different diagnostic strategies to detect incontinence (Table 77). 

 The pathophysiology of incontinence needs further investigation to develop effective 

preventive and curative treatments. Muscle-derived stem cells showed promising results in 

animal and in vivo studies.950,951 Injections of myoblasts to bladder walls resulted in regeneration 

of myofibers and improved contractility.952 Recombinant human insulin-like growth factor-I 

delivered with plasmid to denervated sphincter muscle improved recovery of sphincter function 

in animal models.953 Gene transfer therapy with hMaxi-K was successfully tested in one Phase I 

clinical trial.954 Another ongoing trial in patients with overactive bladder will examine the effects 

of gene therapy of the alpha subunit of the human smooth muscle Maxi-K channel 

(NCT00495053). Continence devices that work on demand, similar to cardiac pacemakers, may 

be developed in the future to prevent involuntary leakage of urine and feces. 

 An important continuing and unresolved problem is defining what is meant by either type of 

incontinence. The failure to resolve this issue impedes both prevalence and diagnostic and 

efficacy research. The inconsistencies between patient reports and physiological measures 

continue to pose a serious problem. For efficacy studies, some combined measure might be 

applied, but for prevalence assessments, such an approach would pose serious logistical 

problems. The differences are even more severe when one considers the implications of 

differences in utility weights applied to measures of incontinence between patients and 

clinicians.484,515

 The pressures for finding effective treatments have increased as a result of advertising of 

medications to treat UI that is directed to patients. Expectations have been raised. The need for 

more and better studies of treatments for both types of incontinence (UI and FI) remains. Given 

the social problems caused by incontinence, enthusiasm for surgical treatment remains high for 

treating both UI and FI,955-957 although future research is needed to examine the balance between 

benefits and harms related to surgery and the cost-effectiveness of surgical treatments compared 

to conservative preventive interventions. 

 Managing both types of incontinence in LTC settings remains problematic. Programs that 

work under experimental conditions have not been sustained because they are labor intensive and 

essentially unreimbursed. Indeed, case mix based payments for nursing homes create a 

disincentive to manage incontinence. 

 Several other specific areas have been identified as needing more research. They include: 

• Interaction between age, race, and other risk factors for UI and FI in women and men 

• Effective strategies to prevent UI in women and men in community and LTC settings 

• Effective interventions to reduce risk of institutionalization due to UI or FI. 
330 

• Association between race and severity of FI and quality of life related to FI in men and 

women from the community and in LTC settings 

• Strategies to reduce the risk of FI related to pregnancy and childbirth 

• Effectiveness of clinical interventions for incontinence across subgroups by cognitive and 

physical functioning, gender, and ethnicity 

• Long-term effectiveness of individual conservative therapies, conservative management 

programs including community-based nonmedical interventions, and mechanical devices 

for UI and FI 

• Comparative long-term effectiveness of conservative interventions, pharmacological 

interventions, combined conservative and pharmacological interventions, mechanical 

devices, and surgery for UI 

• Individual patient factors that may modify the effects of different procedures 

• Effects on FI of surgeries for hemorrhoids, rectal prolapse, rectal cancer, and anal fissures 

• Cost-effective strategies to identify patients at risk of FI, including residents of LTC 

settings 

• Long-term effects of conservative management programs for FI in community dwelling 

adults and residents of LTC settings 
331 

Table 76. Ongoing clinical trials of the interventions for incontinence (registered in www.clinicaltrials.gov) 

Sponsors Clinical 

trials.gov 

Identifier

Incontinence Intervention Arms 

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 

00212264 Postprostatectomy 

UI 

Behavioral: behavior training 

Device: biofeedback Device: pelvic floor 

electrical stimulation 

Department of Veterans Affairs 

00292318 FI Behavioral: biofeedback 

University of Pittsburgh 

00177541 Urge UI Behavioral: biofeedback, 

pelvic floor muscle training 

University of Michigan 

00125177 Stress UI Behavioral: knack therapy 

NHS Health Technology Assessment Programme 

00237029 UI after treatments 

for PC 

Behavioral: pelvic floor muscle training 

Behavioral: bladder training 

Device: biofeedback 

Norwegian Foundation for Health and Rehabilitation 

00271297 Pelvic organ 

prolapse 

Behavioral: pelvic floor muscle training 

National Institute of Child Health and Human Development (NICHD) 

00270998 UI Behavioral: pelvic muscle 

training and exercises 

Device: intravaginal incontinence pessary 

Device: both pessary and pelvic muscle exercises 

University of British Columbia 

00323245 UI Behavioral: physiotherapy 

for urinary incontinence 

Norwegian Fund for Postgraduate Training in Physiotherapy 

00476567 Pregnancy-related 

diseases and complications during labor 

Behavioral: regular exercise 45-60 minutes minimum three times per week 

Hospices Civils de Lyon 

00387439 AI Behavioral: standard 

medical treatment + anoperineal physiotherapy 

Behavioral: standard medical treatment 

Queen's University 00427778 Stress UI Device: incontinence ring 

(Milex) 

Solace Therapeutics, Inc. 

00492596 Stress UI Device: AttenueX 

IntraVesical System 

 
Table 76. Ongoing clinical trials of the interventions for incontinence (registered in www.clinicaltrials.gov) (continued) 

332 

Sponsors Clinical 

trials.gov 

Identifier

Incontinence Intervention Arms 

Contura 00333073 UI Device: Bulkamid - 

bulking agent 

Ethicon, Inc. 00453739 Stress UI Device: GYNECARE 

TVT-SECUR* System 

Device: GYNECARE TVT* System 

Device: GYNECARE TVT* Obturator System 

William Beaumont Hospitals 

00441935 UI Device: InterStim 

Neuromodulation 

CL Medical 00442078 UI Device: I-STOP TOMS Device: transobturator 

male sling 

 

Department of Veterans Affairs 

00345397 FI in SCI Device: percutaneous 

endoscopic colostomy tube 

The Cleveland Clinic 

00475839 Stress UI Device: tension-free 

vaginal tape 

 Device: Monarc 

subfascial hammock 

Austrian Urogynecology Working Group (AUWG) 

00441454 UI Device: tension-free 

vaginal tape (retropubic vs. transobturator) 

South Glasgow University Hospitals NHS Trust 

00136071 Stress UI Device: transobturator 

tape-ARIS 

Device: TVT-O 

National Institute of Child Health and Human Development (NICHD) 

00460434 Pelvic organ 

prolapse 

Device: TVT 

Uroplasty, Inc 00448175 Overactive bladder Device: urgent PC Medstar Research Institute 

00475540 Pelvic organ 

prolapse 

Device: vaginal mesh 

Cellerix 00475410 Anal fistula Drug: autologous 

adipose-derived stem cells (Cx 401) 

 

Urological Sciences Research Foundation 

00479596 Overactive bladder Drug: Botox 

National Institutes of Health (NIH) 

00178191 UI Drug: botulinum A toxin 

Allergan 00168454 Overactive bladder 

UI 

Drug: botulinum toxin type A 

Drug: placebo 

Allergan 00439140 Overactive bladder Drug: botulinum toxin type 

A 

 
Table 76. Ongoing clinical trials of the interventions for incontinence (registered in www.clinicaltrials.gov) (continued) 

333 

Sponsors Clinical 

trials.gov 

Identifier

Incontinence Intervention Arms 

Allergan 00311376 Overactive bladder Drug: botulinum toxin type 

A 

 

Allergan 00461292 Overactive bladder Drug: botulinum toxin type 

A 

 

University of Rochester 

00345332 Severe urge UI Drug: botulinum-A toxin 

Department of Veterans Affairs 

00223821 UI Drug: extended release 

oxybutynin chloride 

Behavioral: behavior training 

Asset Hospital Systems 

00498888 Urge UI Drug: tolterodine Procedure: bladder 

training 

Procedure: pelvic floor rehabilitation 

Ion Channel Innovations 

00495053 Overactive bladder Gene Transfer: hMaxi-K 

University of Pittsburgh 

00177450 UI Procedure: acupuncture 

National Center for Complementary and Alternative Medicine (NCCAM) 

00297427 UI Procedure: acupuncture 

University Hospital of North Norway 

00303030 FI Procedure: anal injection 

of bulking agent 

Procedure: biofeedback 

The Cleveland Clinic 

00485355 Hysterectomy for 

benign indications 

Procedure: conventional laparoscopic hysterectomy 

Procedure: robotic assisted laparoscopic hysterectomy 

National Cancer Institute (NCI) 

00238381 Colorectal cancer Procedure: conventional 

surgery 

Procedure: laparoscopic surgery 

Procedure: surgery 

University Hospital, Rouen 

00213317 FI Procedure: cortical and 

lumbar-sacral magnetic stimulation 

National Taiwan University Hospital 

00270738 UI Procedure: indirect 

training of the pelvic floor muscles via transversus abdominis 

Central Carolina Surgery, PA 

00329862 UI after 

laparoscopic adjustable gastric banding for morbid obesity 

Procedure: laparoscopic truncal vagotomy 

William Beaumont Hospitals 

00378664 UI in SCI Procedure: lumbar to 

sacral ventral nerve rerouting procedure 

 
Table 76. Ongoing clinical trials of the interventions for incontinence (registered in www.clinicaltrials.gov) (continued) 

334 

Sponsors Clinical 

trials.gov 

Identifier

Incontinence Intervention Arms 

Canadian Institutes of Health Research (CIHR) 

00187369 Multiple pregnancy Procedure: method of 

delivery (CS versus VB) 

William Beaumont Hospitals 

00444730 UI in PC Procedure: radical 

prostatectomy 

Procedure: interstim implantation 

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 

00325039 UI Procedure: retropubic 

mid-urethral sling (TVT) 

Procedure: transobturator mid-urethral sling (TVT-O and the Monarc) 

 

Assistance Publique - Hôpitaux de Paris 

00472069 UI Procedure: 

transplantation of the squeletic muscular cells 

Procedure: surgery Procedure: relation of 

the continence urinary 

University of Calgary 

00234754 Stress UI Procedure: trans-vaginal 

tape, trans-obturator tape

Assistance Publique - Hôpitaux de Paris 

00231491 Overactive bladder 

(OAB) 

Drug: botulinum toxin A (Botox) 

 

Women's Health Clinical Research Center at the University of California, San Francisco 

 UI PRIDE (Program to 

Reduce Incontinence by Diet and Exercise) Diet, exercise, and weight loss 

Regular care 

University of Rochester 

00345332 Severe urge UI Drug: botulinum-A toxin Placebo 

Avera Pharmaceuticals 

NCT00335660 

Overactive bladder Drug: AV608, a 

neurokinin 1 (NK-1) antagonist 

Placebo 

GlaxoSmithKline 00321477 Overactive bladder Drug: GW679769 Placebo University of L'Aquila 

00441428 Overactive bladder 

and detrusor underactivity 

Drug: solifenacin Uncontrolled 

University of Alabama at Birmingham 

00465894 Overactive bladder 

postmenopausal 

Drug: Detrol LA Drug: estrace vaginal 

cream 
335 

Table 77. Ongoing studies of diagnosis of incontinence 

Sponsor Clinicaltrials.

gov Identifier 

Condition Examined Strategy 

Rambam Health 

Care Campus 

00437528 Overactive bladder without 

incontinence, urge incontinence 

and voiding difficulties 

Novel heat flow sensor unit for measuring 

urinary bladder capacity 

Hospital de Clinicas 

de Porto Alegre 

00490438 Before and after surgeries for UI Measurement of vaginal squeeze 

pressure in incontinent patients 

Tripler Army 

Medical Center 

00355433 Non-pregnant females referred to 

the urogynecology clinic for 

bladder testing 

Body and room temperature saline in 

urodynamics 

Pfizer 00481728 Sympathetic skin response or 

heart rate variability as an 

objective biomarker of bladder 

sensation 

Bladder sensation and changes in skin 

electrical conductance and heart rate 

337 

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List of Acronyms/Abbreviations 

ADL Activities of daily living 

AI Anal incontinence 

BMI Body mass index 

CI Confidence interval 

COPD Chronic obstructive pulmonary disease 

EMG Electromyography 

FI Fecal incontinence 

FIQL Fecal incontinence quality of life 

GI Gastrointestinal 

IBD Inflammatory bowel disease 

IBS Irritable bowel syndrome 

ICI International consultation on incontinence 

ICS International Continence Society 

LTC Long-term care 

MDS Minimum data set 

MMSE Mini mental state examination 

PPV Positive predictive value 

RCT Randomized controlled trial 

RR Relative risk 

SNRI Serotonin norephinephine reuptake inhibitors 

SSRI Selective serotonin reuptake inhibitors 

SUIQQ Stress and urge incontinence and quality of life questionnaire 

TEP Technical expert panel 

UI Urinary incontinence 

UISS Urinary incontinence severity score 
A-1 

Appendix A. Analytic Framework 

Appendix D contains details on analytical framework of the report: algorithm to define eligibility 

of the studies, definitions, hypotheses, and statistical models. 

Conceptual and operational definitions of incontinence and risk factors of incontinence are 

presented below. 

Conceptual Definitions 

Fecal Incontinence—failure of voluntary control of the anal sphincters, with involuntary passage 

of feces and flatus (solid and liquid) and flatus1

Urinary Incontinence—complaint of any involuntary leakage of urine2

Urge urinary incontinence—involuntary urine leakage accompanied by or immediate preceded 

by urgency, usually related to the involuntary contractions of the detrusor muscle of the bladder 

(detrusor overactivity)2

Stress Urinary Incontinence—involuntary urine leakage as a result of physical effort or exertion 

that increases abdominal pressure on the urinary bladder in the absence of detrusor contraction 2

Table 1. Operational definitions of incontinence 

Variable Definition 

Symptoms of Urinary 

incontinence2

Signs of urinary 

Incontinence. 

Extra-urethral incontinence 

Uncategorized 

incontinence 

The complaint of any involuntary leakage of urine. 

Urine leakage seen during examination: this may be urethral or extraurethral. 

The observation of urine leakage through channels other than the urethra. 

The observation of involuntary leakage that cannot be classified into one of the above 

categories on the basis of signs and symptoms 

Transient urinary 

incontinence3,4 A potentially reversible incontinence due to conditions that may resolve if the 

underlying cause is managed. These conditions include: delirium/confusional state; 

infection—urinary (symptomatic); atrophic urethritis/vaginitis; pharmaceuticals use; 

psychological conditions, especially depression; excessive urine output (e.g., CHF, 

hyperglycemia); restricted mobility; stool impaction 

Established urinary 

incontinence3,4 Urinary incontinence that is attributed to bladder or urethral dysfunction such as: 

detrusor overactivity; detrusor underactivity; urethral obstruction; urethral 

incompetence 

Stress urinary incontinence Complaint of involuntary urine leakage on effort or exertion, or in sneezing or 

coughing 

Urge urinary incontinence Complaint of involuntary leakage accompanied by or immediately preceded by 

urgency 

Overflow incontinence 5 Urinary incontinence associated with: bladder overdistention; a contractile detrusor; 

hypotonic or underactive detrusor secondary to drugs, fecal impaction, diabetes, 

lower spinal cord injury, or disruption of the motor innervation of the detrusor muscle

Mixed urinary 

incontinence2,6

Situational urinary 

incontinence 

The complaint of involuntary leakage associated with urgency and also with exertion, 

effort, sneezing, or coughing 

The report of incontinence during sexual intercourse, or giggle incontinence. 
A-2 

Variable Definition 

Continuous urinary leakage Complaint of continuous urinary leakage 

Acute incontinence7

Chronic incontinence 

Sudden onset of symptoms related to an illness, treatment, or medication 

Persistent urinary incontinence includes disorders of storage (stress and urge), 

disorder of emptying (overflow), and functional and mixed incontinence. 

Severity of incontinence Incontinent episodes/unit time; pad changes/unit time; pad weight/unit time; number 

of micturitions/unit time; urinary pad test—measured loss; urodynamic-diagnosed 

detrusor overactivity; urodynamic stress incontinence 

Sandvik’s severity index8

Slight incontinence 

Moderate incontinence 

Severe incontinence 

Multiplied reported frequency (4 levels) by the amount of leakage (2 levels). 

Leakage of drops a few times a month (~6g/24 hours, 95%CI 2-9) 

Daily leakage or drops (~17g/24 hours, 95%CI 13-22) 

Leakage of large amount of urine at least once a week (~56g/24 hours, 95%CI 44-67) 

Impact of incontinence 

Impact of incontinence on 

quality of life 

Actions patients have taken to ameliorate the incontinence including wearing pads, 

reducing activities, seeking medical treatment (visits to clinicians, prescriptions of 

medications, surgical procedures). 

Measurement using a validated generic or condition-specific measure of quality of life 

developed to address issues related specifically to fecal incontinence or urinary 

incontinence 

Remission of incontinence 

Contained Incontinence 

Dependent Continence 

Independent Continence 

Diminution of symptoms and signs of incontinence. 

Urine contained with pads or appliances 

Dry with toileting assistance, behavioral treatment, and/pr medications 

Dry, not dependent on ongoing treatment 

Symptoms of 

Incontinence2,6

Signs of Incontinence 

Urodynamic observations 

The subjective indicator of incontinence or change in its severity as perceived by the 

patient, caregiver, or partner and may lead him/her to seek help from health care 

professionals. 

Observed by the physician including simple means, to verify symptoms and quantify 

them. 

Observations made during urodynamic studies which have a number of possible 

underlying causes and do not represent a definitive diagnosis of a disease. 

Measures of the frequency, severity and impact of urinary incontinence2

Micturition time chart 

Frequency volume chart 

(FVC) 

Bladder diary 

Daytime frequency 

24-hour frequency 

24-hour production 

Maximum voided volume 

Pelvic floor muscle function 

Pad testing 

Records of times of micturitions, day and night, for at least 24 hours. 

Records of volumes voided as well as the time of each micturition, day and night, for 

at least 24 hours. 

Records of times of micturitions and voided volumes, incontinence episodes, pad 

usage, and other information such as fluid intake, the degree of urgency, and the 

degree of incontinence. 

The number of voids recorded during waking hours and includes the last void before 

sleep and the first void after waking and rising in the morning. 

The total number of daytime voids and episodes of nocturia during a specified 24-

hour period 

All urine produced during 24 hours 

The largest volume of urine voided during a single micturition and is determined either 

from the frequency/volume chart or bladder diary. 

Measured during rectal examination by the tone at rest and the strength of a voluntary 

contraction, as strong, weak or absent. A pelvic muscle contraction may be 

assessed by visual inspection, by palpation, electromyography, or perineometry. 

Factors to be assessed include strength, duration, displacement, and repeatability 

The amount of urine lost during incontinence episodes (a short provocative test to a 

24-hour pad test) 

Improvement in 

incontinence 

Progression of 

incontinence 

Reduction frequency and severity of incontinence episodes. Reduction in restrictions 

of daily activities due to incontinence. 

Increase in frequency and severity of incontinence episodes. Increase in restrictions 

of daily activities due to incontinence. Failure of achieve continence. Failure to 

reduce frequency and severity of incontinent episodes. 
A-3 

Variable Definition 

Urodynamic Techniques2,9-11

Conventional urodynamic 

studies 

Ambulatory urodynamic 

studies 

Intravesical pressure 

Abdominal pressure 

Detrusor pressure 

Urodynamic laboratory measurement of artificial bladder filling—filling the bladder, via 

a catheter, with a specified liquid at a specified rate. 

A functional test of the lower urinary tract, utilizing natural filling (the bladder is filled 

by the production of urine rather than by an artificial medium), and reproducing the 

subject’s every day activities 

The pressure within the bladder 

The pressure surrounding the bladder. In current practice it is estimated from rectal, 

vaginal or, less commonly, from extraperitoneal pressure or a bowel stoma. The 

simultaneous measurement of abdominal pressure is essential for the interpretation 

of the intravesical pressure trace. 

The component of intravesical pressure that is created by forces in the bladder wall 

(passive and active). It is estimated by subtracting abdominal pressure from 

intravesical pressure. 

Filling cystometry 

Bladder function during 

filling. 

Physiological filling rate 

Nonphysiological filling rate 

Bladder storage function 

Normal bladder sensation 

First sensation of bladder 

filling 

First desire to void 

Strong desire to void 

Increased bladder 

sensation 

Reduced bladder sensation 

Absent bladder sensation 

Bladder pain 

Urgency 

The vesical/urethral 

sensory threshold 

Normal detrusor function 

Detrusor overactivity 

Phasic detrusor 

overactivity 

Terminal detrusor 

overactivity 

Detrusor overactivity 

incontinence 

Neurogenic detrusor 

overactivity 

Idiopathic detrusor 

overactivity 

Provocative maneuvers 

Urodynamic investigation of the filling phase of the micturition cycle. The method by 

which the pressure/volume relationship of the bladder is measured during bladder 

filling 

The rate at which the bladder is filled. 

A filling rate less than the predicted maximum – predicted maximum body weight in 

kg divided by 4 expressed as ml/min 

A filling rate greater than the predicted maximum filling rate –predicted maximum 

body weight in kg divided by 4 expressed as ml/min. 

Bladder sensation, detrusor activity, bladder compliance, and bladder capacity. 

Sensation judged by three defined points noted during filling cystometry and 

evaluated in relation to the bladder volume at that moment and in relation to the 

patient’s symptomatic complaints. 

The feeling the patient has, during filling cystometry, when he/she first becomes 

aware of the bladder filling. 

The feeling, during filling cystometry that would lead the patient to pass urine at the 

next convenient moment, but voiding can be delayed if necessary. 

Persistent desire to void without the fear of leakage. 

An early first sensation of bladder filling (or an early desire to void) and/or an early 

strong desire to void, which occurs at low bladder volume and which persists. 

Diminished sensation throughout bladder filling. 

The absence of bladder sensation during filling cystometry. 

A self explanatory term and is an abnormal finding. 

A sudden compelling desire to void. 

The least current which consistently produces a sensation perceived by the subject 

during stimulation at the site under investigation. 

Bladder filling with little or no change in pressure. No involuntary phasic contractions 

occur despite provocation. 

An urodynamic observation characterized by involuntary detrusor contractions during 

the filling phase which may be spontaneous or provoked. 

Defined by a characteristic wave form and may or may not lead to urinary 

incontinence 

A single, involuntary detrusor contraction, occurring at cystometric capacity, which 

cannot be suppressed and results in incontinence usually resulting in bladder 

emptying (voiding). 

Incontinence due to an involuntary detrusor contraction. 

Detrusor overactivity caused by a relevant neurological condition. 

Detrusor overactivity with unknown cause. 

Techniques used during urodynamics in an effort to provoke detrusor overactivity; for 

example, rapid filling, use of cooled or acid medium, postural changes and hand 

washing. 
A-4 

Variable Definition 

Bladder compliance during filling 

Cystometry Description of the relationship between change in bladder volume and change in 

detrusor pressure; calculated by dividing the volume change (ΔV) by the change in 

detrusor pressure (Δpdet) during that change in bladder volume (C=V. Δpdet). It is 

expressed in ml/cm H2O. 

Two standard points: 

1. The detrusor pressure at the start of bladder filling and the corresponding bladder 

volume (usually zero) 

2. The detrusor pressure (and corresponding bladder volume) at cystometric capacity 

or immediately before the start of any detrusor contraction that causes significant 

leakage (and therefore causes the bladder volume to decrease, affecting 

compliance calculation). Both points are measured excluding any detrusor 

contraction. 

Bladder capacity during filling cystometry 

Cystometric capacity 

Maximum cystometric 

capacity 

Maximum anaesthetic 

bladder capacity 

The bladder volume at the end of the filling cystometrogram, when “permission to 

void” is usually given. The end point should be specified, for example, if filling is 

stopped when the patient has a normal desire to void. The cystometric capacity is 

the volume voided together with any residual urine. 

The volume at which the patient feels he/she can no longer delay micturition (has a 

strong desire to void). 

The volume to which the bladder can be filled under deep general or spinal anesthetic 

and should be qualified according to the type of anesthesia used and the speed, 

the length of time, and the pressure at which the bladder is filled. 

Urethral function during 

filling cystometry 

Normal urethral closure 

mechanism 

Incompetent urethral 

closure mechanism 

Urethral relaxation 

incontinence 

Urodynamic stress 

incontinence (genuine 

stress incontinence) 

The urethral closure mechanism during storage 

A positive urethral closure pressure during bladder filling even in the presence of 

increased abdominal pressure, although it may be overcome by detrusor 

overactivity. 

Patho-physiologic condition which allows leakage of urine in the absence of a 

detrusor contraction. 

A leakage due to urethral relaxation in the absence of raised abdominal pressure or 

detrusor overactivity. 

The involuntary leakage of urine during increased abdominal pressure, in the 

absence of a detrusor contraction 

Assessment of urethral function during filling cystometry 

Urethral pressure 

measurement 

The urethral pressure 

profile 

The urethral closure 

pressure profile 

Maximum urethral pressure 

Maximum urethral closure 

pressure (MUCP) 

Functional profile length 

Pressure “transmission” 

ratio 

Abdominal leak point 

pressure 

Detrusor leak point 

pressure 

The fluid pressure needed to just open a closed urethra. 

A graph indicating the intraluminal pressure along the length of the urethra 

Given by the subtraction of intravesical pressure from urethral pressure 

The maximum pressure of the measured profile. 

The maximum difference between the urethral pressure and the intravesical pressure. 

The length of the urethra along which the urethral pressure exceeds intravesical 

pressure in women. 

The increment in urethral pressure on stress as a percentage of the simultaneously 

recorded increment in intravesical pressure 

The intravesical pressure at which urine leakage occurs due to increased abdominal 

pressure in the absence of a detrusor contraction. 

The lowest detrusor pressure at which urine leakage occurs in the absence of either a 

detrusor contraction or increased abdominal pressure. 
A-5 

Variable Definition 

Pressure Flow Studies 

Urine flow 

Flow rate 

Voided volume 

Maximum flow rate 

Voiding time 

Flow time 

Average flow rate 

Time to maximum flow 

The method by which the relationship between pressure in the bladder and urine flow 

rate is measured during bladder emptying. 

Continuous, that is without interruption, or as intermittent urine flow, when an 

individual states that the flow stops and starts during a single visit to the bathroom 

in order to void. The continuous flow curve is defined as a smooth arc-shaped 

curve or fluctuating when there are multiple peaks during a period of continuous 

urine flow 

The volume of fluid expelled via the urethra per unit time expressed in ml/s 

The total volume expelled via the urethra 

The maximum measured value of the flow rate after correction for artifacts 

Total duration of micturition, i.e., includes interruptions. When voiding is completed 

without interruption, voiding time is equal to flow time 

The time over which measurable flow actually occurs. 

Voided volume divided by flow time. The average does not reflect flow interruptions or 

terminal dribble. 

The elapsed time from onset of flow to maximum flow. 

Pressure measurements during pressure flow studies (PFS) 

Premicturition pressure 

Opening pressure 

Opening time 

Maximum pressure 

Pressure at maximum flow 

Closing pressure 

Minimum voiding pressure 

Flow delay 

The pressure recorded immediately before the initial isovolumetric contraction. 

The pressure recorded at the onset of urine flow. 

The elapsed time from initial rise in detrusor pressure to onset of flow. 

The maximum value of the measured pressure 

The lowest pressure recorded at maximum measured flow rate. 

The pressure measured at the end of measured flow. 

The minimum pressure during measurable flow but is not necessarily equal to either 

the opening or closing pressures. 

The time delay between a change in bladder pressure and the corresponding change 

in measured flow rate. 

Detrusor function during voiding 

Normal detrusor function 

Detrusor underactivity 

Acontractile detrusor 

Post void residual (PVR) 

Allows bladder filling with little or no change in pressure. No involuntary phasic 

contractions occur despite provocation 

A contraction of reduced strength and/or duration, resulting in prolonged bladder 

emptying and/or a failure to achieve complete bladder emptying within a normal 

time span. 

No contractility can be detected during urodynamic studies. 

The volume of urine left in the bladder at the end of micturition 

Urethral function during voiding 

Normal urethra function 

Abnormal urethra function 

Bladder outlet obstruction 

Dysfunctional voiding 

Detrusor sphincter 

dyssynergia 

Non-relaxing urethral 

sphincter obstruction 

Urethra that opens and is continuously relaxed to allow the bladder to be emptied at a 

normal pressure. 

Obstruction to urethral overactivity or the urethra cannot open due to anatomic 

abnormality, such as an enlarged prostate or a urethral stricture 

Obstruction during voiding and is characterized by increased detrusor pressure and 

reduced urine flow rate diagnosed by studying the synchronous values of flow rate 

and detrusor pressure. 

An intermittent and/or fluctuating flow rate due to involuntary intermittent contractions 

of the periurethral striated muscle during voiding in neurologically normal 

individuals. 

A detrusor contraction concurrent with an involuntary contraction of the urethral 

and/or periurethral striated muscle. 

Non-relaxing, obstructing urethra resulting in reduced urine flow in individuals with a 

neurological lesion 

Long-term care—care over an extended period, usually for a chronic condition or disability, 

requiring periodic, intermittent, or continuous care 

Conceptual definition of race—continental population groups of individuals whose putative 

ancestry is from native continental populations based on similarities in physical appearance 

Conceptual definition of ethnicity—ethnic groups of people with a common cultural heritage that 

sets them apart from others in a variety of social relationships 
A-6 

Table 2. Operational definitions of patient race and ethnicity12

Variable Definition 

Race 

African Continental Ancestry Group 

Asian Continental Ancestry Group 

European Continental Ancestry Group 

Individuals whose ancestral origins are in the continent of Africa. 

Individuals whose ancestral origins are in the continent of Asia. 

Individuals whose ancestral origins are in the continent of Europe 

Ethnic Groups 

African Americans 

Arabs 

Asian Americans 

Hispanic Americans 

Persons living in the United States having origins in any of the black 

groups of Africa 

Members of a Semitic people inhabiting the Arabian peninsula or other 

countries of the Middle East and North Africa. The term may be used 

with reference to ancient, medieval, or modern ethnic or cultural 

groups 

Persons living in the United States having origins in any of the original 

peoples of the Far East, Southeast Asia, or the Indian subcontinent. 

Persons living in the United States of Mexican (Mexican Americans), 

Puerto Rican, Cuban, Central or South American, or other Spanish 

culture or origin. The concept does not include Brazilian Americans or 

Portuguese Americans. 

Conceptual definitions of risk factors12—aspects of personal behavior or lifestyle, environmental 

exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is 

known to be associated with urinary and fecal incontinence considered important to prevent 

incontinence. 

Prevalence of incontinence—probability of experiencing a symptom or having a disease within a 

defined population and at a defined time point.1,6 

Incidence—probability of developing incontinence under study during a defined time period, 

usually reported for one, two-, or five-year interval.1,6

Relative risk estimation of the magnitude of an association between exposure and a condition, 

indicates the likelihood of having the condition in the exposed group relative to those who are 

not exposed.1,6

Odds ratio is the odds for having a risk factor in persons with a condition divided by the odds 

among those without the condition1,6.

Table 3. Operational definitions of known risk factors of urinary and fecal incontinence 

Variable Definition 

Age 

Elderly 

Persons classified by age from birth to octogenarians and older 

 Age categories: 19-44 years; 45-64 years, 65+ years; 80 and over 

Aged- person 65 through 79 years of age; 80 and over 

Functional impairment (Frailty) 13 Combination of three or more of five factors: unintentional weight loss 

(10 pounds or more in a year); general feeling of exhaustion; 

weakness (as measured by grip strength); slow walking speed; low 

levels of physical activity. 

Prostate disorders3,4 Prostatic enlargement, urethral stricture, bladder neck contracture, or 

prostate cancer that may cause urethral obstruction 

Pregnancy12 The status during which female mammals carry their developing young 

embryos, or fetuses in uteri before birth, beginning from fertilization to 

birth 

Postpartum period In females, 4 weeks after giving birth 
A-7 

Variable Definition 

Menopause The last menstrual period. Permanent cessation of menses usually 

defined after 6 to 12 months of amenorrhea in a woman over 45 

years of age. 

Institutionalization Caring for individuals in institutions and their adaptation to routines 

characteristic of the institutional environment, and/or their loss of 

adaptation to life outside the institution. 

Dementia An acquired organic mental disorder with loss of intellectual abilities of 

sufficient severity to interfere with social or occupational functioning. 

The dysfunction is multifaceted and involves memory, behavior, 

personality, judgment, attention, spatial relations, language, abstract 

thought, and other executive functions. The intellectual decline is 

usually progressive, and initially spares the level of consciousness. 

Depression 

Depressive disorder 

Depression, postpartum 

Depressive disorder, major 

Depressive states usually of moderate intensity in contrast with major 

depression present in neurotic and psychotic disorders 

An affective disorder manifested by either a dysphoric mood or loss of 

interest or pleasure in usual activities. The mood disturbance is 

prominent and relatively persistent. 

Depression in postpartum women, usually within four weeks after giving 

birth. The degree of depression ranges from mild transient 

depression to neurotic or psychotic depressive disorders 

Marked depression appearing in the involution period and characterized 

by hallucinations, delusions, paranoia, and agitation 

Psychiatric disorders Psychiatric illness or diseases manifested by breakdowns in the 

adaptational process expressed primarily as abnormalities of thought, 

feeling, and behavior producing either distress or impairment of 

function 

Diabetes 

Diabetes mellitus, Type 2 

Diabetes mellitus, Type 1 

A heterogeneous group of disorders characterized by hyperglycemia 

and glucose intolerance 

A subclass of diabetes that is not Insulin-responsive or dependent 

(NIDDM). It is characterized initially by insulin resistance and 

hyperinsulinemia; and eventually by glucose intolerance; 

hyperglycemia and overt diabetes. Patients often exhibit obesity 

A subtype of diabetes mellitus that is characterized by Insulin 

deficiency. It is manifested by the sudden onset of severe 

hyperglycemia, rapid progression to diabetic ketoacidosis, and death 

unless treated with insulin. 

Obesity A status with body weight that is grossly above the acceptable or 

desirable weight, usually due to accumulation of excess fats in the 

body. The standards may vary with age, sex, genetic or cultural 

background. In the body mass index, a BMI greater than 30.0 kg/m2 

is considered obese, and a BMI greater than 40.0 kg/m2 is 

considered morbidly obese 

Diet Regular course of eating and drinking adopted by a person measured 

by a nutrient intake over a specific period of time 

Irritable bowel syndrome A disorder with chronic or recurrent colonic symptoms. This condition is 

characterized by chronic or recurrent abdominal pain, bloating, 

mucus in feces, and an erratic disturbance of defecation 

Diarrhea An increased liquidity or decreased consistency of feces, such as 

running stool. Fecal consistency is partially related to the ratio of 

water-holding capacity of insoluble solids to total water, rather than 

only the amount of water present. Diarrhea is not hyperdefecation or 

increased fecal weight 

Constipation14 Presence of at least two symptoms, which must be present at least 

25% of the time. Symptoms include: fewer than 3 bowel movements 

per week, hard or lumpy stools, straining with defecation, a sensation 

of incomplete evacuation, a sensation of anorectal obstruction, and 

the use of manual maneuvers to assist defecation. 

Chronicity: 12 weeks in the previous year, which do not need to be 

consecutive. 

3 subtypes:14 colonic inertia (delayed motility), outlet obstruction, and 

functional constipation. 
A-8 

Variable Definition 

Inflammatory Bowel Diseases 

Irritable Bowel Syndrome 

Chronic, nonspecific inflammation of the gastrointestinal tract including 

Crohn disease and ulcerative colitis 

A disorder with chronic or recurrent colonic symptoms without a clearcut etiology characterized by chronic or recurrent abdominal pain, 

bloating, mucus in feces, and an erratic disturbance of defecation 

Fecal impaction Formation of a firm impassable mass of stool in the rectum or distal colon

Cardiovascular diseases Pathological conditions involving the cardiovascular system including 

the heart; blood vessels; or pericardium: arrhythmia; congestive heart 

failure; coronary disease; myocardial infarction; hypertension 

Smoking Inhaling and exhaling the smoke of tobacco or something similar to 

tobacco 

Smoking related respiratory tract 

diseases 

Lung neoplasm 

Chronic obstructive pulmonary disease—a disease of chronic diffuse 

irreversible airflow obstruction 

Pneumonia—Inflammation of the lungs 

Asthma—A form of bronchial disorder associated with airway 

obstruction, marked by recurrent attacks of paroxysmal dyspnea, with 

wheezing due to spasmodic contraction of the bronchi. 

Gastrointestinal procedures 

Major abdominal/pelvic surgery 

Proctocolectomy, Restorative—A surgical procedure involving the 

excision of the colon and rectum and the formation of an illeoanal 

reservoir 

Anterior resection; abdominal aortic aneurism surgery 

Gynecologic procedures Surgery performed on the female genitalia. 

Colposcopy—The examination, therapy or surgery of the cervix and 

vagina by means of a specially designed endoscope introduced 

vaginally 

Culdoscopy—Endoscopic examination, therapy, or surgery of the 

female pelvic viscera by means of an endoscope introduced into the 

pelvic cavity through the posterior vaginal fornix. 

Hysteroscopy—Endoscopic examination, therapy, or surgery of the 

interior of the uterus 

Gynecological surgery for pelvic organ prolapse repair, pelvic organ 

prolapse 

Urologic surgical procedures Surgery performed on the urinary tract or its parts in the male or female 

Cystectomy—Used for excision of the urinary bladder 

Cystoscopy—Endoscopic examination, therapy, or surgery of the 

urinary bladder 

Ureteroscopy—Endoscopic examination, therapy, or surgery of the 

ureter. 

Urinary diversion—Temporary or permanent diversion of the flow of 

urine through the ureter away from the urinary bladder in the 

presence of a bladder disease or after cystectomy 

Prostatectomy—Complete or partial surgical removal of the prostate. 

Three primary approaches are commonly employed: suprapubic—

removal through an incision above the pubis and through the urinary 

bladder; retropubic—as for suprapubic but without entering the 

urinary bladder; and transurethral 

Ultrasound, high-intensity focused, transrectal—Tissue ablation of the 

prostate performed by ultrasound from a transducer placed in the 

rectum 

Stroke A sudden, nonconvulsive loss of neurologic function due to an ischemic 

or hemorrhagic intracranial vascular event classified by anatomic 

location in the brain, vascular distribution, etiology, age of the 

affected individual, and hemorrhagic vs. nonhemorrhagic nature 

Spinal cord diseases Pathologic conditions which feature spinal cord damage or dysfunction, 

including disorders involving the meninges and perimeningeal spaces 

surrounding the spinal cord. Traumatic injuries, vascular diseases, 

infections, and inflammatory/autoimmune processes may affect the 

spinal cord. 

Hip fractures Fractures of the femur head; the femur neck; the trochanters; or the 

inter- or subtrochanteric region 
A-9 

Variable Definition 

Degenerative joint diseases 

Osteoarthritis 

Diseases of the bones and cartilage viewed collectively. 

A progressive, degenerative joint disease, the most common form of 

arthritis, especially in older persons 

Parkinson’s disease A progressive, degenerative neurologic disease characterized by a 

tremor that is maximal at rest, retropulsion, rigidity, stooped posture, 

slowness of voluntary movements, and a mask like facial expression. 

Multiple sclerosis An autoimmune disorder mainly affecting young adults and 

characterized by destruction of myelin in the central nervous system. 

Pathologic findings include multiple sharply demarcated areas of 

demyelination throughout the white matter of the central nervous 

system. Clinical manifestations include visual loss, extra-ocular 

movement disorders, paresthesias, loss of sensation, weakness, 

dysarthria, spasticity, ataxia, and bladder dysfunction 

Rectal diseases and surgeries Hemorroidectomy -surgical removal of hemorrhoids; bowel resection; 

anal and recto-vaginal fistula; rectal prolapse; acute sphincter trauma 

and sphincter repair 

Obstetrical and other injuries to the pelvic 

floor 

Parity—the number of offspring a female has borne 

Delivery, Obstetric—delivery of the fetus and placenta under the care of 

an obstetrician or a health worker including vaginal, forceps delivery; 

vacuum extraction; episiotomy; and cesarean. 

Fetal characteristics: increased fetal weight and head circumference 

Family History 

History of childhood nocturnal enuresis

History of incontinence in parents and first degree siblings 

History of childhood involuntary discharge of urine during sleep at night 

after expected age of completed development of urinary control 

Demographics: 

Education 

Socioeconomic factors 

Marital status 

Educational attainment or level of education of individuals 

Social and economic factors that characterize the individual or group 

within the social structure 

Person's status with respect to marriage, divorce, widowhood, 

singleness. 

Physical activity The physical activity as a behavioral phenomenon characterized by 

frequency and intensity of motor activity per unit of time (day, week). 

Sexual abuse 

Torture 

Sodomy 

Violation of established legal or moral codes in respect to sexual 

behavior. A condition in which there is a derivation of pleasure from 

inflicting pain, discomfort, or humiliation on another person or 

persons. 

The intentional infliction of physical or mental suffering upon an 

individual. 

Anal sexual intercourse 

Alcohol use Behaviors associated with the ingesting of alcoholic beverages, 

including social drinking 

Nutritional deficits, malnutrition, fiber-free 

tube-feeding formulas 

An imbalanced nutritional status resulting from insufficient intake of 

nutrients to meet normal physiological requirement. Nutritional 

support given via the alimentary canal or any route connected to the 

gastrointestinal system (i.e., the enteral route). This includes oral 

feeding, sip feeding, and tube feeding using nasogastric, 

gastrostomy, and jejunostomy tubes 

Mobility status Bedbound, wheelchair bound, assistive device; physical restraints 

Sleep disturbances Conditions characterized by disturbances of usual sleep patterns or 

behaviors: dyssomnias (i.e., disorders characterized by insomnia or 

hypersomnia), parasomnias (abnormal sleep behaviors), and sleep 

disorders secondary to medical or psychiatric disorders 
A-10 

Conceptual definition of clinical interventions to reduce the risk of fecal and urinary 

incontinence—epidemiologic investigations designed to test a hypothesized cause-effect relation 

between intervention and incidence (progression) of fecal and urinary incontinence in the study 

population 

Primary prevention—specific practices for the prevention of incontinence in susceptible 

individuals or populations; aims to remove the causes of the disease 

Secondary prevention1,6— intervention for existing symptoms of incontinence to prevent disease 

progression 

Table 4. Operational definitions of clinical interventions for the primary and secondary prevention of 

incontinence 

Variable Definition 

Health education Education that increases the awareness and favorably influences 

the attitudes and knowledge relating to the early detection and 

prevention of fecal and urinary incontinence 

Behavioral therapy The application of behavioral changes to detect and manage 

incontinence including: education about urinary and fecal tract 

structure and function; development of individualized diaries of 

daily dietary, physical activities, urinary and fecal habits; pelvic 

floor muscle exercises; voiding schedules: prompted, timed, 

habit retraining, patterned urge response toileting 

Biofeedback Process by which a person uses biofeedback information to gain 

voluntary control over pelvic floor muscle function, urination 

and defecation processes 

Pelvic floor muscle training for urinary 

incontinence 

Pelvic floor muscle training for fecal 

incontinence

A systematic program of pelvic floor muscle exercises (Kegel 

exercises) designed to improve the strength and coordination 

of the pelvic floor muscles in order to improve urinary sphincter 

function and to control urgency 

Training technique to become aware of the presence of fecal 

material in the rectum and relearning skills necessary for 

coordinating contractions of external anal sphincter and 

improving the force of muscle contraction. 

Vaginal cones Insertion of vaginal cone (weighted device) into the vagina and 

contraction of the pelvic floor muscles in an effort to hold the 

device in place. 

Electrical stimulation Application of electric current in treatment without the generation 

of perceptible heat. 

Using low-voltage electric current to stimulate the correct group of 

muscles delivered using an anal or vaginal probe 

Sacral neuromodulation Placement of a "bladder pacemaker" for continuous stimulation to 

the sacral nerve that controls the urinary sphincter 

Placement of a "pacemaker" for continuous stimulation of the 

sacral nerves to control fecal incontinence 

Percutaneous tibial neuromodulation—Placement of a fine needle 

into the skin above the ankles for intermittent stimulation of the 

post tibial nerve 

Urethral "plugs" and patches Insertion of plastic shapes into the urethra to stop the flow of 

urine or placed externally at the urinary meatus to prevent urine 

leakage; Used for female stress urinary incontinence 

Pessaries 

Sanitary shield 

A plastic or silicone device which is inserted into the vagina to 

provide support to the uterus, vagina, bladder, or rectum when 

there is pelvic organ prolapse. Special pessaries with knobs 

are available for use in treatment of urinary incontinence. 

Sanitary products for a single use in incontinent patients 
A-11 

Variable Definition 

Penile compression devices A special clamp that is placed around the penis to prevent urinary 

leakage. 

Intermittent catheterization Drainage or aspiration of the bladder or a urinary reservoir with 

subsequent removal of the catheter. 

Intermittent self-catheterization is performed by the patient 

himself/herself 

Intermittent catheterization is performed by an attendant (e.g., 

doctor, nurse or relative) 

Clean intermittent catheterization: use of a clean technique. This 

implies ordinary washing techniques and use of disposable or 

cleansed reusable catheters. 

Aseptic intermittent catheterization: use of a sterile technique. 

This implies genital disinfection and the use of sterile catheters 

and instruments/gloves. 

Indwelling catheterization Indwelling catheter remains in the bladder, urinary reservoir, or 

urinary conduit for a period of time longer than one emptying. 

Clamps and compression rings in males are placed over the 

penis to squeeze the urethra shut 

Bladder reflex triggering Various maneuvers performed by the patient or the therapist in 

order to elicit reflex detrusor contraction by exteroceptive 

stimuli including suprapubic tapping, thigh scratching, and 

anal/rectal manipulation. 

Weight loss Intentional decrease in existing body weight as a results of 

reduced calorie intake and/or increased physical activity 

Smoking cessation Discontinuation of the habit of smoking, the inhaling and exhaling 

of tobacco smoke 

Diet therapy Adjusting the quantity and quality of food intake to improve health 

status of an individual (alcohol, fluid, and caffeine intake) 

Magnetic stimulation Stimulation with a brief magnetic field on the pelvic floor muscles 

and sacral roots without insertion of an annals or vaginal probe 

Elective Caesarian delivery Extraction of the fetus by means of abdominal hysterotomy 

Direct neuromodulation of the sacral spinal 

cord 

Placement of quadripolar electrode into S3 foramen for stimulation 

of S3 nerve in order to normalize vesico urethral function 

Urethropexy 

Laparoscopic and open Burch retropubic 

urethropexies 

Abdominal sacrocolpopexy 

Surgical suspension of the urethra from the posterior surface of 

the pubic symphysis in order to correct urinary stress 

incontinence 

Extra/transperitoneal laparoscopic/retropubic urethropexies using 

non absorbable sutures or prolene meshes fixed with tackers or 

staplers 

Support of the vaginal vault by affixing it to the periosteum of the 

sacrum following a hysterectomy 

Traditional Burch urethropexy included the basic principles of the 

Tanagho modification: (1) minimal dissection within 2cm of the 

urethrovesical junction and urethra, (2) placement of sutures 

through full thickness of shiny white paravaginal fascia, (3) use 

of two sutures on each side, one opposite to the urethrovesical 

junction and another at the level of the midurethra, (4) removal 

of adipose tissue lateral to the sutures to stimulate fibrosis, and 

(5) facilitating typing of sutures to the Cooper ligament with 

intravaginal fingers elevating the anterior vaginal wall. Modified 

Burch colposuspension includes the suspension of anterior 

vaginal wall at the level of the bladder neck with permanent 

sutures connected to the iliopectineal ligament

Urethral bulking procedures: 

Transurethral or periurethral injection 

techniques for females and transurethral 

or antegrade injection for males 

Artificially inflating the submucosal tissues of the bladder neck 

Urethral bulking agents approved by the FDA include collagen 

(Contigen), autologous fat, and carbon bead technology 

(Durasphere). 

Autologous fat from the lower abdomen injected around the 

urethra. Glutaraldehyde, cross-linked collagen-extracted and 

purified bovine collagen. Durasphere - pyrolytic carbon-coated 

beads suspended in a water-based gel. Synthetic calcium 
A-12 

Variable Definition 

hydroxylapatite, cross-linked hyaluronic acid (HA), and 

ethylene vinyl alcohol copolymer suspended in dimethyl 

sulfoxide are under investigation. 

Anterior colporrhaphy (anterior repair) 

Posterior colporrhaphy (posterior repair) 

An operation of placating and suturing the anterior wall of the 

vagina to provide support to the anterior wall of the vagina and 

the bladder. 

An operation of placating and suturing of the posterior wall of the 

vagina to provide support to the rectum. 

Artificial bowel sphincter A surgical procedure that inserts an inflatable artificial sphincter in 

cases of bowel (fecal) incontinence caused by a sphincter 

dysfunction or injury. 

Devices implanted under the skin to mimic the natural function of 

the anal sphincter include an inflatable cuff, placed in the anus, 

a balloon reservoir, placed in the pubic area, and a pump, 

placed in the pubic area, connecting the cuff and balloon 

Overlapping sphincteroplasty A surgical technique designed to restore integrity and function to 

anal sphincter: 

Incision and removal of episiotomy scar tissue from the sphincter 

muscles; mobilization of external anal sphincter muscle; the 

stitching of muscle to itself 

Dynamic graciloplasty Transposition of the gracilis muscle to the anus with the 

implantation of stimulating electrodes 

Hormone replacement therapy Therapeutic use of hormones to alleviate the effects of hormone 

deficiency in menopausal females 

Topical estrogen therapy Topical vaginal administration of estrogenes 

Table 5. Clinical interventions by type of incontinence 

Urinary Incontinence Fecal Incontinence 

Prolapse surgery 

Estrogens: Topical; oral 

Scheduled voiding regimens, e.g., timed voiding, 

prompted voiding, patterned urge response 

toileting, habit training, bladder training 

Pelvic floor muscle training 

Vaginal cones 

Biofeedback 

Electrical stimulation 

Urethral "plugs," patches, and urethral pessaries 

Penile compression devices 

Bladder reflex triggering 

Detrol (tolterodine tartrate) 

Ditropan, oxytrol (oxybutynin chloride) 

Sanctura (trospium chloride) 

Enablex (darifenacin) 

Vesicare (solifenacin succinate) 

Magnetic stimulation 

Direct neuromodulation of the sacral spinal nerves 

Percutaneous nerve stimulation 

Urethropexy 

Laparoscopic and open Burch retropubic 

urethropexies 

Abdominal sacrocolpopexy 

 Anterior colporrhaphy (anterior repair) 

Posterior colporrhaphy (posterior repair) 

Artificial sling 

Botulinum toxin injections for detrusor-sphincter 

dyssyndergia or detrusor hyperreflexia) 

Bulking injections 

 Prolapse surgery 

Dietary fiber supplements, diet high in fiber foods, or 

fiber supplemented tube feeding formula 

Yogurt, other lactobacillus preparations, or and other 

probiotics, fructooligosaccharides 

Diet modifications: avoiding caffeine, sorbitol containing 

artificial sweeteners 

Overlapping sphincteroplasty 

Dynamic graciloplasty 

Biofeedback 

Electrical stimulation 

Antimotility or antidiarrheal medications 

Artificial bowel sphincter 

Anal plug 

Overlapping sphincteroplasty 

Pelvic floor muscle or Kegel exercises 

Urgency suppression, relaxation 

Bowel training techniques: toileting, prompting, 

scheduled toileting upon awakening or after 

meals, digital stimulation, abdominal massage 

Rectal evacuation or irrigation using small enema, 

suppository or laxative 

Direct neuromodulation of the sacral spinal nerves 
A-13 

Commonly used medications that may affect urinary and fecal continence 

Type of Medication Examples Potential Effects on Continence

Sedatives/hypnotics Long-acting benzodiazepines (e.g., 

diazepam, flurazepam) 

Sedation, delirium, immobility 

Alcohol Polyuria, frequency, urgency, sedation, 

delirium, immobility 

Anticholinergics Dicyclomine, disopyramide, sedating 

antihistamines 

Urinary retention, overflow incontinence, 

delirium, impaction 

Antipsychotics Thioridazine, haloperidol Anticholinergic actions, sedation, rigidity, 

immobility 

Tricyclic antidepressants 

Selective serotonin 

reuptake inhibitors 

Serotonin norepinephrine 

reuptake inhibitors 

Amitriptyline, desipramine 

Duloxetine fluoxetine, citalopram, 

paroxetine, sertraline, fluvoxamine, and 

venlafaxine 

Anticholinergic actions, sedation 

Antiparkinsonians Trihexyphenidyl, benztropine mesylate 

(not L-dopa/selegiline) 

Anticholinergic actions, sedation 

Narcotic analgesics Opiates Urinary retention, fecal impaction, 

sedation, delirium 

-Adrenergic antagonists Prazosin, terazosin, doxazosin Urethral relaxation may precipitate stress 

incontinence in women 

-Adrenergic agonists Nasal decongestants Urinary retention in men 

Calcium channel blockers All dihydropyridines Urinary retention; nocturnal diuresis due 

to fluid retention 

Potent diuretics Furosemide, bumetanide Polyuria, frequency, urgency 

Angiotensin-converting 

enzyme inhibitors 

Furosemide, bumetanide Drug-induced cough can precipitate 

stress incontinence in women and in 

some men with prior prostatectomy 

Thiazolidinediones Rosiglitazone Nocturnal diuresis due to fluid retention 

Cyclooxygenase 2 selective 

NSAIDs 

Rofecoxib, celecoxib Nocturnal diuresis due to fluid retention 

Vincristine Urinary retention 

Algorithm to Define Eligibility of Studies 

RESEARCH QUESTION. 

1. What are the prevalence and incidence of fecal and urinary incontinence in the community 

and long-term care settings? By: 

• Race 

• Ethnicity 

• Gender 

• Age 

What is the range of estimates? 

What factors account for the variance? 

 Nature of the sample 

 Definition of incontinence 

 Manner of ascertainment 
A-14 

VERIFICATION/SELECTION OF STUDY ELIGIBILITY 

Criteria 1 - Confirm eligibility of target population 

Eligible descriptors: 

Adults in the community Yes No Combined 

Adults in long-term care settings Yes No Combined 

If NO – exclude 

Criteria 2 - Confirm eligibility of the outcomes 

Eligible descriptors: 

Prevalence of urinary/fecal incontinence Yes No Combined 

Incidence of urinary/fecal incontinence Yes No Combined 

If No – exclude 

Criteria 3. Confirm eligible level of evidence 

Eligible descriptors: 

Large population based cross sectional analyses Yes 

Large population based cohort studies Yes 

Large cross sectional analyses in long-term care settings Yes 

Large cohort studies in long-term care settings Yes 

Case-series with more than 100 subjects Yes 

If NO for all descriptors – exclude 

2. What are the independent contributions of risk factors for fecal and urinary incontinence, 

including: 

• Age 

• Frailty 

• Prostate disorders 

• Pregnancy and postpartum state 

• Menopause 

• Institutionalization 

• Neurological impairment 

• Dementia 

• Psychiatric disorders, specifically depression 

• Diabetes 

• Obesity 

• Chronic GI conditions such as IBS, diarrhea, constipation, and IBD 

• Cardiovascular and pulmonary conditions, specifically smokers 

• Gastrointestinal, gynecologic, and urological procedures 

• Neurological disorders, such as stroke and spinal cord problems 

VERIFICATION/SELECTION OF STUDY ELIGIBILITY 

Criteria 1 – Confirm eligibility of target population 

Eligible descriptors: 

Adults in the community 

Adults in long-term care settings Yes No Combined 

If NO – exclude 
A-15 

Criteria 2 – Confirm eligibility of the outcomes 

Eligible descriptors: 

Prevalence of urinary/fecal incontinence Yes No Combined 

Incidence of urinary/fecal incontinence Yes No Combined 

If No – exclude 

Criteria 3 – Confirm eligibility of risk factors 

Eligible descriptors are listed in the tables with definitions (Table 2) 

If NO – exclude 

Criteria 4 - Confirm eligible level of evidence 

Eligible descriptors: 

Large population based cross sectional analyses Yes 

Large population based cohort studies Yes 

Large cross sectional analyses in long-term care settings Yes 

Large cohort studies in long-term care settings Yes 

Case-series with more than 100 subjects Yes 

Case-control studies with randomly selected controls Yes 

If NO for all descriptors – exclude 

3. What is the evidence to support specific clinical interventions to reduce the risk of fecal and 

urinary incontinence? 

VERIFICATION/SELECTION OF STUDY ELIGIBILITY 

Criteria 1 - Confirm eligibility of target population 

Eligible descriptors: 

Adults in the community 

Adults in long-term care settings Yes No Combined 

If NO – exclude 

Criteria 2 – Confirm eligibility of the outcomes 

Eligible descriptors: 

Prevalence of urinary/fecal incontinence Yes No Combined 

Incidence of urinary/fecal incontinence Yes No Combined 

Progression of urinary/fecal incontinence Yes No Combined 

If No – exclude 

Criteria 3 – Confirm eligibility of interventions 

Eligible descriptors are listed in tables with definitions (Table 4-5) 

If NO – exclude 

Criteria 4 – Confirm eligible level of evidence 

Eligible descriptors: 

For the studies that examined urinary incontinence 

Randomized controlled clinical trials Yes No 

If NO – exclude 
A-16 

For the studies that examined the effects of drug treatment on progression of incontinence: 

Length of follow up 12 months or more Yes No 

If NO – exclude 

For the studies that examined fecal and combined incontinence 

Randomized controlled clinical trials Yes No 

Multi center not randomized clinical trials Yes No 

If NO – exclude 

4. What are the strategies to improve the identification of persons at risk and patients who have 

fecal and urinary incontinence? 

VERIFICATION/SELECTION OF STUDY ELIGIBILITY 

Criteria 1 – Confirm eligibility of target population 

Eligible descriptors: 

Adults in the community 

Adults in long-term care settings Yes No Combined 

If NO – exclude 

Criteria 2 - Confirm eligibility of diagnostic strategies. 

Eligible descriptors are listed in tables with definitions (Table 1) and in the Conceptual model 2. 

If NO – exclude 

Criteria 3 – Confirm eligibility of outcomes. 

Eligible descriptors: 

Diagnosis of urinary and fecal incontinence Yes No Combined 

Cost-effectiveness of diagnostic strategies Yes No Combined 

If No – exclude 

Criteria 4 – Confirm eligibility of the outcomes assessment: 

Eligible descriptors: 

True positive Yes No 

True negative Yes No 

False positive Yes No 

False negative Yes No 

Sensitivity Yes No 

Specificity Yes No 

Positive predictive likelihood of the test Yes No 

Validity of the scale Yes No 

Validity of the questionnaire Yes No 

Reliability of the scale Yes No 

Reliability of the questionnaire Yes No 

For the studies that examined urinary incontinence 

Inter-observer variability Yes No 

If No for all descriptors – exclude 
A-17 

Criteria 5 – Confirm the eligible level of evidence: 

Eligible descriptors: 

Randomized controlled clinical trials Yes No 

Multicenter controlled clinical trials Yes No 

Large (>100 subjects) observational studies Yes No 

Case-control studies with >10 cases Yes No 

If No for all descriptors – exclude 

International classification of diseases, diagnostic codes of incontinence:

15

625.6 Stress incontinence, female 

787.6 Incontinence of feces 

Encopresis NOS 

Incontinence of sphincter ani 

788.32 Stress incontinence, male 

788.31 Urge incontinence 

788.38 Overflow incontinence 

788.39 Other urinary incontinence 

788.34 Incontinence without sensory awareness 

788.33 Mixed incontinence (female) (male) 

596 Other disorders of bladder 

788.30 Urinary incontinence, unspecified 

788.63 Urgency of urination 

788.3 Urinary incontinence 

599.6 Urinary obstruction 

Use additional code to identify urinary incontinence (625.6, 788.30-788.39) 

598 Urethral stricture Includes: pinhole meatus; stricture of urinary meatus 

Use additional code to identify urinary incontinence (625.6, 788.30-788.39) 

596.51 Hypertonicity of bladder 

Hyperactivity 

Overactive bladder 

344.61 With neurogenic bladder 

Acontractile bladder 

Autonomic hyperreflexia of bladder 

Cord bladder 

Detrusor hyperreflexia 

788.43 Nocturia 

788.41 Urinary frequency 

Frequency of micturition 

Definitions of the studies’ design characteristics to estimate the level of evidence. 

Level of evidence as defined by the U.S. Preventive Services Task Force16

Level I: Evidence obtained from at least one properly designed randomized controlled trial. 

Level II-1: Evidence obtained from well-designed controlled trials without randomization. 

Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, 

preferably from more than one center or research group. 

Level II-3: Evidence obtained from multiple time series with or without the intervention. 

Dramatic results in uncontrolled trials. 
A-18 

Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or 

reports of expert committees. 

Independent intervention variables for the question 3 extracted from the studies: 

Type of intervention as a categorical variable: behavioral interventions, drug therapy, device 

therapy, surgery. 

Type of intervention as a categorical variable using author’s definitions. 

Dose of the drug as a continuous variable. 

Dependent incontinence variables for question 3 extracted from the studies:

Type of incontinence as a categorical variable: Urinary, Anal, Combined. 

Urinary incontinence as stress, urge, mixed, total. 

Anal incontinence as flatus, fecal, combined. 

Incontinence outcomes as a categorical variable using author’s definitions. 

Number of cases with outcomes in the active and the control groups as a continuous variable. 

Rates of outcomes (%) in the active and control groups as a continuous variable. 

We applied intention-to treat principle and calculated the number of cases in the active and 

control groups among randomized when the authors reported the rates of outcomes among 

analyzed. 

Outcomes level in the active and control groups as a continuous variable. We extracted means 

and standard deviations of outcomes from the articles. We calculated standard deviations 

when the authors reported standard errors: 

Standard deviation = Standard Error * Square root of the sample size in the group. 

We extracted medians when the authors did not reported means assuming normal distribution of 

the outcome. 

Relative risk of the outcome in the active group compared to the control group. 

Regression coefficient with standard error of association between intervention and outcome. 

Tested sources of heterogeneity:

17

Clinical settings as a categorical variable: Community, nursing homes. 

Sample size as a continuous variable equals the number of randomized subjects. 

Proportion of females in the sample as a continuous variable (%) 

Length of followup months as a continuous variable 

Loss o followup as a continuous variable (%) 

Masking of the treatment status as a categorical variable: open label, single blind, double blind 

Adequacy of randomization and allocation concealment as a categorical variable: not reported, 

adequate, not adequate. 

Intention to treat principle as categorical variable: Yes, no, not stated when all randomized subjects 

were analyzed but the authors did not plan Intention to treat principle in the study design. 

We tested the possible sources of heterogeneity as interaction variables which could modify the 

effect of clinical interventions on incontinence outcomes and conducted sensitivity analysis 

within each category of effect modifiers. 

Analytical framework for pooled analysis of prevalence of incontinence in adults:

Prevalence was calculated as number of subjects with incontinence among total number of 

patients in the study, standard error and confidence interval for population prevalence were 

calculated with Wilson estimate as follows:18
A-19 

SEρ=√ [ρ*(1-ρ)]/[n+4] 

95% level C confidence interval ρ±1.96*SEρ

Where p – prevalence, n- sample size. We calculated logarithm of prevalence for pooling 

analysis. 

Hypotheses tested in pooled analysis19

1. The urinary incontinence outcome is associated with an active treatment as a categorical 

variable compared to the control interventions. Random effects model was used to 

incorporate differences between studies. 

2. The effect size of an active treatment can be modified by the proportion of males and 

females in the sample (when applicable). 

We grouped pelvic floor muscle training programs into one category in the text and for a pooled 

analysis providing the details about different regimes of exercise in the tables. 

We grouped different definitions of continence and improvement in incontinence to have an 

overall estimation of the interventions. 

Algorithms of meta-analysis19

Pooled estimate as a weighted average: 

Weights are inverse of variance (standard error): 

Standard error of pooled estimate: 

Heterogeneity (between-study variability) measured by: 

Assumptions for random effects model: true effect sizes qi have a normal distribution with mean 

q and variance t2; t2 is the between-study variance 

Between study variance: 

Where: 

wi are the weights from the fixed effect inverse-variance method 

∑

∑

=

i

i

i

i i

IV

w

wθ

θ

2 ( )

1

i

i SE

w

θ =

∑ =

i

i

IV

w

SE 1 (θ )

2 ( ) i IV

i

Q = ∑wi θ −θ

∑ ∑

∑

⎟

⎟

⎟

⎠

⎞

⎜

⎜

⎜

⎝

⎛

−

− − =

i

i

i

i

i

i

w

w

w

Q k

2

2 ( 1) τ
A-20 

Q is the heterogeneity test statistic from before (either from inverse-variance method or MantelHaenszel method) 

k is the number of studies, and 

t2 is set to zero if Q<k-1 

Random effect pooled estimate is weighted average: 

Weights used for the pooled estimate are similar to the inverse-variance, but now incorporate a 

component for between-study variation: 

Standard error of pooled estimate 

Meta regression with random effects was obtained using aggregate level data. 

Additive component of variance tau2 was estimated: 

 y[i] = a + B*x[i] + u[i] + e[i], 

where u[i] is a normal error (standard deviations that may vary across units), e[i] is a normal 

error with variance tau2 to be estimated, assumed equal across units. 

t-distribution was used calculating p-values and confidence intervals17,20

Attributable risk was calculated as the outcome events rate in patients exposed to different 

clinical interventions21-23

Attributable risk of the outcome = rate of events in patients in the control group x (relative risk -1) 

Number needed to treat to prevent one event of incontinence was calculated as reciprocal to 

absolute risk differences in rates of outcomes events in the active and control groups:22,24

1/(control group event rate - treatment group event rate). 

The number of avoided or excess events (respectively) per 1000 population is the difference 

between the two event rates multiplied by 1000: 

(control group event rate - treatment group event rate)*1000 

We calculated diagnostic values of different tests to diagnose incontinence: 

Sensitivity=TP/(TP+FN)

Specificity=TN/(FP+TN)

Prevalence=(TP+FN)/(TP+FN+FP+TN)

∑

∑

=

i

i

i

i i

DL

w

w

'

' θ

θ

2 2 ( )

1 ' θ + τ =

i

i SE

w

∑ =

i

i

DL

w

SE '

1 (θ )
A-21 

Predictive value positive=TP/(TP+FP) 

Positive predictive likelihood ratio: 

probability of an individual with the condition having a positive test 

LR+ = probability of an individual without the condition having a positive test 

LR+ = sensitivity

1-specificity 

Number needed to screen to identify one undiagnosed incontinence case = [(prevalence of 

undiagnosed incontinence)(sensitivity of the diagnostic method)]-1

Number of diagnostic tests to identify one undiagnosed incontinence case = 2 + number needed 

to screen (1 - prevalence of undiagnosed incontinence)(1 – specificity of the diagnostic test).25

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EvM1CEswyVBu8QiyZwaWQ9MTIzJmV0PTNk 

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A-22 

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covariate. Stat Med 2003 Sep 15; 22(17):2693-710. 

21. Kahn HA, Sempos CT. Statistical Methods in Epidemiology (Monographs in Epidemiology 

and Biostatistics). USA: Oxford University Press; 1989. 

22. Egger M, Smith GD, Altman DG. Systematic Reviews in Health Care. London: NetLibrary, 

Inc. BMJ Books; 2001. 

23. Dawson B, Trapp RG. Basic & Clinical Biostatistics (LANGE Basic Science). 3rd ed. New 

York: Lange Medical Books-McGraw-Hill; 2004. 

24. Ebrahim S. The use of numbers needed to treat derived from systematic reviews and metaanalysis. Caveats and pitfalls. Eval Health Prof 2001 Jun; 24(2):152-64. 

25. Hoerger TJ, Harris R, Hicks KA, et al. Screening for type 2 diabetes mellitus: a costeffectiveness analysis. Ann Intern Med 2004 May 4; 140(9):689-99. 
B-1 

Appendix B. Exact Search Strings 

Search Strategy 

The following data bases were searched: 

• Med Line (PubMed) 

• The Cochrane Database of Systematic Reviews

• The Cochrane Central Register of Controlled Trials 

• Internet (www.google.com and www.scirus.com/srsapp) with the key words identical MeSH terms 

• CINAHL 

• Manual search of the references in articles to identify eligible studies published before 1990 

 The following MeSH terms and key words (in databases other than Medline) and their combinations 

were used to search the data bases from 1990 through March 2007: 

Medical Subject Headings Terms 

“Urinary incontinence”

“Fecal incontinence”

“Costs and cost analysis”

“Prevalence”

“Incidence”

“Spinal cord”

“Spinal cord injuries”

“Spinal cord neoplasms”

“Spinal cord ischemia”

“Cerebrovascular accident”

“Brain stem infarctions”

“Infarction, middle cerebral artery”

“Infarction, anterior cerebral artery”

“Urologic surgical procedures, male”

“Digestive system surgical procedures”

“Obstetric surgical procedures”

“Gynecologic surgical procedures”

“Ureteroscopy”

“Hysteroscopy”

“Sigmoidoscopy”

“Proctoscopy”

“Mediastinoscopy”

“Cystoscopy”

“Colonoscopy”

“Smoking”

“Lung diseases”

“Pulmonary disease”

“Pulmonary heart disease”

“Lung diseases, obstructive”

“Pulmonary disease, chronic obstructive”

“Cardiovascular diseases”

“Intestinal diseases”

“Obesity”
B-2 

“Diabetes mellitus”

“Diabetes mellitus, Type 2”

“Diabetes mellitus, Type 1”

“Depressive disorder”

“Depression”

“Depression, postpartum”

“Long-term depression (physiology)”

“Dementia” 

“Institutionalization” 

“Menopause” 

“Pregnancy complications” 

“Prostatic neoplasms” 

“Body mass index” 

“Multiple sclerosis” 

“Fibromyalgia” 

“Prostatic hyperplasia” 

“Uterine prolapse” 

“Rectal prolapse” 

“Cystocele” 

“Caffeine” 

“Parkinson disease” 

“Primary prevention” 

Tolterodine tartrate 

“Health education” 

“Behavior therapy” 

“Biofeedback” 

“Bladder retraining “ 

“Kegel exercises” 

Weight loss” 

“Anti-obesity agents” 

“Homosexuality, male” 

“Predictive value of tests” 

“Reproducibility of results” 

"Anal Canal/surgery"

"Biocompatible Materials" 

"Polyethylenes" 

"Electric Stimulation Therapy" 

Exact Literature Search Strings

Medical Subject Headings Terms and Key Words Number of Retrieved References 

Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] 

2,125

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] 

 Limits: adult: 19-44 years, middle aged: 45-64 years, middle aged + aged: 45+ years, aged: 

65+ years, 80 and over: 80+ years, English, humans 

1,307
B-3 

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] 

 Limits: adult: 19-44 years, middle aged: 45-64 years, middle aged + aged: 45+ years, Aged: 

65+ years, 80 and over: 80+ years, English, randomized controlled trial, humans 

59

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] 

845

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] 

 Limits: adult: 19-44 years, middle aged: 45-64 years, middle aged + aged: 45+ years, aged: 

65+ years, 80 and over: 80+ years, English, humans 

398

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH]) 

 Limits: adult: 19-44 years, middle aged: 45-64 years, middle aged + Aged: 45+ years, aged: 

65+ years, 80 and over: 80+ years, English, randomized controlled trial, humans 

15

“Costs and cost analysis” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

30

“Costs and cost analysis” [MeSH] AND urinary incontinence 

 Limits: adult English, humans 

162

“Prevalence” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

124

“Prevalence” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

437

“Incidence” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

73

“Incidence” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

230

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] AND “costs and cost analysis” [MeSH] 

 Limits: adult, English, humans 

10

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] AND “prevalence” [MeSH] 

 Limits: adult, English, humans 

86

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] AND “incidence” [MeSH] 

 Limits: adult, English, humans 

39

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] AND “costs and cost analysis” [MeSH] 

 Limits: adult, English, humans 

49

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] AND “costs and cost analysis” [MeSH] 

71

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] AND “prevalence” [MeSH] 

 Limits: adult, English, humans 

343

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] AND “prevalence” [MeSH] 

460

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] AND “ incidence” [MeSH] 

228

“Urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/prevention and 

control” [MeSH] AND “incidence” [MeSH] 

 Limits: adult, English, humans 

152
B-4 

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] AND “costs and cost analysis” [MeSH] 

14

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] AND “prevalence” [MeSH] 

124

“Fecal incontinence/epidemiology” [MeSH] OR “fecal incontinence/prevention and control” 

[MeSH] AND “incidence” [MeSH] 

58

Fecal incontinence AND (“spinal cord” [MeSH] OR “spinal cord injuries” [MeSH] OR “spinal 

cord neoplasms” [MeSH] OR “spinal cord ischemia” [MeSH]) 

 Limits: adult, English, humans 

88

Urinary incontinence AND (“spinal cord” [MeSH] OR “spinal cord injuries” [MeSH] OR 

“spinal cord neoplasms” [MeSH] OR “spinal cord ischemia” [MeSH]) 

 Limits: adult, English, humans 

195

Fecal incontinence AND (“cerebrovascular accident” [MeSH] OR “brain stem infarctions” 

[MeSH] OR “infarction, middle cerebral artery” [MeSH] OR “infarction, anterior cerebral 

artery” [MeSH]) 

 Limits: adult, English, humans 

10

Urinary incontinence AND (“cerebrovascular accident” [MeSH] OR “brain stem infarctions” 

[MeSH] OR “infarction, middle cerebral artery” [MeSH] OR “infarction, anterior cerebral 

artery” [MeSH]) 

 Limits: adult, English, humans 

77

Fecal incontinence AND (“urologic surgical procedures, male” [MeSH] OR “urologic surgical 

procedures” [MeSH] OR “digestive system surgical procedures” [MeSH] OR “obstetric 

surgical procedures” [MeSH] OR “gynecologic surgical procedures” [MeSH] OR 

“ureteroscopy” [MeSH] OR “hysteroscopy” [MeSH] OR “sigmoidoscopy” [MeSH] OR 

“proctoscopy” [MeSH] OR “mediastinoscopy” [MeSH] OR “cystoscopy” [MeSH] OR 

“colonoscopy” [MeSH]) 

 Limits: adult, English, humans 

566

Urinary incontinence AND (“urologic surgical procedures, male” [MeSH] OR “urologic 

surgical procedures” [MeSH] OR “digestive system surgical procedures” [MeSH] OR 

“obstetric surgical procedures” [MeSH] OR “gynecologic surgical procedures” [MeSH] OR 

“ureteroscopy” [MeSH] OR “hysteroscopy” [MeSH] OR “sigmoidoscopy” [MeSH] OR 

“proctoscopy” [MeSH] OR “mediastinoscopy” [MeSH] OR “cystoscopy” [MeSH] OR 

“colonoscopy” [MeSH]) 

 Limits: adult, English, humans 

1862

“Smoking” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

1

“Smoking” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

25

(“Lung diseases” [MeSH] OR “pulmonary disease (specialty)” [MeSH] OR “pulmonary heart 

disease” [MeSH] OR “lung diseases, obstructive” [MeSH] OR “pulmonary disease, chronic 

obstructive” [MeSH]) AND fecal incontinence 

 Limits: adult, English, humans 

6

(“Lung diseases” [MeSH] OR “pulmonary disease (specialty)” [MeSH] OR “pulmonary heart 

disease” [MeSH] OR “lung diseases, obstructive” [MeSH] OR “pulmonary disease, chronic 

obstructive” [MeSH]) AND urinary incontinence 

 Limits: adult, English, humans 

46

“Cardiovascular diseases” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

135

“Cardiovascular diseases” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

349
B-5 

“Intestinal diseases” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

2,531

“Intestinal diseases” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

693

“Obesity” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

9

“Obesity” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

61

(“Diabetes mellitus” [MeSH] OR “diabetes mellitus, type 2” [MeSH] OR “diabetes mellitus, 

type 1” [MeSH]) AND fecal incontinence 

 Limits: adult, English, humans 

37

(“Diabetes mellitus” [MeSH] OR “diabetes mellitus, type 2” [MeSH] OR “diabetes mellitus, 

type 1” [MeSH]) AND urinary incontinence 

 Limits: adult, English, humans 

69

(“Depressive disorder” [MeSH] OR “depression” [MeSH] OR “depression, postpartum” 

[MeSH] OR “long-term depression (physiology)” [MeSH]) AND fecal incontinence 

 Limits: adult, English, humans 

26

(“Depressive disorder” [MeSH] OR “depression” [MeSH] OR “depression, postpartum” 

[MeSH] OR “long-term depression (physiology)” [MeSH]) AND urinary incontinence 

 Limits: adult, English, humans 

108

“Dementia” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

26

“Dementia” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

175

“Institutionalization” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

11

“Institutionalization” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

34

“Menopause” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

16

“Menopause” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

213

“Pregnancy complications” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

133

“Pregnancy complications” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

155

“Prostatic neoplasms” [MeSH] AND fecal incontinence 

 Limits: adult, English, humans 

39

“Prostatic neoplasms” [MeSH] AND urinary incontinence 

 Limits: adult, English, humans 

346

Urinary incontinence AND “prostatic neoplasms” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

311

Fecal incontinence AND “prostatic neoplasms” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

37

Fecal incontinence AND “pregnancy complications” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

119
B-6 

Urinary incontinence AND “pregnancy complications” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

138

Urinary incontinence AND “menopause” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

177

Fecal incontinence AND “menopause” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

15

Fecal incontinence AND “institutionalization” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

10

Urinary incontinence AND “institutionalization” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, Humans 

30

Urinary incontinence AND “dementia” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

145

Fecal incontinence AND “dementia” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

24

Fecal incontinence AND (“depressive disorder” [MeSH] OR “depression” [MeSH] OR 

“depression, postpartum” [MeSH] OR “long-term depression (physiology)” [MeSH]) NOT 

review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

26

Urinary incontinence AND (“depressive disorder” [MeSH] OR “depression” [MeSH] OR 

“depression, postpartum” [MeSH] OR “long-term depression (physiology)” [MeSH]) NOT 

review NOT letter NOT editorial 

 Limits: all Adult: 19+ years, English, humans 

85

Urinary incontinence AND (“diabetes mellitus” [MeSH] OR “diabetes mellitus, type 2” 

[MeSH] OR “diabetes mellitus, type 1” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

63

Fecal incontinence AND (“diabetes mellitus” [MeSH] OR “diabetes mellitus, type 2” [MeSH] 

OR “diabetes mellitus, type 1” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

34

Fecal incontinence AND “obesity” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

7

Urinary incontinence AND “obesity” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

50

Urinary incontinence AND “intestinal diseases” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

603

Fecal incontinence AND “intestinal diseases” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

2,229

Fecal incontinence AND “cardiovascular Diseases” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

118

Urinary incontinence AND “cardiovascular diseases” [MeSH] NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

286

Urinary incontinence AND (“lung diseases” [MeSH] OR “pulmonary disease (specialty)” 

[MeSH] OR “pulmonary heart disease” [MeSH] OR “lung diseases, obstructive” [MeSH] 

OR “pulmonary disease, chronic obstructive” [MeSH]) NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

34
B-7 

Fecal incontinence AND (“lung diseases” [MeSH] OR “pulmonary disease (specialty)” 

[MeSH] OR “pulmonary heart disease” [MeSH] OR “lung diseases, obstructive” [MeSH] 

OR “pulmonary disease, chronic obstructive” [MeSH]) NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

5

Fecal incontinence AND “smoking” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

0

Urinary incontinence AND “smoking” [MeSH] NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

23

Urinary incontinence AND (“urologic surgical procedures, male” [MeSH] OR “urologic 

surgical procedures” [MeSH] OR “digestive system surgical procedures” [MeSH] OR 

“obstetric surgical procedures” [MeSH] OR “gynecologic surgical procedures” [MeSH] OR 

“ureteroscopy” [MeSH] OR “hysteroscopy” [MeSH] OR “sigmoidoscopy” [MeSH] OR 

“proctoscopy” [MeSH] OR “mediastinoscopy” [MeSH] OR “cystoscopy” [MeSH] OR 

“colonoscopy” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

1669

Fecal incontinence AND (“urologic surgical procedures, male” [MeSH] OR “urologic surgical 

procedures” [MeSH] OR “digestive system surgical procedures” [MeSH] OR “obstetric 

surgical procedures” [MeSH] OR “gynecologic surgical procedures” [MeSH] OR 

“ureteroscopy” [MeSH] OR “hysteroscopy” [MeSH] OR “sigmoidoscopy” [MeSH] OR 

“proctoscopy” [MeSH] OR “mediastinoscopy” [MeSH] OR “cystoscopy” [MeSH] OR 

“colonoscopy” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

524

Fecal incontinence AND (“cerebrovascular accident” [MeSH] OR “brain stem infarctions” 

[MeSH] OR “infarction, middle cerebral artery” [MeSH] OR “infarction, anterior cerebral 

artery” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

6

Urinary incontinence AND (“cerebrovascular accident” [MeSH] OR “brain stem infarctions” 

[MeSH] OR “infarction, middle cerebral artery” [MeSH] OR “infarction, anterior cerebral 

artery” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

64

Urinary incontinence AND (“spinal cord” [MeSH] OR “spinal cord injuries” [MeSH] OR 

“spinal cord neoplasms” [MeSH] OR “spinal cord ischemia” [MeSH]) NOT review NOT 

letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

167

Fecal incontinence AND (“spinal cord” [MeSH] OR “spinal cord injuries” [MeSH] OR “spinal 

cord neoplasms” [MeSH] OR “spinal cord ischemia” [MeSH]) NOT review NOT letter 

NOT editorial 

 Limits: all adult: 19+ years, English, humans 

78

“Costs and cost analysis” [MeSH] AND (“fecal incontinence/diagnosis” [MeSH] OR “fecal 

Incontinence/epidemiology” [MeSH] OR “fecal incontinence/ etiology” [MeSH] OR “fecal 

incontinence/prevention and control” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

16

“Costs and cost analysis” [MeSH] AND (“urinary incontinence/diagnosis” [MeSH] OR 

“urinary incontinence/epidemiology” [MeSH] OR “urinary incontinence/ etiology” [MeSH] 

OR “urinary incontinence/prevention and control” [MeSH]) NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

57

“Costs and cost analysis” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

25,982
B-8 

“Incidence” [MeSH] AND urinary incontinence NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

180

“Incidence” [MeSH] AND fecal incontinence NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

65

“Prevalence” [MeSH] AND urinary incontinence NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

358

“Prevalence” [MeSH] AND fecal incontinence NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

104

“Costs and cost analysis” [MeSH] AND urinary incontinence NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

128

“Costs and cost analysis” [MeSH] AND fecal incontinence NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

26

(“Fecal incontinence/diagnosis” [MeSH] OR “fecal incontinence/epidemiology” [MeSH] OR 

“fecal incontinence/etiology” [MeSH] OR “fecal incontinence/ prevention and control” 

[MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

1,436

(“Fecal incontinence/diagnosis” [MeSH] OR “fecal incontinence/epidemiology” [MeSH] OR 

“fecal incontinence/etiology” [MeSH] OR “fecal incontinence/ prevention and control” 

[MeSH]) 

 Limits: all adult: 19+ years, English, humans 

1,635

(“Urinary incontinence/diagnosis” [MeSH] OR “urinary incontinence/epidemiology” [MeSH] 

OR “urinary incontinence/etiology” [MeSH] OR “urinary incontinence/ prevention and 

control” [MeSH]) NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

3,815

(“Urinary incontinence/diagnosis” [MeSH] OR “urinary incontinence/epidemiology” [MeSH] 

OR “urinary incontinence/etiology” [MeSH] OR “urinary Incontinence/ prevention and 

control” [MeSH]) 

 Limits: all adult: 19+ years, English, humans 

4,470

(“Urinary incontinence/diagnosis” [MeSH] OR “urinary incontinence/epidemiology” [MeSH] 

OR “urinary incontinence/etiology” [MeSH] OR “urinary incontinence/ prevention and 

control” [MeSH]) 

 Limits: English, humans 

6,966

(“Urinary incontinence/diagnosis” [MeSH] OR “urinary incontinence/epidemiology” [MeSH] 

OR “urinary incontinence/etiology” [MeSH] OR “urinary incontinence/ prevention and 

control” [MeSH]) 

9,492

(“Urinary incontinence” [MeSH] OR “urinary incontinence, urge” [MeSH] OR “urinary 

incontinence, stress” [MeSH]) AND "primary prevention" [MeSH] NOT review NOT letter 

NOT editorial 

 Limits: all adult: 19+ years, English, humans 

6

(“Urinary incontinence” [MeSH] OR “urinary incontinence, urge” [MeSH] OR “urinary 

incontinence, stress” [MeSH]) AND “primary prevention” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

12

(“Urinary incontinence” [MeSH] OR “urinary incontinence, urge” [MeSH] OR “urinary 

incontinence, stress” [MeSH]) AND “primary prevention” [MeSH] 

29

“Primary prevention” [MeSH] AND fecal incontinence 

 Limits: all adult: 19+ years, English, randomized controlled trial, humans 

1

“Primary prevention” [MeSH] AND urinary incontinence 

 Limits: all adult: 19+ years, English, randomized controlled trial, humans 

1

“Primary prevention” [MeSH] 83,315
B-9 

“Fecal incontinence” [MeSH] AND “primary prevention” [MeSH] 

 Limits: all adult: 19+ years, English, randomized controlled trial, humans 

1

“Fecal incontinence” [MeSH] 

 Limits: all adult: 19+ years, English, randomized controlled trial, humans 

99

(“Urinary incontinence” [MeSH] OR “urinary incontinence, urge” [MeSH] OR “urinary 

incontinence, stress” [MeSH]) AND “primary prevention” [MeSH] 

 Limits: all adult: 19+ years, English, randomized controlled trial, humans 

1

(“Urinary incontinence” [MeSH] OR “urinary incontinence, urge” [MeSH] OR “urinary 

incontinence, stress” [MeSH]) 

18,254

Tolterodine tartrate 307

“Fecal incontinence” [MeSH] 

 Limits: all adult: 19+ years, English, clinical trial, randomized controlled trial, “clinical 

trial, phase I”, “clinical trial, phase II”, “clinical trial, phase III”, “clinical trial, phase IV”, 

controlled clinical trial, multicenter study, humans 

268

“Urinary incontinence” [MeSH] 

 Limits: all adult: 19+ years, English, clinical trial, randomized controlled trial, “clinical 

trial, phase I”, “clinical trial, phase II”, “clinical trial, phase III”, “clinical trial, phase IV”, 

controlled clinical trial, multicenter study, humans 

1,077

“Urinary incontinence” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

8,007

“Health education” [MeSH] AND “urinary incontinence” NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

133

“Health education” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

23,976

“Behavior therapy” [MeSH] AND “urinary incontinence” NOT review NOT letter NOT 

editorial 

 Limits: all adult: 19+ years, English, humans 

194

“Behavior therapy” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

13,495

“Biofeedback” AND “urinary incontinence” NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

126

“Bladder retraining” AND “urinary incontinence” NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

26

“Kegel exercises” AND “urinary incontinence” NOT review NOT letter NOT editorial 

 Limits: all adult: 19+ years, English, humans 

13

Incontinence AND (“weight loss” [MeSH] OR “anti-obesity agents” [MeSH]) 

 Limits: all adult: 19+ years, English, randomized controlled trial, humans 

5

Incontinence AND “weight loss” 

 Limits: all adult: 19+ years, English, randomized controlled trial, humans 

3

“Fecal incontinence/diagnosis” [MeSH] 

 Limits: all adult: 19+ years, English, clinical trial, randomized controlled trial, humans 

43

“Fecal incontinence/diagnosis” [MeSH] 817

“Urinary incontinence/diagnosis” [MeSH] 

 Limits: all adult: 19+ years, English, clinical trial, randomized controlled trial, humans 

143

“Fecal incontinence” [MeSH] AND “homosexuality, male” [MeSH] 1

“Fecal incontinence” [MeSH] 5,420

“Homosexuality, male” [MeSH] 4,303

“Urinary incontinence” [MeSH] AND “predictive value of tests” [MeSH] NOT review NOT 

letter NOT comment 

 Limits: all adult: 19+ years, English, humans 

122
B-10 

“Urinary incontinence” [MeSH] AND “predictive value of tests” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

136

“Urinary incontinence” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

8,216

“Fecal incontinence” [MeSH] AND “predictive value of tests” [MeSH] NOT review NOT 

letter NOT comment 

 Limits: all adult: 19+ years, English, humans 

34

“Fecal incontinence” [MeSH] AND “predictive value of tests” [MeSH] 48

“Predictive value of tests” [MeSH] 72,697

“Urinary incontinence/diagnosis” [MeSH] 

 Limits: all adult: 19+ years, English, validation studies, humans 

18

“Fecal incontinence/diagnosis” [MeSH] 

 Limits: all adult: 19+ years, English, validation studies, humans 

0

“Fecal incontinence/diagnosis” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

348

“Reproducibility of results” [MeSH] AND “urinary incontinence” [MeSH] NOT review NOT 

letter NOT comment 

 Limits: all adult: 19+ years, English, humans 

148

“Reproducibility of results” [MeSH] AND “fecal incontinence” [MeSH] NOT review NOT 

letter NOT comment 

 Limits: all adult: 19+ years, English, humans 

45

“Reproducibility of results” [MeSH] AND “fecal incontinence” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

47

“Reproducibility of results” [MeSH] 

 Limits: all adult: 19+ years, English, humans 

45,118

Hormone AND incontinence 

 Limits: all adult: 19+ years, English, randomized controlled trial, female, humans 

39

“Parkinson disease” [MeSH] AND “fecal incontinence” [MeSH] NOT review NOT comment 

NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

4

“Parkinson disease” [MeSH] AND “urinary incontinence” [MeSH] NOT review NOT 

comment NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

12

“Parkinson disease” [MeSH] 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

9,932

“Caffeine” [MeSH] AND “fecal incontinence” [MeSH] NOT review NOT comment NOT 

case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

0

“Caffeine” [MeSH] AND “urinary incontinence” [MeSH] NOT review NOT comment NOT 

case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

Humans 

5

“Caffeine” [MeSH] 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

1,832
B-11 

(“Uterine prolapse” [MeSH] OR “rectal prolapse” [MeSH] OR “cystocele” [MeSH]) AND 

“fecal incontinence” [MeSH] NOT review NOT comment NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

105

(“Uterine prolapse” [MeSH] OR “rectal prolapse” [MeSH] OR “cystocele” [MeSH]) AND 

“urinary incontinence” [MeSH] NOT review NOT comment NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

265

(“Uterine prolapse” [MeSH] OR “rectal prolapse” [MeSH] OR “vystocele” [MeSH]) 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

1,341

“Prostatic hyperplasia” [MeSH] AND “fecal incontinence” [MeSH] NOT review NOT 

comment NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

0

“Prostatic hyperplasia” [MeSH] AND “urinary incontinence” [MeSH] NOT review NOT 

comment NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

47

“Prostatic hyperplasia” [MeSH] 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

3,980

“Fibromyalgia” [MeSH] AND “fecal incontinence” [MeSH] NOT review NOT comment NOT 

case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

0

“Fibromyalgia” [MeSH] AND “urinary incontinence” [MeSH] NOT review NOT comment 

NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

1

“Fibromyalgia” [MeSH] 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

1,416

“Fecal incontinence” [MeSH] AND “multiple sclerosis” [MeSH] NOT review NOT comment 

NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

12

“Multiple sclerosis” [MeSH] AND “urinary incontinence” [MeSH] NOT review NOT 

comment NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

23

“Multiple sclerosis” [MeSH] 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

7,758

“Fecal incontinence” [MeSH] AND “body mass index” [MeSH] NOT review NOT comment 

NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

5
B-12 

“Urinary incontinence” [MeSH] AND “body mass index” [MeSH] NOT review NOT 

comment NOT case-reports NOT letter 

 Limits: all adult: 19+ years, English, publication date from 1990/01/01 to 2007/07/31, 

humans 

74

“Body mass index” [MeSH] 32,517

"Anal Canal/surgery"[MeSH] AND fecal continence Limits: Entrez Date from 1990/01/01 to 

2007/08/31, English, Clinical Trial, Randomized Controlled Trial, Humans 

34

gracilis transposition AND fecal continence Limits: English, Clinical Trial, Randomized 

Controlled Trial, Multicenter Study, Humans 

2

Fecal incontinence AND ("Biocompatible Materials"[MeSH] OR "Biocompatible 

Materials"[Pharmacological Action] OR "Polyethylenes"[MeSH]) Limits: All Adult: 19+ 

years, English, Clinical Trial, Randomized Controlled Trial, Multicenter Study, Humans 

2

Sacral nerve stimulation AND fecal Limits: All Adult: 19+ years, English, Clinical Trial, 

Randomized Controlled Trial, Multicenter Study, Humans 

18

"Electric Stimulation Therapy"[MeSH] AND fecal Limits: All Adult: 19+ years, English, 

Clinical Trial, Randomized Controlled Trial, Multicenter Study, Humans 

27

"Colostomy"[MeSH] AND fecal incontinence Limits: All Adult: 19+ years, English, Clinical 

Trial, Randomized Controlled Trial, Multicenter Study, Humans 

9

"Colorectal Neoplasms"[Mesh] AND "fecal continence" Limits: published in the last 10 years, 

Humans, Randomized Controlled Trial, English, All Adult: 19+ years 

2

"Colorectal Neoplasms"[Mesh] AND "fecal incontinence" Limits: published in the last 10 

years, Humans, Randomized Controlled Trial, English, All Adult: 19+ years 

12

"Colorectal Neoplasms"[Mesh] Limits: published in the last 10 years, Humans, Randomized 

Controlled Trial, English, All Adult: 19+ years 

959

"Colorectal Neoplasms" [Mesh] 95,866

"Fecal Incontinence"[Mesh] AND "Proctocolectomy, Restorative"[Mesh] Limits: published in 

the last 10 years, Humans, Randomized Controlled Trial, Controlled Clinical Trial, 

Multicenter Study, English, All Adult: 19+ years 

9

"Fecal Incontinence"[Mesh] Limits: Humans, Clinical Trial, Randomized Controlled Trial, 

Controlled Clinical Trial, Multicenter Study, All Adult: 19+ years 

305

"Proctocolectomy, Restorative"[Mesh] Limits: Humans, Clinical Trial, Randomized 

Controlled Trial, Controlled Clinical Trial, Multicenter Study, All Adult: 19+ years 

123

Coloanal anastomoses AND fecal incontinence Limits: Humans, Clinical Trial, Randomized 

Controlled Trial, Controlled Clinical Trial, Multicenter Study, All Adult: 19+ years 

2

Coloanal anastomoses AND fecal incontinence 18

Coloanal anastomoses 85

Manual search of Cochrane review on treatment options for fecal incontinence 

Source: Cochrane Incontinence Group reviews. 

Topic. Nonsurgical therapy for anal fissure (Review) 

Reference: Nelson R. Nonsurgical therapy for anal fissure 

Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003431. Review 

PMID: 17054170 

Analysis 02.02. Comparison 02 GTN or IDN versus sphincterotomy, Outcome 02 Minor Incontinence 

Review: Non surgical therapy for anal fissure 

Comparison: 02 GTN or IDN versus sphincterotomy 

Outcome: 02 Minor Incontinence 
B-13 

 GTN LIS 

 n N n N 

Evans 2001 0 34 2 31 

Libertiny 2002 0 35 1 35 

Mishra 2005 0 20 3 20 

x Oettle 1997 0 12 0 12 

Parellada 2004 0 27 4 27 

Richard 2000 7 34 3 33 

Analysis 08.02. Comparison 08 Botox versus sphincterotomy, Outcome 02 Minor Incontinence 

Review: Nonsurgical therapy for anal fissure 

Comparison: 08 Botox versus sphincterotomy 

Outcome: 02 Minor Incontinence 

Analysis 08.02. Comparison 08 Botox versus sphincterotomy, Outcome 02 Minor Incontinence 

 Botox low dose Botox high dose 

 n N n N 

Arroyo 2005 0 40 2 40 

Mentes 2001 0 61 8 50 

Topic. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. 

Reference: Norton C, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of 

faecal incontinence in adults. Cochrane Database Syst Rev. 2006 Jul 19;3:CD002111. Review. PMID: 

16855987 

Analysis 03.01. Comparison 03 BIOFEEDBACK ALONE versus NO TREATMENT, Outcome 01 

Number of people failing to achieve full continence (worse, unchanged or improved) 

Review: Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults 

Comparison: 03 BIOFEEDBACK ALONE versus NO TREATMENT 

Outcome: 01 Number of people failing to achieve full continence (worse, unchanged or improved) 

 Exercises or BFB No exercises or BFB 

 n N n N 

Miner 1990 9 13 12 12 

Analysis 03.02. Comparison 03 BIOFEEDBACK ALONE versus NO TREATMENT, Outcome 02 

Number of people with no improvement in incontinence status (worse or unchanged) 

Review: Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults 

Comparison: 03 BIOFEEDBACK ALONE versus NO TREATMENT 

Outcome: 02 Number of people with no improvement in incontinence status (worse or unchanged) 
B-14 

 Exercises or BFB No exercises or BFB 

 n N n N 

Miner 1990 2 13 7 12 

Analysis 03.04. Comparison 03 BIOFEEDBACK ALONE versus NO TREATMENT, Outcome 04 

Number of incontinence episodes per week 

Review: Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults 

Comparison: 03 BIOFEEDBACK ALONE versus NO TREATMENT 

Outcome: 04 Number of incontinence episodes per week 

 Exercises or BFB No exercises or BFB 

 N Mean STD N Mean STD 

Miner 1990 13 0.9 0.08 12 2.3 0.17 

Analysis 06.01. Comparison 06 ANAL SPHINCTER EXERCISES/PELVIC FLOOR MUSCLE 

TRAINING AND BIOFEEDBACK versus ANY OTHER TREATMENT, Outcome 01 Number of 

people failing to achieve full continence (worse, unchanged or improved) 

Review: Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults 

Comparison: 06 ANAL SPHINCTER EXERCISES/PELVIC FLOOR MUSCLE TRAINING AND 

BIOFEEDBACK versus ANY OTHER TREATMENT 

Outcome: 01 Number of people failing to achieve full continence (worse, unchanged or improved) 

 Exercises or BFB No exercises or BFB 

 n N n N 

Fynes 1999 12 19 5 20 

Analysis 06.02. Comparison 06 ANAL SPHINCTER EXERCISES/PELVIC FLOOR MUSCLE 

TRAINING AND BIOFEEDBACK versus ANY OTHER TREATMENT, Outcome 02 Number of 

people with no improvement in incontinence status (worse or unchanged) 

Review: Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults 

Comparison: 06 ANAL SPHINCTER EXERCISES/PELVIC FLOOR MUSCLE TRAINING AND 

BIOFEEDBACK versus ANY OTHER TREATMENT 

Outcome: 02 Number of people with no improvement in incontinence status (worse or unchanged) 

 Exercises or BFB No exercises or BFB 

 n N n N 

Fynes 1999 8 19 0 20 

Topic: Drug treatment for faecal incontinence in adults. 

Reference: Cheetham M, Brazzelli M, Norton C, Glazener CM Drug treatment for faecal incontinence in 

adults. 

Cochrane Database Syst Rev. 2003;(3):CD002116. 

No summary tables. 

1 reference was excluded from our analysis as non RCT: Kusunoki M, Shoji Y, Ikeuchi H, Yamagata K, 

Yamamura T, Utsunomiya J. Usefulness of valproate sodium for treatment of incontinence after ileoanal 

anastomosis. Surgery. 1990 Mar;107(3):311-5. 
B-15 

Topic: Electrical stimulation for faecal incontinence in adults. 

Reference: Hosker G, Norton C, Brazzelli M. Electrical stimulation for faecal incontinence in adults. 

Cochrane Database Syst Rev. 2000;(2):CD001310. 

References to studies included in this review: 

Fynes 1999 – included in our analysis 

Fynes MM,Marshall K, Cassidy M, Behan M,Walsh D, O'Connell PR, O'Herlihy C. A prospective, 

randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on 

fecal incontinence after obstetric trauma. Diseases of the Colon and Rectum 1999;42(6):753-8; discussion 

758-61. [MedLine: 99304944] 

Topic: Management of faecal incontinence and constipation in adults with central neurological diseases. 

Reference: Coggrave M, Wiesel PH, Norton C. Management of faecal incontinence and constipation in 

adults with central neurological diseases. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD002115. 

Review. 

PMID: 16625555 

No studies reported fecal incontinence as an outcomes. 

Analysis 01.34. Comparison 01 CISAPRIDE versus PLACEBO, Outcome 34 Number of bowel motions 

or successes bowel care routine per week 

Review: Management of faecal incontinence and constipation in adults with central neurological diseases 

Comparison: 01 CISAPRIDE versus PLACEBO 

Outcome: 34 Number of bowel motions or successes bowel care routine per week 

 Mean difference (95% CI) 

Badiali 1991 -0.5 (-2.26; 1.26) 

de Both 1992 -0.1 (-1; 0.8) 

Total (95% CI) -0.18 (-0.99; 0.62) 

Analysis 01.35. Comparison 01 CISAPRIDE versus PLACEBO, Outcome 35 Ease of evacuation or 

straining effort (score) 

Review: Management of faecal incontinence and constipation in adults with central neurological diseases 

Comparison: 01 CISAPRIDE versus PLACEBO 

Outcome: 35 Ease of evacuation or straining effort (score) 

 Mean difference (95% CI) 

Badiali 1991 0.6 (-0.18; 1.38) 

de Both 1992 -0.1 (-0.51; 0.31) 

Total (95% CI) 0.05 (-0.31; 0.42) 

Analysis 01.36. Comparison 01 CISAPRIDE versus PLACEBO, Outcome 36 Oro-anal transit time 

(hours) 

Review: Management of faecal incontinence and constipation in adults with central neurological diseases 

Comparison: 01 CISAPRIDE versus PLACEBO 

Outcome: 36 Oro-anal transit time (hours) 
B-16 

 Mean difference (95% CI) 

Badiali 1991 10 (-19.01; 39.01) 

de Both 1992 19.2 (-38.23; 76.63) 

Total (95% CI) 11.87 (-14.02; 37.76) 

Authors' conclusions: ”There is still remarkably little research on this common and, to patients, very 

significant condition. It is not possible to draw any recommendation for bowel care in people with 

neurological diseases from the trials included in this review. Bowel management for these people must 

remain empirical until well-designed controlled trials with adequate numbers and clinically relevant 

outcome measures become available”. 

Topic: Operative procedures for fissure in ano. 

Reference: Nelson R. Operative procedures for fissure in ano. 

Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002199. Review. 

PMID: 15846630 

The review included the studies with minor incontinence to flatus only. 

Analysis 01.01. Comparison 01 Anal Stretch and partial internal sphincterotomy, Outcome 01 Persistence 

of the anal fissure 

Review: Operative procedures for fissure in ano 

Comparison: 01 Anal Stretch and partial internal sphincterotomy 

Outcome: 01 Persistence of the anal fissure 

 Anal Stretch Sphincterotomy Peto Odds Ratio (95% CI) 

 n N n N 

Fischer 1976 3 34 1 32 2.68 (0.36; 19.96) 

Jensen 1984 8 28 1 30 6.63 (1.62; 27.17) 

Marby 1979 3 41 10 45 0.32 (0.1; 1.03) 

Olsen 1987 3 10 1 10 3.28 (0.39; 27.75) 

Saad 1992 3 37 2 20 0.79 (0.12; 5.33) 

Weaver 1987 3 59 2 39 0.99 (0.16; 6.17) 

Total (95% CI) 209 176 (.66; 2.48) 

Analysis 01.02. Comparison 01 Anal Stretch and partial internal sphincterotomy, Outcome 02 Minor 

incontinence to flatus 

Review: Operative procedures for fissure in ano 

Comparison: 01 Anal Stretch and partial internal sphincterotomy 

Outcome: 02 Minor incontinence to flatus 

 Anal Stretch Sphincterotomy Peto Odds Ratio (95% CI) 

 n N n N 

Fischer 1976 6 34 0 32 8.19 (1.55; 43.35) 

Jensen 1984 8 28 0 30 10.61 (2.41; 46.62) 

Marby 1979 0 41 0 45 Not estimable 

Olsen 1987 2 10 1 10 1 (0.12; 8.46) 

Saad 1992 8 37 1 20 3.41 (0.78; 14.98) 

Weaver 1987 0 59 2 39 0.08 (0; 4.44) 

Total (95% CI) 209 176 4.22 (1.89; 9.41) 
B-17 

Analysis 02.02. Comparison 02 Open versus closed partial lateral internal sphincterotomy, Outcome 02 

Minor incontinence to flatus 

Review: Operative procedures for fissure in ano 

Comparison: 02 Open versus closed partial lateral internal sphincterotomy 

Outcome: 02 Minor incontinence to flatus 

 Open LIS Closed LIS Peto Odds Ratio (95% CI) 

 n N n N 

Arroyo 2004 2 40 1 40 1.98 (0.2; 19.62) 

Boulos 1984 2 14 3 14 0.63 (0.09; 4.18) 

Kortbeek 1992 4 54 5 58 0.85 (0.22; 3.3) 

Wiley 2002 2 40 3 36 0.59 (0.1; 3.56) 

Total (95% CI) 148 148 0.83 (0.35; 1.97) 

Topic: Surgery for complete rectal prolapse in adults. 

Reference: Bachoo P, Brazzelli M, Grant A. Surgery for complete rectal prolapse in adults. Cochrane 

Database Syst Rev. 2000;(2):CD001758. Review. 

PMID: 10796817 

McKee 1992 added to the review 

Galili 1997 added to the review 

Novell 1994 added to the review 

Topic: Plugs for containing faecal incontinence. 

Reference: Deutekom M, Dobben A. Plugs for containing faecal incontinence. Cochrane Database Syst 

Rev. 2005 Jul 20;(3):CD005086. 

PMID: 16034966 

Analysis 01.04. Comparison 01 Anal plugs versus no plugs, Outcome 04 Condition specific measures of 

faecal incontinence improved 

Review: Plugs for containing faecal incontinence 

Comparison: 01 Anal plugs versus no plugs 

Outcome: 04 Condition specific measures of faecal incontinence improved 

Based on unpublished data:

Bond 2005 unpublished data only ́ 

Bond C. The anal plug: an evaluation of a novel management option for faecal incontinence. Final report 

to Chief Scientist Office, Scottish 

Executive Health Department, Edinburgh 2005. 

Analysis 01.07. Comparison 01 Anal plugs versus no plugs, Outcome 07 Achievement of pseudocontinence 

Achievement of pseudo-continence 

Study Anal plug period Control period 

Analysis 02.01. Comparison 02 One type of anal plug versus another type, Outcome 01 Plug 

effectiveness: number of people with no soiling 

Plug effectiveness: number of people with no soiling 

Study PU plug PVA plug 
B-18 

Van Winckel 2005 unpublished data only ́ 

Van Winckel M. Clinical evaluation of a new anal medical device to achieve faecal continence in spina 

bi_da and anal atresia patients. 

personal communication 2005. 

VanWinckel M, Van Biervliet S,Van Laecke E,Hoebeke P. Is an anal plug useful in the treatment of fecal 

incontinence in children with spina bi_da or anal atresia?. Journal of Urology 2006;176(1):342{4. 

[MedLine: 22027]. 

Topic: Methods of repair for obstetric anal sphincter injury 

Reference: Fernando R, Sultan AH, Kettle C, Thakar R, Radley S. Methods of repair for obstetric anal 

sphincter injury. 

Cochrane Database Syst Rev. 2006 Jul 19;3:CD002866. 

No additional published references identified. 

Topic: Sacral nerve stimulation for faecal incontinence in adults(protocol only). 

Topic: Surgery for faecal incontinence in adults. 

Reference: Brown S, Nelson R. Surgery for faecal incontinence in adults. 

Cochrane Database Syst Rev. 2007 Apr 18;2:CD001757. 

PMID: 17443511 

All references included in our review. 
B-1 

Appendix C: List of Excluded Studies 

1. Urinary incontinence among hospitalized 

persons aged 65 years and older--United 

States, 1984-1987. MMWR Morb Mortal 

Wkly Rep 1991 Jul 5; 40(26):433-6. Not 

eligible target population 

2. Rectal prolapse. Lancet 1991 Sep 7; 

338(8767):605-6. Review 

3. Urinary incontinence in adults. Agency for 

Health Care Policy and Research. Clin Pract 

Guidel Quick Ref Guide Clin 1992; (2):QR1-

27. Guideline 

4. High quality long-term care for elderly people. 

A summary of a report of the Royal College of 

Physicians and the British Geriatrics Society. J 

R Coll Physicians Lond 1992 Apr; 26(2):130-

3. Review 

5. Effects of terodiline on urinary incontinence 

among older non-institutionalized women. 

Terodiline in the Elderly American 

Multicenter Study Group. J Am Geriatr Soc 

1993 Sep; 41(9):915-22. Not eligible exposure 

6. Professional development. Promoting 

continence: knowledge for practice 

(continuing education credit). Nurs Times 

1994 Nov 2-8; 90(44):suppl 1-4. Review 

7. Goals in continence training. Prof Nurse 1994 

Sep; 9(12):783. Review 

8. Incontinence. Causes, management and 

provision of services. A Working Party of the 

Royal College of Physicians. J R Coll 

Physicians Lond 1995 Jul-Aug; 29(4):272-4. 

Review 

9. The chief scientist reports .... 'Incontinence 

research--the way ahead'. Health Bull (Edinb) 

1995 May; 53(3):174-9. Congresses 

publication 

10. Managing acute and chronic urinary 

incontinence. AHCPR Urinary Incontinence in 

Adults Guideline Update Panel. Am Fam 

Physician 1996 Oct; 54(5):1661-72. Review 

11. Managing acute and chronic urinary 

incontinence. U.S. Department of Health and 

human services. J Am Acad Nurse Pract 1996 

Aug; 8(8):390-403. Guideline 

12. RU3: making a difference for women. 

AWHONN's continence research reveals 

preliminary findings. AWHONN Lifelines 

1998 Aug; 2(4):55-6. News 

13. Clinical practice guidelines: Neurogenic 

bowel management in adults with spinal cord 

injury. Spinal Cord Medicine Consortium. J 

Spinal Cord Med 1998 Jul; 21(3):248-93. 

Guideline 

14. Continence care. Elder Care 1998 Feb-Mar; 

10(1):35. Comment 

15. Case records of the Massachusetts General 

Hospital. Weekly clinicopathological 

exercises. Case 11-1999. A 60-year-old 

woman with epidural and paraspinal masses. 

N Engl J Med 1999 Apr 15; 340(15):1188-96. 

Case-reports 

16. Goserelin and locally advanced prostate 

cancer: new indication. Pros and cons. 

Prescrire Int 2000 Jun; 9(47):75-6. Comment 

17. Biofeedback in the treatment of urinary 

incontinence in adults. Tecnologica MAP 

Suppl 2000 Apr:3-5. Not eligible target 

population 

18. Solutions for declining bladder control. Johns 

Hopkins Med Lett Health After 50 2001 Jul; 

13(5):6-7. Comment 

19. Patient information. Understanding urinary 

incontinence. Adv Nurse Pract 2001 Mar; 

9(3):64. Patient Education Handout 

20. Market research on urinary incontinence 

offers insightful findings. Urol Nurs 2001 

Dec; 21(6):413. News 

21. I've been having problems controlling my 

bowels and have had some "accidents" lately. 

Is this common? Can it be helped? Mayo Clin 

Health Lett 2001 Mar; 19(3):8. Comment 

22. Page for patients. Menopause. Prev Med 2001 

Mar; 32(3):207-8. Patient Education Handout 

23. Simpler solutions for incontinence. Health 

News 2002 Sep; 8(9):9. News 

24. Behavior therapy and urge incontinence. 

Mayo Clin Health Lett 2003 May; 21(5):4. 

News 

25. New treatment for fecal incontinence. Health 

News 2004 Jul; 10(7):11. News 

26. Summaries for patients. Factors associated 

with acute kidney infections in healthy 

women. Ann Intern Med 2005 Jan 4; 

142(1):I34. Patient Education Handout 

27. Many effective treatments for urinary 

incontinence. There's no need to suffer in 

silence; there are many treatments and 

therapies for this disorder. Health News 2006 

Aug; 12(8):7-8. News 
B-2 

28. Summaries for patients. A simple test to 

diagnose urinary incontinence in women. Ann 

Intern Med 2006 May 16; 144(10):I30. Patient 

Education Handout 

29. Promoting urinary continence in older people. 

Nurs Older People 2006 Apr; 18(3):35-6. 

Comment 

30. Elderly care. Controlling interest. Health Serv 

J 2006 Nov 23; 116(6033):26-7. Comment 

31. When nature calls too often. Johns Hopkins 

Med Lett Health After 50 2006 Nov; 18(9):4-

5. Comment 

32. Aanestad O, Flink R. Interference pattern in 

perineal muscles. A quantitative 

electromyographic study in patients with 

faecal incontinence. Eur J Surg 1994 Feb; 

160(2):111-8. Case-series 

33. Aanestad O, Flink R. Urinary stress 

incontinence. A urodynamic and quantitative 

electromyographic study of the perineal 

muscles. Acta Obstet Gynecol Scand 1999 

Mar; 78(3):245-53. Not eligible outcomes 

34. Aanestad O, Flink R, Haggman M, et al. 

Interference pattern in the urethral sphincter: a 

quantitative electromyographic study in 

patients before and after radical retropubic 

prostatectomy. Scand J Urol Nephrol 1998 

Dec; 32(6):378-82. Not eligible outcomes 

35. Aaron R, Muliyil J, Abraham S. Medicosocial dimensions of menopause: a crosssectional study from rural south India. Natl 

Med J India 2002 Jan-Feb; 15(1):14-7. Not 

eligible level of evidence 

36. Abayomi J, Kirwan J, Hackett A, et al. A 

study to investigate women's experiences of 

radiation enteritis following radiotherapy for 

cervical cancer. J Hum Nutr Diet 2005 Oct; 

18(5):353-63. Case-series 

37. Abbas F, Siddiqui K, Biyabani SR, et al. Early 

surgical results with intent to treat by radical 

retropubic prostatectomy for clinically 

localized prostate cancer. J Pak Med Assoc 

2002 May; 52(5):200-5. Case-series 

38. Abbas SM, Bissett IP, Neill ME, et al. Longterm results of the anterior Delorme's 

operation in the management of symptomatic 

rectocele. Dis Colon Rectum 2005 Feb; 

48(2):317-22. Case-series 

39. Abbas SM, Bissett IP, Neill ME, et al. Longterm outcome of postanal repair in the 

treatment of faecal incontinence. ANZ J Surg 

2005 Sep; 75(9):783-6. Case-series 

40. Abbasakoor F, Nelson M, Beynon J, et al. 

Anal endosonography in patients with 

anorectal symptoms after haemorrhoidectomy. 

Br J Surg 1998 Nov; 85(11):1522-4. Not 

eligible target population 

41. Abdelghany S, Hughes J, Lammers J, et al. 

Biofeedback and electrical stimulation therapy 

for treating urinary incontinence and voiding 

dysfunction: one center's experience. Urol 

Nurs 2001 Dec; 21(6):401-5, 10. No 

associative hypothesis tested 

42. Abdel-Hady el S, Constantine G. Outcome of 

the use of tension-free vaginal tape in women 

with mixed urinary incontinence, previous 

failed surgery, or low valsalva pressure. J 

Obstet Gynaecol Res 2005 Feb; 31(1):38-42. 

Case-series 

43. Abercrombie JF, Rogers J, Swash M. Faecal 

incontinence in myotonic dystrophy. J Neurol 

Neurosurg Psychiatry 1998 Jan; 64(1):128-30. 

Case-reports 

44. Abes M, Sarihan H, Madenci E. Evaluation of 

bone mineral density with dual x-ray 

absorptiometry for osteoporosis in children 

with bladder augmentation. J Pediatr Surg 

2003 Feb; 38(2):230-2. Not eligible target 

population 

45. Abicht-Swensen LM, Debner LK. The 

Minimum Data Set 2.0: a functional 

assessment to predict mortality in nursing 

home residents. Am J Hosp Palliat Care 1999 

May-Jun; 16(3):527-32. Not eligible target 

population 

46. Aboseif S, Tamaddon K, Chalfin S, et al. 

Sacral neuromodulation as an effective 

treatment for refractory pelvic floor 

dysfunction. Urology 2002 Jul; 60(1):52-6. 

Not eligible target population 

47. Aboseif SR, Borirakchanyavat S, Lue TF, et 

al. Continence mechanism of the ileal 

neobladder in women: a urodynamics study. 

World J Urol 1998; 16(6):400-4. Case-series 

48. Aboseif SR, Konety B, Schmidt RA, et al. 

Preoperative urodynamic evaluation: does it 

predict the degree of urinary continence after 

radical retropubic prostatectomy? Urol Int 

1994; 53(2):68-73. Not eligible outcomes 

49. Aboseif SR, O'Connell HE, Usui A, et al. 

Collagen injection for intrinsic sphincteric 

deficiency in men. J Urol 1996 Jan; 

155(1):10-3. Case-series 

50. Abouassaly R, Lane BR, Lakin MM, et al. 

Ejaculatory urine incontinence after radical 

prostatectomy. Urology 2006 Dec; 

68(6):1248-52. Case-series 
B-3 

51. Abouassaly R, Steinberg JR, Lemieux M, et 

al. Complications of tension-free vaginal tape 

surgery: a multi-institutional review. BJU Int 

2004 Jul; 94(1):110-3. Case-series 

52. Abou-Zeid AA. Preliminary experience in 

management of fecal incontinence caused by 

internal anal sphincter injury. Dis Colon 

Rectum 2000 Feb; 43(2):198-202; discussion -

4. Case-series 

53. Abramov Y, Gandhi S, Goldberg RP, et al. 

Site-specific rectocele repair compared with 

standard posterior colporrhaphy. Obstet 

Gynecol 2005 Feb; 105(2):314-8. Not eligible 

outcomes 

54. Abramov Y, Goldberg RP, McGuire M, et al. 

Eosinophilic cystitis after bladder instillation 

with dimethyl sulfoxide. Urology 2004 Jun; 

63(6):1182-3. Case-reports 

55. Abrams P, Blaivas JG, Fowler CJ, et al. The 

role of neuromodulation in the management of 

urinary urge incontinence. BJU Int 2003 Mar; 

91(4):355-9. Secondary data analysis 

56. Abrams P, Cardozo L, Chapple C, et al. 

Comparison of the efficacy, safety, and 

tolerability of propiverine and oxybutynin for 

the treatment of overactive bladder syndrome. 

Int J Urol 2006 Jun; 13(6):692-8. Not eligible 

target population 

57. Abrams P, Donovan JL, de la Rosette JJ, et al. 

International Continence Society "Benign 

Prostatic Hyperplasia" Study: background, 

aims, and methodology. Neurourol Urodyn 

1997; 16(2):79-91. Not eligible outcomes 

58. Abrams P, Kaplan S, De Koning Gans HJ, et 

al. Safety and tolerability of tolterodine for the 

treatment of overactive bladder in men with 

bladder outlet obstruction. J Urol 2006 Mar; 

175(3 Pt 1):999-1004; discussion Not eligible 

exposure 

59. Abu J, Wong MY, Foo KT, et al. A case 

report on vesico-uterine fistula: a very rare 

complication of the lower caesarean section. 

Singapore Med J 2000 Nov; 41(11):554-6. 

Case-reports 

60. Achtergael W, Michielsen D, Gorus FK, et al. 

Indoxyl sulphate and the purple urine bag 

syndrome: a case report. Acta Clin Belg 2006 

Jan-Feb; 61(1):38-41. Case Reports 

61. Adams C, Lorish C, Cushing C, et al. 

Anatomical urinary stress incontinence in 

women with rheumatoid arthritis: its 

frequency and coping strategies. Arthritis Care 

Res 1994 Jun; 7(2):97-103. Not eligible level 

of evidence 

62. Adams D, Samuel D, Goulon-Goeau C, et al. 

The course and prognostic factors of familial 

amyloid polyneuropathy after liver 

transplantation. Brain 2000 Jul; 123 ( Pt 

7):1495-504. Not eligible outcomes 

63. Adams JB, 2nd, Micali S, Moore RG, et al. 

Complications of extraperitoneal balloon 

dilation. J Endourol 1996 Aug; 10(4):375-8. 

Case Reports 

64. Adang EM, Engel GL, Rutten FF, et al. Costeffectiveness of dynamic graciloplasty in 

patients with fecal incontinence. Dis Colon 

Rectum 1998 Jun; 41(6):725-33; discussion 

33-4. Not eligible target population 

65. Addington-Hall J, Lay M, Altmann D, et al. 

Symptom control, communication with health 

professionals, and hospital care of stroke 

patients in the last year of life as reported by 

surviving family, friends, and officials. Stroke 

1995 Dec; 26(12):2242-8. Not eligible 

outcomes 

66. Addison R, Dodd L, Abili J, et al. Stroke, 

catheters and constipation: action plans. Nurs 

Times 2001 Jul 26-Aug 1; 97(30):54-5. Case 

Reports 

67. Adekanmi OA, Freeman RM, Reed H, et al. 

Improving the diagnosis of genuine stress 

incontinence in symptomatic women with 

negative cough stress test: the Distal Urethral 

Electrical Conductance test (DUEC) revisited. 

Int Urogynecol J Pelvic Floor Dysfunct 2003 

Feb; 14(1):9-12; discussion Not eligible 

outcomes 

68. Adkins VK, Mathews RM. Prompted voiding 

to reduce incontinence in community-dwelling 

older adults. J Appl Behav Anal 1997 Spring; 

30(1):153-6. Case-series 

69. Adler US, Kirshblum SC. A new assistive 

device for intermittent self-catheterization in 

men with tetraplegia. J Spinal Cord Med 2003 

Summer; 26(2):155-8. Case-series 

70. Agachan F, Pfeifer J, Joo JS, et al. Results of 

perineal procedures for the treatment of rectal 

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Case-series 

71. Agachan F, Pfeifer J, Wexner SD. 

Defecography and proctography. Results of 

744 patients. Dis Colon Rectum 1996 Aug; 

39(8):899-905. Not eligible outcomes 

72. Agachan F, Reissman P, Pfeifer J, et al. 

Comparison of three perineal procedures for 

the treatment of rectal prolapse. South Med J 

1997 Sep; 90(9):925-32. Case-series 
B-4 

73. Agarwal A, Dhiraaj S, Singhal V, et al. 

Comparison of efficacy of oxybutynin and 

tolterodine for prevention of catheter related 

bladder discomfort: a prospective, 

randomized, placebo-controlled, double-blind 

study. Br J Anaesth 2006 Mar; 96(3):377-80. 

Not eligible outcomes 

74. Aghaji AE, Odoemene C. Ureteric injuries in 

Enugu, Nigeria. East Afr Med J 1999 Apr; 

76(4):184-8. Case-series 

75. Agnew G, Byrne P. The evaluation and 

treatment of female urinary incontinence--a 

comparison of clinical practice in the Republic 

of Ireland with the recommendations of the 

International Continence Society. Ir Med J 

2004 Sep; 97(8):238-40. Not eligible 

outcomes 

76. Agostini A, De Lapparent T, Bretelle F, et al. 

Abscess of the thigh and psoas muscle after 

transobturator suburethral sling procedure. 

Acta Obstet Gynecol Scand 2006; 85(5):628-

9. Case report 

77. Aharon-Peretz J, Kliot D, Finkelstein R, et al. 

Cryptococcal meningitis mimicking vascular 

dementia. Neurology 2004 Jun 8; 

62(11):2135. Case Reports 

78. Ahlering TE, Skarecky D, Lee D, et al. 

Successful transfer of open surgical skills to a 

laparoscopic environment using a robotic 

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radical prostatectomy. J Urol 2003 Nov; 

170(5):1738-41. Case-series 

79. Ahlering TE, Weinberg AC, Razor B. 

Modified Indiana pouch. J Urol 1991 Jun; 

145(6):1156-8. Case-series 

80. Ahn SC, Brown AW. Cobalamin deficiency 

and subacute combined degeneration after 

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Phys Med Rehabil 2005 Jan; 86(1):150-3. 

Case-reports 

81. Ahn SM, Han SW, Choi SH. The results of 

antegrade continence enema using a 

retubularized sigmoidostomy. Pediatr Surg Int 

2004 Jul; 20(7):488-91. Not eligible target 

population 

82. Aitchison M, Fisher BM, Carter K, et al. 

Impaired anal sensation and early diabetic 

faecal incontinence. Diabet Med 1991 Dec; 

8(10):960-3. Not eligible exposure 

83. Aitola P, Hiltunen KM, Matikainen M. 

Functional results of anterior levatorplasty and 

external sphincter plication for faecal 

incontinence. Ann Chir Gynaecol 2000; 

89(1):29-32. Case-series 

84. Aitola PT, Hiltunen KM, Matikainen MJ. 

Functional results of operative treatment of 

rectal prolapse over an 11-year period: 

emphasis on transabdominal approach. Dis 

Colon Rectum 1999 May; 42(5):655-60. 

Case-series 

85. Akpinar H, Cetinel B, Demirkesen O, et al. 

Long-term results of Burch colposuspension. 

Int J Urol 2000 Apr; 7(4):119-25. Case-series 

86. al Baba N, Spencer P, Bower C, et al. 

Continence management. Perspectives 2000 

Fall; 24(3):9-15. Comment 

87. Al-Abany M, Helgason AR, Adolfsson J, et al. 

Reliability of assessment of urgency and other 

symptoms indicating anal sphincter, large 

bowel or urinary dysfunction. Scand J Urol 

Nephrol 2006; 40(5):397-408. Not eligible 

outcomes 

88. al-Abany M, Helgason AR, Cronqvist AK, et 

al. Toward a definition of a threshold for 

harmless doses to the anal-sphincter region 

and the rectum. Int J Radiat Oncol Biol Phys 

2005 Mar 15; 61(4):1035-44. Case-series 

89. Alappat JP. Scimitar sacrum. Neurol India 

2004 Jun; 52(2):288. Case report 

90. Al-Badr A, Fouda K. Suprapubic-assisted 

cystoscopic excision of intravesical tensionfree vaginal tape. J Minim Invasive Gynecol 

2005 Jul-Aug; 12(4):370-1. Case Reports 

91. Albani JM, Zippe CD. Urethral catheter 

removal 3 days after radical retropubic 

prostatectomy is feasible and desirable. 

Prostate Cancer Prostatic Dis 2002; 5(4):291-

5. Not eligible exposure 

92. Albayrak S, Goktas C, Canguven O. Use of 

atresic vagina as a urethra to repair iatrogenic 

incontinence, secondary to a complete 

longitudinal urethral incision. Int J Urol 2005 

Mar; 12(3):325-7. Case Reports 

93. Albertsen PC. Clinical and physical 

determinants for toxicity of 125-I seed 

prostate brachytherapy. J Urol 2005 Nov; 

174(5):1969-70. Comment 

94. Albouy B, Grise P, Sambuis C, et al. Pediatric 

urinary incontinence: evaluation of bladder 

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Feb; 177(2):716-9. Case-series 

95. Albright TS, Garlich CL, Iglesia CB. 

Complications after laparoscopic burch with 

hernia mesh and surgical tacks. Obstet 

Gynecol 2006 Sep; 108(3 Pt 2):718-20. Case 

Reports 
B-5 

96. Alcalay M, Thompson PK, Boone TB. Ball 

urethroplasty combined with MarshallMarchetti-Krantz urethropexy versus 

suburethral sling in patients with intrinsic 

sphincter deficiency and urethral 

hypermobility. Am J Obstet Gynecol 2000 

Dec; 183(6):1348-53; discussion 53-4. Caseseries 

97. Alcini E, Racioppi M, D'Addessi A, et al. The 

ileocaeco-urethrostomy with multiple 

transverse taeniamyotomies for bladder 

replacement: an alternative to detubularized 

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metabolic results after 9 years' experience. Br 

J Urol 1997 Mar; 79(3):333-8. Case-series 

98. Alessi CA, Schnelle JF, MacRae PG, et al. 

Does physical activity improve sleep in 

impaired nursing home residents? J Am 

Geriatr Soc 1995 Oct; 43(10):1098-102. Not 

eligible outcomes 

99. Alessi CA, Schnelle JF, Traub S, et al. 

Psychotropic medications in incontinent 

nursing home residents: association with sleep 

and bed mobility. J Am Geriatr Soc 1995 Jul; 

43(7):788-92. Not eligible outcomes 

100. Alessi CA, Yoon EJ, Schnelle JF, et al. A 

randomized trial of a combined physical 

activity and environmental intervention in 

nursing home residents: do sleep and agitation 

improve? J Am Geriatr Soc 1999 Jul; 

47(7):784-91. Not eligible outcomes 

101. Alexander AA, Liu JB, Merton DA, et al. 

Fecal incontinence: transvaginal US 

evaluation of anatomic causes. Radiology 

1996 May; 199(2):529-32. Case-series 

102. Al-Fahad T, Ismael A, Soliman MO, et al. 

Very early onset of Wernicke's 

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103. Alford DM. How do you carry out the Healthy 

People 2000 and the United States Preventive 

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Oct; 24(10):45-7. Guideline 

104. Alhasso A, Bryden AA, Neilson D. Lithium 

toxicity after urinary diversion with ileal 

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Case-reports 

105. Aliabadi H, Gonzalez R. Success of the 

artificial urinary sphincter after failed surgery 

for incontinence. J Urol 1990 May; 

143(5):987-90. Not eligible target population 

106. Al-Jadid MS, Al-Asmari AK, Al-Moutaery 

KR. Quality of life in males with spinal cord 

injury in Saudi Arabia. Saudi Med J 2004 

Dec; 25(12):1979-85. Cse-series 

107. Allahdin S, McKinley C, Mahmood TA, et al. 

Tension-free vaginal tape: 162 cases in a 

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2004 Aug; 24(5):539-41. Case-series 

108. Allahdin S, McKinley CA, Mahmood TA. 

Tension free vaginal tape: a procedure for all 

ages. Acta Obstet Gynecol Scand 2004 Oct; 

83(10):937-40. Case-series 

109. Allahdin S, McKinley CA, Mahmood TA, et 

al. Vaginal wall erosion of the tension-free 

vaginal tape procedure: an unusual 

complication. J Obstet Gynaecol 2003 Jul; 

23(4):443. Case Reports 

110. Allareddy V, Kennedy J, West MM, et al. 

Quality of life in long-term survivors of 

bladder cancer. Cancer 2006 Jun 1; 

106(11):2355-62. Not eligible outcomes 

111. Allen D. Desperate for improvement. Nurs 

Older People 2006 Jan; 17(10):7. News 

112. Allen-Mersh TG, Turner MJ, Mann CV. 

Effect of abdominal Ivalon rectopexy on 

bowel habit and rectal wall. Dis Colon 

Rectum 1990 Jul; 33(7):550-3. Case-series 

113. Almeida FG, Bruschini H, Srougi M. 

Urodynamic and clinical evaluation of 91 

female patients with urinary incontinence 

treated with perineal magnetic stimulation: 1-

year followup. J Urol 2004 Apr; 171(4):1571-

4; discussion 4-5. Not eligible target 

population 

114. Almeida SH, Gregorio E, El Sayed S, et al. 

Variables predictive of voiding disfunction 

following aponeurotic sling surgery: 

multivariate analysis. Int Braz J Urol 2004 

Jul-Aug; 30(4):302-6. Case-series 

115. Al-Mulhim AA, Al-Gazzar SA, Bahnassy AA. 

Conservative treatment of idiopathic detrusor 

instability in elderly women. Saudi Med J 

2002 May; 23(5):543-5. Not eligible target 

population 

116. Al-Rifaei MA, Al-Rifaei AM, Al-Angabawy 

A. Management of urinary incontinence after 

bulboprostatic anastomotic urethroplasty for 

posterior urethral obstruction secondary to 

pelvic fracture. Scand J Urol Nephrol 2004; 

38(1):42-6. Not eligible outcomes 

117. Al-Samarrai NR, Uman GC, Al-Samarrai T, et 

al. Introducing a new incontinence 

management system for nursing home 

residents. J Am Med Dir Assoc 2007 May; 

8(4):253-61. Not eligible outcomes 
B-6 

118. Al-Shammari SA, Al-Subaie A. Prevalence 

and correlates of depression among Saudi 

elderly. Int J Geriatr Psychiatry 1999 Sep; 

14(9):739-47. Not eligible level of evidence 

119. Alstrup NI, Rasmussen OO, Christiansen J. 

Effect of rectal dilation in fecal incontinence 

with low rectal compliance. Report of a case. 

Dis Colon Rectum 1995 Sep; 38(9):988-9. 

Case-reports 

120. Altan-Yaycioglu R, Yaycioglu O, Aydin 

Akova Y, et al. Ocular side-effects of 

tolterodine and oxybutynin, a single-blind 

prospective randomized trial. Br J Clin 

Pharmacol 2005 May; 59(5):588-92. Not 

eligible outcomes 

121. Altman D, Lopez A, Falconer C, et al. The 

impact of hysterectomy on lower urinary tract 

symptoms. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Dec; 14(6):418-23. Case-series 

122. Altman D, Zetterstrom J, Lopez A, et al. 

Effect of hysterectomy on bowel function. Dis 

Colon Rectum 2004 Apr; 47(4):502-8; 

discussion 8-9. Case-series 

123. Altomare DF, Dodi G, La Torre F, et al. 

Multicentre retrospective analysis of the 

outcome of artificial anal sphincter 

implantation for severe faecal incontinence. 

Br J Surg 2001 Nov; 88(11):1481-6. Caseseries 

124. Altomare DF, Rinaldi M, Pannarale O, et al. 

Vaginal repair of rectocele after dynamic 

graciloplasty for fecal incontinence due to 

imperforate anus. Int J Colorectal Dis 1996; 

11(5):243-5. Case-reports 

125. Altomare DF, Rinaldi M, Pannarale OC, et al. 

Electrostimulated gracilis neosphincter for 

faecal incontinence and in total anorectal 

reconstruction: still an experimental 

procedure? Int J Colorectal Dis 1997; 

12(5):308-12. Case-series 

126. Altomare DF, Rinaldi M, Petrolino M, et al. 

Permanent sacral nerve modulation for fecal 

incontinence and associated urinary 

disturbances. Int J Colorectal Dis 2004 May; 

19(3):203-9. Case-series 

127. Altomare DF, Rinaldi M, Petrolino M, et al. 

Reliability of electrophysiologic anal tests in 

predicting the outcome of sacral nerve 

modulation for fecal incontinence. Dis Colon 

Rectum 2004 Jun; 47(6):853-7. Not eligible 

outcomes 

128. Altomare DF, Rinaldi M, Sallustio PL, et al. 

Long-term effects of stapled 

haemorrhoidectomy on internal anal function 

and sensitivity. Br J Surg 2001 Nov; 

88(11):1487-91. Case-series 

129. Altomare DF, Rinaldi M, Veglia A, et al. 

Contribution of posture to the maintenance of 

anal continence. Int J Colorectal Dis 2001 

Feb; 16(1):51-4. Not eligible outcomes 

130. Alvi T, Reza H. Neuroleptic induced 

incontinence--case report. J Pak Med Assoc 

1997 Jul; 47(7):195-6. Case-reports 

131. Amarenco G, Bayle B, Ismael SS, et al. 

Bulbocavernosus muscle responses after 

suprapubic stimulation: analysis and 

measurement of suprapubic bulbocavernosus 

reflex latency. Neurourol Urodyn 2002; 

21(3):210-3. Case-series 

132. Amarenco G, Ismael SS, Even-Schneider A, et 

al. Urodynamic effect of acute transcutaneous 

posterior tibial nerve stimulation in overactive 

bladder. J Urol 2003 Jun; 169(6):2210-5. Not 

eligible target population 

133. Amaro JL, Oliveira Gameiro MO, Padovani 

CR. Treatment of urinary stress incontinence 

by intravaginal electrical stimulation and 

pelvic floor physiotherapy. Int Urogynecol J 

Pelvic Floor Dysfunct 2003 Aug; 14(3):204-8; 

discussion 8. Not eligible target population 

134. Amaye-Obu FA, Drutz HP. Surgical 

management of recurrent stress urinary 

incontinence: A 12-year experience. Am J 

Obstet Gynecol 1999 Dec; 181(6):1296-307; 

discussion 307-9. Case-series 

135. Ambroze WL, Jr., Dozois RR, Pemberton JH, 

et al. Familial adenomatous polyposis: results 

following ileal pouch-anal anastomosis and 

ileorectostomy. Dis Colon Rectum 1992 Jan; 

35(1):12-5. Case-series 

136. Ambroze WL, Pemberton JH, Bell AM, et al. 

The effect of stool consistency on rectal and 

neorectal emptying. Dis Colon Rectum 1991 

Jan; 34(1):1-7. Not eligible exposure 

137. Ameda K, Kakizaki H, Machino R, et al. 

Laparoscopic antegrade continence enema 

procedure for fecal incontinence in a patient 

with spina bifida. Int J Urol 2003 Jul; 

10(7):401-3. Case-reports 

138. Ameda K, Koyanagi T, Nantani M, et al. The 

relevance of preoperative cystometrography in 

patients with benign prostatic hyperplasia: 

correlating the findings with clinical features 

and outcome after prostatectomy. J Urol 1994 

Aug; 152(2 Pt 1):443-7. Not eligible exposure 

139. Ames D, Hastie IR. Urinary incontinence. 

Postgrad Med J 1995 Apr; 71(834):195-7. No 

associative hypothesis tested 
B-7 

140. Amin AI, Hallbook O, Lee AJ, et al. A 5-cm 

colonic J pouch colo-anal reconstruction 

following anterior resection for low rectal 

cancer results in acceptable evacuation and 

continence in the long term. Colorectal Dis 

2003 Jan; 5(1):33-7. Case-series 

141. Amna MB, Randrianantenaina A, Michel F. 

Colic perforation as a complication of tensionfree vaginal tape procedure. J Urol 2003 Dec; 

170(6 Pt 1):2387. Case Reports 

142. Amoroso L, Pelliccioni G, Ghiselli R, et al. 

Sacral-neuromodulation CT-guided. Radiol 

Med (Torino) 2005 Apr; 109(4):421-9. Caseseries 

143. Amundsen CL, Flynn BJ, Webster GD. 

Anatomical correction of vaginal vault 

prolapse by uterosacral ligament fixation in 

women who also require a pubovaginal sling. 

J Urol 2003 May; 169(5):1770-4. Case-series 

144. Amundsen CL, Guralnick ML, Webster GD. 

Variations in strategy for the treatment of 

urethral obstruction after a pubovaginal sling 

procedure. J Urol 2000 Aug; 164(2):434-7. 

Case-series 

145. Amundsen CL, Romero AA, Jamison MG, et 

al. Sacral neuromodulation for intractable urge 

incontinence: are there factors associated with 

cure? Urology 2005 Oct; 66(4):746-50. Not 

eligible target population 

146. Anand KB, Wolf-Klein GP, Silverstone FA, et 

al. Demographic changes and their financial 

implications. Clin Geriatr Med 1990 Feb; 

6(1):1-12. Review paper; not original data 

147. Anastasiadis AG, Ebert T, Gerharz CD, et al. 

Epididymal metastasis of a prostatic 

carcinoma. Urol Int 1998; 60(2):124-5. Case 

Reports 

148. Anastasiadis AG, Salomon L, Katz R, et al. 

Radical retropubic versus laparoscopic 

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functional outcome. Urology 2003 Aug; 

62(2):292-7. Case-Series 

149. Andersen JT, Sander P. Minimal care--a new 

concept for the management of urinary 

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interdisciplinary incontinence clinic. The way 

ahead? Scand J Urol Nephrol Suppl 1996; 

179:55-60. Not eligible exposure 

150. Anderson CS, Jamrozik KD, Broadhurst RJ, et 

al. Predicting survival for 1 year among 

different subtypes of stroke. Results from the 

Perth Community Stroke Study. Stroke 1994 

Oct; 25(10):1935-44. Not eligible outcomes 

151. Anderson M. Continence. Painting a new 

picture. Nurs Times 1990 Aug 15-21; 

86(33):74. Case Reports 

152. Anderson P. Continence care: improving 

services for older people. Community Nurse 

1997 Apr; 3(3):26-8. Comment 

153. Anderson RU, Mobley D, Blank B, et al. Once 

daily controlled versus immediate release 

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eligible exposure 

154. Andrades M, Paul R, Ambreen A, et al. 

Distribution of lower urinary tract symptoms 

(LUTS) in adult women. J Coll Physicians 

Surg Pak 2004 Mar; 14(3):132-5. Not eligible 

outcomes 

155. Andrews BJ, Reynard JM. Transcutaneous 

posterior tibial nerve stimulation for treatment 

of detrusor hyperreflexia in spinal cord injury. 

J Urol 2003 Sep; 170(3):926. Case-reports 

156. Andrews HO, Shah PJ. Surgical management 

of urethral damage in neurologically impaired 

female patients with chronic indwelling 

catheters. Br J Urol 1998 Dec; 82(6):820-4. 

Csae-series 

157. Andreyev HJ, Vlavianos P, Blake P, et al. 

Gastrointestinal symptoms after pelvic 

radiotherapy: role for the gastroenterologist? 

Int J Radiat Oncol Biol Phys 2005 Aug 1; 

62(5):1464-71. Not eligible level of evidence 

158. Andriesse GI, Gooszen HG, Schipper ME, et 

al. Functional results and visceral perception 

after ileo neo-rectal anastomosis in patients: a 

pilot study. Gut 2001 May; 48(5):683-9. Caseseries 

159. Ang LP, Tay KP, Lim PH, et al. Endoscopic 

injection of collagen for the treatment of 

female urinary stress incontinence. Int J Urol 

1997 May; 4(3):254-8. Not eligible target 

population 

160. Anger JT, Litwin MS, Wang Q, et al. 

Complications of sling surgery among female 

Medicare beneficiaries. Obstet Gynecol 2007 

Mar; 109(3):707-14. Not eligible outcomes 

161. Anger JT, Rodriguez LV, Wang Q, et al. 

Racial disparities in the surgical management 

of stress incontinence among female Medicare 

beneficiaries. J Urol 2007 May; 177(5):1846-

50. Not eligible outcomes 

162. Anger JT, Rodriguez LV, Wang Q, et al. The 

role of provider volume on outcomes after 

sling surgery for stress urinary incontinence. J 

Urol 2007 Apr; 177(4):1457-62; discussion 

62. Not eligible exposure 
B-8 

163. Anger JT, Saigal CS, Madison R, et al. 

Increasing costs of urinary incontinence 

among female Medicare beneficiaries. J Urol 

2006 Jul; 176(1):247-51; discussion 51. Not 

eligible outcomes 

164. Anghelacopoulos SE, Tagarakis GI, Pilpilidis 

I, et al. Albumin-glutaraldehyde bioadhesive 

("Bioglue") for prevention of postoperative 

complications after stapled hemorrhoidopexy: 

A randomized controlled trial. Wien Klin 

Wochenschr 2006 Aug; 118(15-16):469-72. 

Not eligible exposure 

165. Angioli R, Gomez-Marin O, Cantuaria G, et 

al. Severe perineal lacerations during vaginal 

delivery: the University of Miami experience. 

Am J Obstet Gynecol 2000 May; 

182(5):1083-5. Not eligible outcomes 

166. Aniuliene R, Bariliene S. New surgical 

technique for the treatment of urinary 

incontinence in Clinic of Obstetrics and 

Gynecology of Kaunas University of 

Medicine. Medicina (Kaunas) 2006; 

42(9):725-31. Case-series 

167. Ankardal M, Heiwall B, Lausten-Thomsen N, 

et al. Short- and long-term results of the 

tension-free vaginal tape procedure in the 

treatment of female urinary incontinence. Acta 

Obstet Gynecol Scand 2006; 85(8):986-92. 

Case-series 

168. Ansquer Y, Marcollet A, Yazbeck C, et al. 

The suburethral sling for female stress urinary 

incontinence: a retropubic or obturator 

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2004 Aug; 11(3):353-8. Not eligible target 

population 

169. Antonakos CL, Miller JM, Sampselle CM. 

Indices for studying urinary incontinence and 

levator ani function in primiparous women. J 

Clin Nurs 2003 Jul; 12(4):554-61. Not eligible 

outcomes 

170. Antovska SV, Dimitrov DG. Vaginosacral 

colpopexy (VSC)--a new modification of the 

Mc Call operation using vaginosacral 

ligaments as autologous sliding grafts in 

posthysterectomy vault prolapse. Bratisl Lek 

Listy 2006; 107(3):62-72. 

171. Apostolidis A, Popat R, Yiangou Y, et al. 

Decreased sensory receptors P2X3 and 

TRPV1 in suburothelial nerve fibers following 

intradetrusor injections of botulinum toxin for 

human detrusor overactivity. J Urol 2005 Sep; 

174(3):977-82; discussion 82-3. Not eligible 

outcomes 

172. Appell RA. Clinical efficacy and safety of 

tolterodine in the treatment of overactive 

bladder: a pooled analysis. Urology 1997 Dec; 

50(6A Suppl):90-6; discussion 7-9. Review 

and meta-analysis 

173. Appell RA, Baum N. Evaluation of urinary 

incontinence in the elderly. J La State Med 

Soc 1992 Nov; 144(11):517-22. Comment 

174. Appell RA, Sand P, Dmochowski R, et al. 

Prospective randomized controlled trial of 

extended-release oxybutynin chloride and 

tolterodine tartrate in the treatment of 

overactive bladder: results of the OBJECT 

Study. Mayo Clin Proc 2001 Apr; 76(4):358-

63. Not eligible exposure 

175. Appell RA, Vasavada SP, Rackley RR, et al. 

Percutaneous antegrade collagen injection 

therapy for urinary incontinence following 

radical prostatectomy. Urology 1996 Nov; 

48(5):769-72. Not eligible target population 

176. Aprikian A, Berardinucci G, Pike J, et al. 

Experience with the AS-800 artificial urinary 

sphincter in myelodysplastic children. Can J 

Surg 1992 Aug; 35(4):396-400. Not eligible 

target population 

177. Arai Y, Okubo K, Aoki Y, et al. Patientreported quality of life after radical 

prostatectomy for prostate cancer. Int J Urol 

1999 Feb; 6(2):78-86. Case-series 

178. Arai Y, Taki Y, Kawase N, et al. Orthotopic 

ileal neobladder in male patients: functional 

outcomes of 66 cases. Int J Urol 1999 Aug; 

6(8):388-92. Case-series 

179. Araki I, Du S, Kamiyama M, et al. 

Overexpression of epithelial sodium channels 

in epithelium of human urinary bladder with 

outlet obstruction. Urology 2004 Dec; 

64(6):1255-60. Not eligible outcomes 

180. Araki Y, Isomoto H, Tsuzi Y, et al. 

Transsacral rectopexy for complete rectal 

prolapse. Kurume Med J 1998; 45(3):235-8. 

Case-reports 

181. Araki Y, Isomoto H, Tsuzi Y, et al. 

Transsacral rectopexy for recurrent complete 

rectal prolapse. Surg Today 1999; 29(9):970-

2. Case-reports 

182. Arena MG, Di Rosa AE, Arcudi L, et al. 

Voiding disorders in patients with 

cerebrovascular disease. Funct Neurol 1992 

Jan-Feb; 7(1):47-9. Case-series 

183. Armstrong RB, Luber KM, Peters KM. 

Comparison of dry mouth in women treated 

with extended-release formulations of 

oxybutynin or tolterodine for overactive 

bladder. Int Urol Nephrol 2005; 37(2):247-52. 

Not eligible outcomes 
B-9 

184. Arnaud A, Sarles JC, Sielezneff I, et al. 

Sphincter repair without overlapping for fecal 

incontinence. Dis Colon Rectum 1991 Sep; 

34(9):744-7. Case-series 

185. Aron M, Manal K, Gupta NP. Urinary 

incontinence: an unusual manifestation of a 

forgotten stent. Br J Urol 1998 May; 

81(5):766-7. Case Reports 

186. Aronovitch SA. A descriptive study of the 

career mobility of ET nurses. J Wound 

Ostomy Continence Nurs 1995 Jul; 22(4):166-

72. Not eligible target population 

187. Aronson MP, Bates SM, Jacoby AF, et al. 

Periurethral and paravaginal anatomy: an 

endovaginal magnetic resonance imaging 

study. Am J Obstet Gynecol 1995 Dec; 

173(6):1702-8; discussion 8-10. Not eligible 

outcomes 

188. Aronson MP, Lee RA, Berquist TH. Anatomy 

of anal sphincters and related structures in 

continent women studied with magnetic 

resonance imaging. Obstet Gynecol 1990 

Nov; 76(5 Pt 1):846-51. Case-series 

189. Arpa Gutierrez J, Morales C, Lara M, et al. 

Type I familial amyloid polyneuropathy and 

pontine haemorrhage. Acta Neuropathol (Berl) 

1993; 86(5):542-5. Case Reports 

190. Arrowsmith SD. Genitourinary reconstruction 

in obstetric fistulas. J Urol 1994 Aug; 152(2 Pt 

1):403-6. Case-series 

191. Arruda RM, Castro RA, Sartori MG, et al. 

Clinical and urodynamic evaluation of women 

with detrusor instability before and after 

functional pelvic floor electrostimulation. Clin 

Exp Obstet Gynecol 2003; 30(4):220-2. Caseseries 

192. Arumugam PJ, Patel B, Rieck G, et al. Are 

obstetric risk factors and bowel symptoms 

associated with defaecographic and 

manometric abnormalities in women awaiting 

hysterectomy? J Obstet Gynaecol 2004 Apr; 

24(3):274-8. Case-series 

193. Arunkalaivanan AS, Barrington JW. 

Questionnaire-based survey on obstetricians 

and gynaecologists' attitudes towards the 

surgical management of urinary incontinence 

in women during their childbearing years. Eur 

J Obstet Gynecol Reprod Biol 2003 May 1; 

108(1):85-93. Not eligible outcomes 

194. Arunkalaivanan AS, Smith AR. Bladder 

calculus after laparoscopic colposuspension. J 

Obstet Gynaecol 2002 Jan; 22(1):101. Case 

Reports 

195. Arya LA, Myers DL, Jackson ND. Dietary 

caffeine intake and the risk for detrusor 

instability: a case-control study. Obstet 

Gynecol 2000 Jul; 96(1):85-9. Not eligible 

target population 

196. Ashworth PD, Hagan MT. The meaning of 

incontinence: a qualitative study of nongeriatric urinary incontinence sufferers. J Adv 

Nurs 1993 Sep; 18(9):1415-23. Not eligible 

outcomes 

197. Aslan E, Beji NK, Coskun A, et al. An 

assessment of the importance of pad testing in 

stress urinary incontinence and the effects of 

incontinence on the life quality of women. Int 

Urogynecol J Pelvic Floor Dysfunct 2003 

Nov; 14(5):316-9; discussion 20. Not eligible 

outomces 

198. Aslan G, Koseoglu H, Sadik O, et al. Sexual 

function in women with urinary incontinence. 

Int J Impot Res 2005 May-Jun; 17(3):248-51. 

Not eligible outcomes 

199. Aslan V, Akay OM, Durak B, et al. 

Langerhans cell histiocytosis with 

transformation to acute leukemia showing 

45,X, t(8; 21), 5q-, -Y karyotype. Leuk 

Lymphoma 2002 Aug; 43(8):1683-5. Case 

Reports 

200. Atahan O, Kayigil O, Metin A. Modified four 

corner bladder neck suspension in anatomical 

stress incontinence with moderate cystocele. 

Int Urol Nephrol 1998; 30(4):439-44. Caseseries 

201. Atala A, Bauer SB, Dyro FM, et al. Bladder 

functional changes resulting from 

lipomyelomeningocele repair. J Urol 1992 

Aug; 148(2 Pt 2):592-4. Not eligible target 

population 

202. Atan A, Konety BR, Erickson JR, et al. 

Tolterodine for overactive bladder: time to 

onset of action, preferred dosage, and 9-month 

follow-up. Tech Urol 1999 Jun; 5(2):67-70. 

Not eligible target population 

203. Athanasiou S, Khullar V, Boos K, et al. 

Imaging the urethral sphincter with threedimensional ultrasound. Obstet Gynecol 1999 

Aug; 94(2):295-301. Not eligible outcomes 

204. Athanasopoulos A, Barlas P, Perimenis P, et 

al. Long-term results of transvaginal 

colposuspension for the treatment of genuine 

stress incontinence combined with vaginal 

hysterectomy. Urol Int 2003; 71(1):41-4. 

Case-series 
B-10 

205. Athanasopoulos A, Liatsikos EN, Perimenis P, 

et al. Delayed suture intravesical migration as 

a complication of a Stamey endoscopic 

bladder neck suspension. Int Urol Nephrol 

2002; 34(1):5-7. Case-reports 

206. Athanasopoulos A, Perimenis P, Giannitsas K, 

et al. The relationship between the perineal 

length measurements and the urodynamic 

stress incontinence. Int Urol Nephrol 2005; 

37(4):701-5. Not eligible level of evidence 

207. Athanassopoulos A, Barbalias G. Burch 

colposuspension versus stamey endoscopic 

bladder neck suspension: a urodynamic 

appraisal. Urol Int 1996; 56(1):23-7. CaseSeries 

208. Athanassopoulos A, Melekos MD, Speakman 

M, et al. Stamey endoscopic vesical neck 

suspension in female urinary stress 

incontinence: results and changes in various 

urodynamic parameters. Int Urol Nephrol 

1994; 26(3):293-9. Not eligible target 

population 

209. Athanassopoulos A, Perimenis P, Markou S, 

et al. Prognostic factors for the operative 

correction of stress urinary incontinence. Int 

Urol Nephrol 1995; 27(1):43-9. Not eligible 

outcomes 

210. Auguste T, Dubreuil A, Bost R, et al. 

Technical and functional results after 

laparoscopic rectopexy to the promontory for 

complete rectal prolapse. Prospective study in 

54 consecutive patients. Gastroenterol Clin 

Biol 2006 May; 30(5):659-63. Case-series 

211. Aukee P, Usenius JP, Kirkinen P. An 

evaluation of pelvic floor anatomy and 

function by MRI. Eur J Obstet Gynecol 

Reprod Biol 2004 Jan 15; 112(1):84-8. Not 

eligible outcomes 

212. Aungst M, Wagner M. Foley balloon to 

tamponade bleeding in the retropubic space. 

Obstet Gynecol 2003 Nov; 102(5 Pt 1):1037-

8. Case-reports 

213. Austin P, Spyropoulos E, Arango H, et al. The 

failed anti-incontinence mechanism: a flap 

valve or cecal wrap for surgical 

reconstruction. J Urol 1997 May; 

157(5):1638-41. Case-series 

214. Austoni E, Guarneri A, Colombo F, et al. The 

new transperineal-prerectal approach in 

posterior urethroplasty. Arch Ital Urol Androl 

2005 Jun; 77(2):122-4. Case-series 

215. Autry MG, Davis JW, Sanders R. Type III 

stress urinary incontinence: response to 

interdisciplinary pelvic physiotherapy. Urol 

Nurs 2002 Aug; 22(4):251-5. Case-reports 

216. Auwad W, Bombieri L, Adekanmi O, et al. 

The development of pelvic organ prolapse 

after colposuspension: a prospective, longterm follow-up study on the prevalence and 

predisposing factors. Int Urogynecol J Pelvic 

Floor Dysfunct 2006 Jun; 17(4):389-94. Caseseries 

217. Avant OL, Jones JA, Beck H, et al. New 

method to improve treatment outcomes for 

radical prostatectomy. Urology 2000 Oct 1; 

56(4):658-62. Case-series 

218. Averink M, Melein L, Duker PC. Establishing 

diurnal bladder control with the response 

restriction method: extended study on its 

effectiveness. Res Dev Disabil 2005 Mar-Apr; 

26(2):143-51. Not eligible outcomes 

219. Awad RA. Biofeedback treatment of fecal 

incontinence incorporating a mental variable 

without instrumentation: a prospective pilot 

study in Hispanic population. Acta 

Gastroenterol Latinoam 2005; 35(4):230-7. 

Not eligible target population 

220. Awad SA, Al-Zahrani HM, Gajewski JB, et al. 

Long-term results and complications of 

augmentation ileocystoplasty for idiopathic 

urge incontinence in women. Br J Urol 1998 

Apr; 81(4):569-73. Case-series 

221. Awad SA, Gajewski JB, Katz NO, et al. Final 

diagnosis and therapeutic implications of 

mixed symptoms of urinary incontinence in 

women. Urology 1992 Apr; 39(4):352-7. Not 

eligible outcomes 

222. Axelsen SM, Bek KM. Anterior vaginal wall 

repair using local anaesthesia. Eur J Obstet 

Gynecol Reprod Biol 2004 Feb 10; 

112(2):214-6. Not eligible outcomes 

223. Axelsen SM, Petersen LK. Urogynaecological 

dysfunction after radical hysterectomy. Eur J 

Surg Oncol 2006 May; 32(4):445-9. Not 

eligible level of evidence 

224. Ayabaca SM, Zbar AP, Pescatori M. Anal 

continence after rectocele repair. Dis Colon 

Rectum 2002 Jan; 45(1):63-9. Case-series 

225. Ayan S, Gokce G, Kilicarslan H, et al. An 

unusual cause of incontinence: urethral coitus. 

Scand J Urol Nephrol 2001 Jun; 35(3):254. 

Case-reports 

226. Ayas S, Leblebici B, Sozay S, et al. The effect 

of abdominal massage on bowel function in 

patients with spinal cord injury. Am J Phys 

Med Rehabil 2006 Dec; 85(12):951-5. Not 

eligible outcomes 

227. Aygen EM, Ekmekcioglu O, Basbug M. The 

menopause and bladder weight. Int 

Urogynecol J Pelvic Floor Dysfunct 1999; 

10(5):316-20. Not eligible exposure 
B-11 

228. Ayhan A, Esin S, Guven S, et al. The 

Manchester operation for uterine prolapse. Int 

J Gynaecol Obstet 2006 Mar; 92(3):228-33. 

Not eligible exposure 

229. Baatenburg de Jong H, Admiraal H. 

Comparing cost per use of 3M Cavilon No 

Sting Barrier Film with zinc oxide oil in 

incontinent patients. J Wound Care 2004 Oct; 

13(9):398-400. Not eligible outcomes 

230. Baba T, Koizumi M, Tanaka R, et al. Surgical 

management of genital prolapse: is chain 

cystourethrography useful for evaluating 

anatomical corrections and urinary symptoms 

after surgery? J Obstet Gynaecol Res 2000 

Aug; 26(4):289-94. Case-series 

231. Bachmann G. Urogenital ageing: an old 

problem newly recognized. Maturitas 1995 

Dec; 22 Suppl:S1-S5. Review 

232. Bacon CG, Giovannucci E, Testa M, et al. The 

association of treatment-related symptoms 

with quality-of-life outcomes for localized 

prostate carcinoma patients. Cancer 2002 Feb 

1; 94(3):862-71. Not eligible outcomes 

233. Bader P, Hugonnet CL, Burkhard FC, et al. 

Inefficient urethral milking secondary to 

urethral dysfunction as an additional risk 

factor for incontinence after radical 

prostatectomy. J Urol 2001 Dec; 166(6):2247-

52. Case-series 

234. Badvie S, Andreyev HJ. Topical 

phenylephrine in the treatment of radiationinduced faecal incontinence. Clin Oncol (R 

Coll Radiol) 2005 Apr; 17(2):122-6. Not 

eligible target population 

235. Baessler K, Bircher MD, Stanton SL. Pelvic 

floor dysfunction in women after pelvic 

trauma. Bjog 2004 May; 111(5):499-502. 

Case-series 

236. Baessler K, Hewson AD, Tunn R, et al. 

Severe mesh complications following 

intravaginal slingplasty. Obstet Gynecol 2005 

Oct; 106(4):713-6. Case-series 

237. Baessler K, Stanton SL. Does Burch 

colposuspension cure coital incontinence? Am 

J Obstet Gynecol 2004 Apr; 190(4):1030-3. 

Case-series 

238. Baeten CG, Geerdes BP, Adang EM, et al. 

Anal dynamic graciloplasty in the treatment of 

intractable fecal incontinence. N Engl J Med 

1995 Jun 15; 332(24):1600-5. Case-series 

239. Baeten CG, Konsten J, Heineman E, et al. 

Dynamic graciloplasty for anal atresia. J 

Pediatr Surg 1994 Jul; 29(7):922-4; discussion 

5. Case-series 

240. Baeten CG, Konsten J, Spaans F, et al. 

Dynamic graciloplasty for treatment of faecal 

incontinence. Lancet 1991 Nov 9; 

338(8776):1163-5. Case-series 

241. Baeten CG, Uludag OO, Rongen MJ. 

Dynamic graciloplasty for fecal incontinence. 

Microsurgery 2001; 21(6):230-4. Not eligible 

target population 

242. Baffy G, Strate LL, Krnsky ML. Image of the 

month. Adherent, yellow exudate speckled 

with black spots in the distal two thirds of the 

esophagus. Diagnosis: This distinctive 

endoscopic image shows an acute necrotizing 

esophagitis, also known as the black 

esophagus. Gastroenterology 2000 Feb; 

118(2):252, 453. Not eligible exposure 

243. Bafghi A, Valerio L, Benizri EI, et al. 

Comparison between monofilament and 

multifilament polypropylene tapes in urinary 

incontinence. Eur J Obstet Gynecol Reprod 

Biol 2005 Oct 1; 122(2):232-6. Not eligible 

exposure 

244. Bagi P, Biering-Sorensen F. Botulinum toxin 

A for treatment of neurogenic detrusor 

overactivity and incontinence in patients with 

spinal cord lesions. Scand J Urol Nephrol 

2004; 38(6):495-8. Not eligible target 

population 

245. Bahl R, Strachan B, Murphy DJ. Pelvic floor 

morbidity at 3 years after instrumental 

delivery and cesarean delivery in the second 

stage of labor and the impact of a subsequent 

delivery. Am J Obstet Gynecol 2005 Mar; 

192(3):789-94. Not eligible level of evidence 

246. Bai SW, Cho JM, Kwon HS, et al. The 

relationship between maximal urethral closure 

pressure and functional urethral length in 

anterior vaginal wall prolapse patients 

according to stage and age. Yonsei Med J 

2005 Jun 30; 46(3):408-13. Case-series 

247. Bai SW, Chung KA, Rha KH, et al. 

Correlation between urodynamic test results, 

perineal ultrasound and degree of stress 

urinary incontinence. J Reprod Med 2003 Sep; 

48(9):718-22. Not eligible target population 

248. Bai SW, Jeon JD, Chung KA, et al. The 

effectiveness of modified six-corner 

suspension in patients with paravaginal defect 

and stress urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2002; 

13(5):303-7. Case-series 

249. Bai SW, Jeon MJ, Kim JY, et al. Relationship 

between stress urinary incontinence and pelvic 

organ prolapse. Int Urogynecol J Pelvic Floor 

Dysfunct 2002; 13(4):256-60; discussion 60. 

Case-series 
B-12 

250. Bai SW, Jung BH, Chung BC, et al. 

Relationship between urinary profile of the 

endogenous steroids and postmenopausal 

women with stress urinary incontinence. 

Neurourol Urodyn 2003; 22(3):198-205. Not 

eligible level of evidence 

251. Bai SW, Jung YW, Kwon HS, et al. The role 

of estrogen receptor, progesterone receptor 

and p53 in development of stress urinary 

incontinence. Yonsei Med J 2004 Oct 31; 

45(5):885-90. Case-series 

252. Bai SW, Kang JY, Rha KH, et al. Relationship 

of urodynamic parameters and obesity in 

women with stress urinary incontinence. J 

Reprod Med 2002 Jul; 47(7):559-63. Not 

eligible level of evidence 

253. Bai SW, Kwon JY, Chung da J, et al. 

Differences in urodynamic study, perineal 

sonography and treatment outcome according 

to urethrovesical junction hypermobility in 

stress urinary incontinence. J Obstet Gynaecol 

Res 2006 Apr; 32(2):206-11. Case-series 

254. Bai SW, Lee JW, Shin JS, et al. The predictive 

values of various parameters in the diagnosis 

of stress urinary incontinence. Yonsei Med J 

2004 Apr 30; 45(2):287-92. Not eligible level 

of evidence 

255. Bai SW, Park JH, Kim SK, et al. Analysis of 

the success rates of Burch colposuspension in 

relation to Valsalva leak-point pressure. J 

Reprod Med 2005 Mar; 50(3):189-92. Not 

eligible outcomes 

256. Bai SW, Roh JL, Kim JY, et al. Outcomes and 

surgical therapeutic index of Burch 

colposuspension in stress urinary 

incontinence. J Reprod Med 2003 Feb; 

48(2):102-6. No associative hypothesis tested 

257. Baig LA, Karim SA. Age at menopause, and 

knowledge of and attitudes to menopause, of 

women in Karachi, Pakistan. J Br Menopause 

Soc 2006 Jun; 12(2):71-4. Not eligible 

outcomes 

258. Baik SH, Kim NK, Lee KY, et al. Hand-sewn 

coloanal anastomosis for distal rectal cancer: 

long-term clinical outcomes. J Gastrointest 

Surg 2005 Jul-Aug; 9(6):775-80. No 

associative hypothesis tested 

259. Baird AD, Frimberger D, Gearhart JP. 

Reconstructive lower urinary tract surgery in 

incontinent adolescents with 

exstrophy/epispadias complex. Urology 2005 

Sep; 66(3):636-40. Not eligible target 

population 

260. Bakas P, Liapis A, Giner M, et al. Quality of 

life in relation to TVT procedure for the 

treatment of stress urinary incontinence. Acta 

Obstet Gynecol Scand 2006; 85(6):748-52. 

Case-series 

261. Bakas P, Liapis A, Karandreas A, et al. 

Pudendal nerve terminal motor latency in 

women with genuine stress incontinence and 

prolapse. Gynecol Obstet Invest 2001; 

51(3):187-90. Case-series 

262. Bakas P, Liapis A, Salamalekis E, et al. 

Tension-free vaginal tape efficacy in relation 

to collagen quantity of pubocervical fascia. 

Gynecol Obstet Invest 2004; 57(3):149-52. 

Case-series 

263. Bakas PG, Liapis AE, Zervolea I, et al. 

mRNA assessment for procollagen production 

in women with genuine stress urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2004 Nov-Dec; 15(6):429-31; 

discussion 31. Not eligible outcomes 

264. Baker DI, Bice TW. The influence of urinary 

incontinence on publicly financed home care 

services to low-income elderly people. 

Gerontologist 1995 Jun; 35(3):360-9. Not 

eligible exposure 

265. Bakke A, Myhr KM, Gronning M, et al. 

Bladder, bowel and sexual dysfunction in 

patients with multiple sclerosis--a cohort 

study. Scand J Urol Nephrol Suppl 1996; 

179:61-6. Not eligible outcomes 

266. Bakx R, Sprangers MA, Oort FJ, et al. 

Development and validation of a colorectal 

functional outcome questionnaire. Int J 

Colorectal Dis 2005 Mar; 20(2):126-36. Not 

eligible outcomes 

267. Balash Y, Peretz C, Leibovich G, et al. Falls 

in outpatients with Parkinson's disease: 

frequency, impact and identifying factors. J 

Neurol 2005 Nov; 252(11):1310-5. Not 

eligible outcomes 

268. Bale S, Tebble N, Jones V, et al. The benefits 

of implementing a new skin care protocol in 

nursing homes. J Tissue Viability 2004 Apr; 

14(2):44-50. Not eligible outcomes 

269. Balkrishnan R, Bhosle MJ, Camacho FT, et al. 

Predictors of medication adherence and 

associated health care costs in an older 

population with overactive bladder syndrome: 

a longitudinal cohort study. J Urol 2006 Mar; 

175(3 Pt 1):1067-71; discussion 71-2. Not 

eligible outcomes 
B-13 

270. Balmforth JR, Mantle J, Bidmead J, et al. A 

prospective observational trial of pelvic floor 

muscle training for female stress urinary 

incontinence. BJU Int 2006 Oct; 98(4):811-7. 

Not eligible target population 

271. Baloh RH, Jen JC, Kim G, et al. Chronic 

cough due to Thr124Met mutation in the 

peripheral myelin protein zero (MPZ gene). 

Neurology 2004 May 25; 62(10):1905-6. Case 

Reports 

272. Bamshad BR, Hadley HR, Ruckle HC, et al. 

Perfusion sphincterometry for objective 

evaluation of postprostatectomy intrinsic 

sphincter deficiency. Urology 1999 May; 

53(5):968-73. Not eligible outcomes 

273. Bander NH. Initial results with slightly 

modified Kock pouch. Urology 1991 Feb; 

37(2):100-5. Case-series 

274. Banerjee AK, Jehle EC, Kreis ME, et al. 

Prospective study of the proctographic and 

functional consequences of transanal 

endoscopic microsurgery. Br J Surg 1996 Feb; 

83(2):211-3. Case-series 

275. Banerjee N, Deka D, Roy KK, et al. 

Vesicocervical fistula: an unusual 

presentation. Aust N Z J Obstet Gynaecol 

2000 May; 40(2):219-20. Case-reports 

276. Banerjee S, Fusey SS. Vesicovaginal fistula 

with bladder eversion: a rare complication of 

third degree cervical descent. J Obstet 

Gynaecol Can 2006 Feb; 28(2):160-1. Case 

Reports 

277. Bang LM, Easthope SE, Perry CM. 

Transdermal oxybutynin: for overactive 

bladder. Drugs Aging 2003; 20(11):857-64. 

Review 

278. Bang RL. Penile oedema induced by 

continuous condom catheter use and 

mimicking keloid scar. Scand J Urol Nephrol 

1994 Sep; 28(3):333-5. Case-seport 

279. Banks FC, Rao AR, Beatty J, et al. Erectile 

incontinence post radical prostatectomy. J R 

Soc Med 2006 May; 99(5):258-9. Case 

Reports 

280. Barabas G, Molstad S. No association 

between elevated post-void residual volume 

and bacteriuria in residents of nursing homes. 

Scand J Prim Health Care 2005 Mar; 

23(1):52-6. Not eligible outcomes 

281. Barber MD, Kuchibhatla MN, Pieper CF, et 

al. Psychometric evaluation of 2 

comprehensive condition-specific quality of 

life instruments for women with pelvic floor 

disorders. Am J Obstet Gynecol 2001 Dec; 

185(6):1388-95. Not eligible outcomes 

282. Barber MD, Visco AG, Wyman JF, et al. 

Sexual function in women with urinary 

incontinence and pelvic organ prolapse. 

Obstet Gynecol 2002 Feb; 99(2):281-9. Not 

eligible outcomes 

283. Barber MD, Walters MD, Bump RC. Short 

forms of two condition-specific quality-of-life 

questionnaires for women with pelvic floor 

disorders (PFDI-20 and PFIQ-7). Am J Obstet 

Gynecol 2005 Jul; 193(1):103-13. Not eligible 

outcomes 

284. Barbic M, Kralj B. Effect of intra-abdominal 

position of the bladder neck and stability of its 

supporting structures on pressure transmission 

ratio after colposuspension. Int Urogynecol J 

Pelvic Floor Dysfunct 2000; 11(2):97-102. 

Case-series 

285. Barbic M, Kralj B, Cor A. Compliance of the 

bladder neck supporting structures: 

importance of activity pattern of levator ani 

muscle and content of elastic fibers of 

endopelvic fascia. Neurourol Urodyn 2003; 

22(4):269-76. Not eligible outcomes 

286. Bardoux N, Leroi AM, Touchais JY, et al. 

Difficult defaecation and/or faecal 

incontinence as a presenting feature of 

neurologic disorders in four patients. 

Neurogastroenterol Motil 1997 Mar; 9(1):13-

8. Case Reports 

287. Bardsley A. Promoting continence. Nurs 

Stand 2002 Sep 25-Oct 1; 17(2):112. 

Comment 

288. Bardsley M, Pather S, Neesham D, et al. 

Benign endocervical cystic glandular change 

mimicking minimal deviation adenocarcinoma 

of the cervix on magnetic resonance imaging: 

a case report. Aust N Z J Obstet Gynaecol 

2004 Aug; 44(4):358-9. Not eligible exposure 

289. Barer DH. The influence of visual and tactile 

inattention on predictions for recovery from 

acute stroke. Q J Med 1990 Jan; 74(273):21-

32. Not eligible outcomes 

290. Barisic G, Krivokapic Z, Markovic V, et al. 

The role of overlapping sphincteroplasty in 

traumatic fecal incontinence. Acta Chir Iugosl 

2000; 47(4 Suppl 1):37-41. Case-series 

291. Barisic GI, Krivokapic ZV, Markovic VA, et 

al. Outcome of overlapping anal sphincter 

repair after 3 months and after a mean of 80 

months. Int J Colorectal Dis 2006 Jan; 

21(1):52-6. No associative hypothesis tested 

292. Barker J, Jr., Wallner K, Merrick G. Gross 

hematuria after prostate brachytherapy. 

Urology 2003 Feb; 61(2):408-11. Not eligible 

level of evidence 
B-14 

293. Barkin J, Corcos J, Radomski S, et al. A 

randomized, double-blind, parallel-group 

comparison of controlled- and immediaterelease oxybutynin chloride in urge urinary 

incontinence. Clin Ther 2004 Jul; 26(7):1026-

36. Not eligible exposure 

294. Barlas P, Hatzipapas J, Bias A, et al. 

Transvaginal colposuspension for the 

treatment of genuine stress incontinence 

combined with vaginal hysterectomy: a 

preliminary report. Int Urogynecol J Pelvic 

Floor Dysfunct 1996; 7(1):20-3. Case-series 

295. Barnes NM, Dmochowski RR, Park R, et al. 

Pubovaginal sling and pelvic prolapse repair 

in women with occult stress urinary 

incontinence: effect on postoperative 

emptying and voiding symptoms. Urology 

2002 Jun; 59(6):856-60. Case-series 

296. Barnick CG, Cardozo LD. Denervation and 

re-innervation of the urethral sphincter in the 

aetiology of genuine stress incontinence: an 

electromyographic study. Br J Obstet 

Gynaecol 1993 Aug; 100(8):750-3. Not 

eligible outcomes 

297. Barranger E, Fritel X, Kadoch O, et al. Results 

of transurethral injection of silicone microimplants for females with intrinsic sphincter 

deficiency. J Urol 2000 Nov; 164(5):1619-22. 

Case-series 

298. Barreto F, Dall'Oglio M, Srougi M. Recurrent 

vesicourethal stenosis after radical 

prostatectomy: how to treat it? Int Braz J Urol 

2005 Nov-Dec; 31(6):552-4. Case-series 

299. Barrett J. Treating faecal incontinence. Nurs 

Times 1990 Aug 15-21; 86(33):66-70. 

Comment 

300. Barrett JA, Brocklehurst JC, Kiff ES, et al. 

Rectal motility studies in faecally incontinent 

geriatric patients. Age Ageing 1990 Sep; 

19(5):311-7. Not eligible outcomes 

301. Barrier A, Martel P, Gallot D, et al. Long-term 

functional results of colonic J pouch versus 

straight coloanal anastomosis. Br J Surg 1999 

Sep; 86(9):1176-9. Case-series 

302. Barrington JW, Abdel-Fattah M, 

Arunkalaivanan AS, et al. Longitudinal study 

of Pelvicol pubovaginal slings using magnetic 

resonance imaging. J Obstet Gynaecol 2004 

Aug; 24(5):542-6. Case-series 

303. Barrington JW, Arunkalaivanan AS, Swart M. 

Post-colposuspension syndrome following a 

tension-free vaginal tape procedure. Int 

Urogynecol J Pelvic Floor Dysfunct 2002; 

13(3):187-8. Case Reports 

304. Barroso U, Jr., Duel B, Barthold JS, et al. 

Orthotopic urethral substitution in female 

patients using the mitrofanoff principle. J Urol 

1999 Jan; 161(1):251-3. Not eligible target 

population 

305. Barrows B, Bavendam T, Leach GE. 

Ectopically draining dysplastic kidney 

associated with genuine stress urinary 

incontinence: unusual combined cause of 

incontinence. Urology 1992 Sep; 40(3):283-5. 

Case-reports 

306. Bartels RH, van Overbeeke JJ. Lumbar 

cerebrospinal fluid drainage for symptomatic 

sacral nerve root cysts: an adjuvant diagnostic 

procedure and/or alternative treatment? 

Technical case report. Neurosurgery 1997 

Apr; 40(4):861-4; discussion 4-5. Casereports 

307. Barthet M, Bellon P, Abou E, et al. Anal 

endosonography for assessment of anal 

incontinence with a linear probe: relationships 

with clinical and manometric features. Int J 

Colorectal Dis 2002 Mar; 17(2):123-8. Not 

eligible outcomes 

308. Bartolo DC, Duthie GS. The physiological 

evaluation of operative repair for incontinence 

and prolapse. Ciba Found Symp 1990; 

151:223-35; discussion 35-45. Case-series 

309. Bartram CI. Anal endosonography. Ann 

Gastroenterol Hepatol (Paris) 1992 Jun-Sep; 

28(4):185-9. Comment 

310. Bartram CI. Anal sphincter disorders. 

Gastrointest Endosc 1996 Feb; 43(2 Pt 2):S32-

4. Comment 

311. Baskin LS. Case no. 2. Right-sided single 

system ureterocele. Tech Urol 1998 Sep; 

4(3):152-3. Case report 

312. Bassiouny IE. Continent urinary reservoir in 

exstrophy/epispadias complex. Br J Urol 1992 

Nov; 70(5):558-62. Not eligible target 

population 

313. Bastian PJ, Albers P, Haferkamp A, et al. 

Modified ureterosigmoidostomy (Mainz 

Pouch II) in different age groups and with 

different techniques of ureteric implantation. 

BJU Int 2004 Aug; 94(3):345-9. Case-series 

314. Bates TS, Wright MP, Gillatt DA. Prevalence 

and impact of incontinence and impotence 

following total prostatectomy assessed 

anonymously by the ICS-male questionnaire. 

Eur Urol 1998; 33(2):165-9. Case-series 
B-15 

315. Bates-Jensen BM, Alessi CA, Al-Samarrai 

NR, et al. The effects of an exercise and 

incontinence intervention on skin health 

outcomes in nursing home residents. J Am 

Geriatr Soc 2003 Mar; 51(3):348-55. Not 

eligible outcomes 

316. Batignani G, Monaci I, Ficari F, et al. What 

affects continence after anterior resection of 

the rectum? Dis Colon Rectum 1991 Apr; 

34(4):329-35. Case-series 

317. Batislam E, Germiyanoglu C, Erol D. 

Simplification of laparoscopic extraperitoneal 

colposuspension: results of two-port 

technique. Int Urol Nephrol 2000; 32(1):47-

51. Not eligible target population 

318. Baumgarten M, Margolis D, Gruber-Baldini 

AL, et al. Pressure ulcers and the transition to 

long-term care. Adv Skin Wound Care 2003 

Nov; 16(6):299-304. Not eligible outcomes 

319. Baumgarten M, Margolis DJ, Localio AR, et 

al. Pressure ulcers among elderly patients 

early in the hospital stay. J Gerontol A Biol 

Sci Med Sci 2006 Jul; 61(7):749-54. Not 

eligible outcomes 

320. Bavbek M, Altinors MN, Caner HH, et al. 

Lumbar myxopapillary ependymoma 

mimicking neurofibroma. Spinal Cord 2001 

Aug; 39(8):449-52. Case Reports 

321. Bayles KA, Tomoeda CK, Cruz RF, et al. 

Communication abilities of individuals with 

late-stage Alzheimer disease. Alzheimer Dis 

Assoc Disord 2000 Jul-Sep; 14(3):176-81. Not 

eligible exposure 

322. Bayliss V, Cherry M, Locke R, et al. 

Pathways for continence care: background and 

audit. Br J Nurs 2000 May 11-24; 9(9):590-2, 

4, 6. No associative hypothesis tested 

323. Bean JF, Kiely DK, Cairns KD, et al. 

Influence of poststroke urinary incontinence 

on disability: the nursing home setting. Am J 

Phys Med Rehabil 2003 Mar; 82(3):175-81. 

Not eligible outcomes 

324. Bear M, Dwyer JW, Benveneste D, et al. 

Home-based management of urinary 

incontinence: a pilot study with both frail and 

independent elders. J Wound Ostomy 

Continence Nurs 1997 May; 24(3):163-71. 

Case-series 

325. Bearz A, Giometto B, Freschi A, et al. Occult 

small cell lung cancer associated with 

paraneoplastic neurologic syndrome: case 

report. Tumori 2001 Nov-Dec; 87(6):447-50. 

Case-reports 

326. Beck RP, McCormick S, Nordstrom L. A 25-

year experience with 519 anterior 

colporrhaphy procedures. Obstet Gynecol 

1991 Dec; 78(6):1011-8. Not eligible level of 

evidence 

327. Beck SD, Koch MO. Spiral ileal neobladder 

substitution with orthotopic ureteral 

reimplantation: early results. Tech Urol 2001 

Sep; 7(3):223-8. Case-series 

328. Becker C, Loy S, Sander S, et al. An 

algorithm to screen long-term care residents at 

risk for accidental falls. Aging Clin Exp Res 

2005 Jun; 17(3):186-92. Not eligible outcomes 

329. Becker K, Enck P, Wilhelm K, et al. Colonic 

and anorectal dysfunction in a patient with the 

tethered cord syndrome. Am J Gastroenterol 

1994 Sep; 89(9):1564-8. Case-reports 

330. Beckwith PS, Wolff BG, Frazee RC. 

Ileorectostomy in the older patient. Dis Colon 

Rectum 1992 Apr; 35(4):301-4. Case-series 

331. Beco J, Climov D, Bex M. Pudendal nerve 

decompression in perineology: a case series. 

BMC Surg 2004; 4:15. Case-series 

332. Beco J, Leonard D, Lambotte R. Study of the 

artefacts induced by linear array transvaginal 

ultrasound scanning in urodynamics. World J 

Urol 1994; 12(6):329-32. Not eligible 

outcomes 

333. Beco J, Leonard D, Leonard F. Study of the 

female urethra's submucous vascular plexus 

by color Doppler. World J Urol 1998; 

16(3):224-8. Not eligible outcomes 

334. Beddy P, Neary P, Eguare EI, et al. 

Electromyographic biofeedback can improve 

subjective and objective measures of fecal 

incontinence in the short term. J Gastrointest 

Surg 2004 Jan; 8(1):64-72; discussion 1-2. 

Case-series 

335. Beer-Gabel M, Teshler M, Barzilai N, et al. 

Dynamic transperineal ultrasound in the 

diagnosis of pelvic floor disorders: pilot study. 

Dis Colon Rectum 2002 Feb; 45(2):239-45; 

discussion 45-8. No associative hypothesis 

tested 

336. Beguin AM, Combes T, Lutzler P, et al. 

Health education improves older subjects' 

attitudes toward urinary incontinence and 

access to care: a randomized study in sheltered 

accommodation centers for the aged. J Am 

Geriatr Soc 1997 Mar; 45(3):391-2. Not 

eligible outcomes 

337. Beier-Holgersen R, Kirkeby LT, Nordling J. 

'Clam' ileocystoplasty. Scand J Urol Nephrol 

1994 Mar; 28(1):55-8. Case-series 
B-16 

338. Beitz JM, Zuzelo PR. The lived experience of 

having a neobladder. West J Nurs Res 2003 

Apr; 25(3):294-316; discussion 7-21. Caseseries 

339. Beji NK, Yalcin O, Erkan HA. The effect of 

pelvic floor training on sexual function of 

treated patients. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Oct; 14(4):234-8; discussion 8. 

Not eligible outcomes 

340. Bellin P, Smith J, Poll W, et al. Results of a 

multicenter trial of the CapSure (Re/Stor) 

Continence shield on women with stress 

urinary incontinence. Urology 1998 May; 

51(5):697-706. Not eligible target population 

341. Bellina J, Kelly R, Sartin B. A unique cause of 

unconscious urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 1999; 

10(1):36-8. Case Reports 

342. Bellina M, Mari M, Ambu A, et al. Seminal 

monolateral nerve-sparing radical 

prostatectomy in selected patients. Urol Int 

2005; 75(2):175-80. Not eligible exposure 

343. Belloli G, Campobasso P, Mercurella A. 

Neuropathic urinary incontinence in pediatric 

patients: management with artificial sphincter. 

J Pediatr Surg 1992 Nov; 27(11):1461-4. Not 

eligible target population 

344. Belmin J, Hervias Y, Avellano E, et al. 

Reliability of sampling urine from disposable 

diapers in elderly incontinent women. J Am 

Geriatr Soc 1993 Nov; 41(11):1182-6. Not 

eligible outcomes 

345. Belmonte-Montes C, Hagerman G, VegaYepez PA, et al. Anal sphincter injury after 

vaginal delivery in primiparous females. Dis 

Colon Rectum 2001 Sep; 44(9):1244-8. Not 

eligible outcomes 

346. Bemelmans BL, Kiemeney LA, Debruyne 

FM. Low-dose oxybutynin for the treatment of 

urge incontinence: good efficacy and few side 

effects. Eur Urol 2000 Jun; 37(6):709-13. Not 

eligible target population 

347. Ben Nagi J, Robinson D, Cardozo L, et al. 

Anatomical entrapment--an unusual cause of 

'urinary incontinence'. J Obstet Gynaecol 2004 

Sep; 24(6):709-10. Case Reports 

348. Ben-Chaim J, Jeffs RD, Peppas DS, et al. 

Submucosal bladder neck injections of 

glutaraldehyde cross-linked bovine collagen 

for the treatment of urinary incontinence in 

patients with the exstrophy/epispadias 

complex. J Urol 1995 Aug; 154(2 Pt 2):862-4. 

Not eligible target population 

349. Ben-Chaim J, Jeffs RD, Reiner WG, et al. The 

outcome of patients with classic bladder 

exstrophy in adult life. J Urol 1996 Apr; 

155(4):1251-2. Case-series 

350. Bender P. Deceptive distress in the elderly. 

Am J Nurs 1992 Oct; 92(10):28-32. Not 

eligible exposure 

351. Benderev TV. Anchor fixation and other 

modifications of endoscopic bladder neck 

suspension. Urology 1992 Nov; 40(5):409-18. 

Case-series 

352. Benedetti-Panici P, Zullo MA, Plotti F, et al. 

Long-term bladder function in patients with 

locally advanced cervical carcinoma treated 

with neoadjuvant chemotherapy and type 3-4 

radical hysterectomy. Cancer 2004 May 15; 

100(10):2110-7. Case-series 

353. Benezra V, Lambrou NC, Salom EM, et al. 

Conversion of an incontinent urinary conduit 

to a continent urinary reservoir (Miami 

Pouch). Gynecol Oncol 2004 Sep; 94(3):814-

7. Case-reports 

354. Benhamou S, Laplanche A, Guillonneau B, et 

al. DNA adducts in normal bladder tissue and 

bladder cancer risk. Mutagenesis 2003 Sep; 

18(5):445-8. Not eligible exposure 

355. Benizri EJ, Volpe P, Pushkar D, et al. A new 

vaginal procedure for cystocele repair and 

treatment of stress urinary incontinence. J 

Urol 1996 Nov; 156(5):1623-5. Case-series 

356. Bennett JK, Green BG, Foote JE, et al. 

Collagen injections for intrinsic sphincter 

deficiency in the neuropathic urethra. 

Paraplegia 1995 Dec; 33(12):697-700. Not 

eligible target population 

357. Bennett RG, Baran PJ, DeVone LV, et al. 

Low airloss hydrotherapy versus standard care 

for incontinent hospitalized patients. J Am 

Geriatr Soc 1998 May; 46(5):569-76. Not 

eligible outcomes 

358. Benoist S, Panis Y, Boleslawski E, et al. 

Functional outcome after coloanal versus low 

colorectal anastomosis for rectal carcinoma. J 

Am Coll Surg 1997 Aug; 185(2):114-9. Caseseries 

359. Benoist S, Panis Y, Michot F, et al. Artificial 

sphincter with colonic reservoir for severe 

anal incontinence because of imperforate anus 

and short-bowel syndrome: report of a case. 

Dis Colon Rectum 2005 Oct; 48(10):1978-82. 

Case-reports 
B-17 

360. Benoit RM, Naslund MJ, Cohen JK. A 

comparison of complications between 

ultrasound-guided prostate brachytherapy and 

open prostate brachytherapy. Int J Radiat 

Oncol Biol Phys 2000 Jul 1; 47(4):909-13. 

Not eligible outcomes 

361. Benson JT, McClellan E. The effect of vaginal 

dissection on the pudendal nerve. Obstet 

Gynecol 1993 Sep; 82(3):387-9. Not eligible 

outcomes 

362. Benson JT, Sumners JE, Pittman JS. 

Definition of normal female pelvic floor 

anatomy using ultrasonographic techniques. J 

Clin Ultrasound 1991 Jun; 19(5):275-82. Not 

eligible outcomes 

363. Bent AE, Foote J, Siegel S, et al. Collagen 

implant for treating stress urinary incontinence 

in women with urethral hypermobility. J Urol 

2001 Oct; 166(4):1354-7. Not eligible target 

population 

364. Bent AE, Tutrone RT, McLennan MT, et al. 

Treatment of intrinsic sphincter deficiency 

using autologous ear chondrocytes as a 

bulking agent. Neurourol Urodyn 2001; 

20(2):157-65. Not eligible target population 

365. Bentas W, Wolfram M, Jones J, et al. Robotic 

technology and the translation of open radical 

prostatectomy to laparoscopy: the early 

Frankfurt experience with robotic radical 

prostatectomy and one year follow-up. Eur 

Urol 2003 Aug; 44(2):175-81. Case-series 

366. Benvenuti F. Incontinence in the elderly. BJU 

Int 2000 May; 85 Suppl 3:79-80; discussion 1-

2. Comment 

367. Benya R, Layden TJ, Mobarhan S. Diarrhea 

associated with tube feeding: the importance 

of using objective criteria. J Clin 

Gastroenterol 1991 Apr; 13(2):167-72. Not 

eligible outcomes 

368. Bercovich E, Manferrari F, Fiore F. A new 

device for self-adjustment of colposuspension. 

Eur Urol 1994; 26(2):189-92. Case-series 

369. Berger A, Tiret E, Parc R, et al. Excision of 

the rectum with colonic J pouch-anal 

anastomosis for adenocarcinoma of the low 

and mid rectum. World J Surg 1992 May-Jun; 

16(3):470-7. Case-series 

370. Berger M, Wagner TH, Baker LC. Internet use 

and stigmatized illness. Soc Sci Med 2005 

Oct; 61(8):1821-7. Not eligible outcomes 

371. Berglund AL, Eisemann M, Lalos A, et al. 

Social adjustment and spouse relationships 

among women with stress incontinence before 

and after surgical treatment. Soc Sci Med 

1996 Jun; 42(11):1537-44. Case -Series 

372. Berglund AL, Eisemann M, Lalos A, et al. 

Predictive factors of the outcome of primary 

surgical treatment of stress incontinence in 

women. Scand J Urol Nephrol 1997 Feb; 

31(1):49-55. No associative hypothesis tested 

373. Berglund AL, Fugl-Meyer KS. Sexual 

problems in women with urinary incontinence. 

A retrospective study of medical records. 

Scand J Caring Sci 1991; 5(1):13-6. Not 

eligible outcomes 

374. Bergman J, Robertson JR, Elia G. Effects of a 

magnetic field on pelvic floor muscle function 

in women with stress urinary incontinence. 

Altern Ther Health Med 2004 May-Jun; 

10(3):70-2. Case-series 

375. Bergquist S. Pressure ulcer prediction in older 

adults receiving home health care: 

implications for use with the OASIS. Adv 

Skin Wound Care 2003 May-Jun; 16(3):132-

9. Not eligible exposure 

376. Bergstrom K, Carlsson CP, Lindholm C, et al. 

Improvement of urge- and mixed-type 

incontinence after acupuncture treatment 

among elderly women - a pilot study. J Auton 

Nerv Syst 2000 Mar 15; 79(2-3):173-80. Not 

eligible target population 

377. Berkelmans I, Heresbach D, Leroi AM, et al. 

Perineal descent at defecography in women 

with straining at stool: a lack of specificity or 

predictive value for future anal incontinence? 

Eur J Gastroenterol Hepatol 1995 Jan; 

7(1):75-9. Case-series 

378. Berkelmans I, Leroi AM, Weber J, et al. 

Faecal incontinence with transitory absence of 

anal contraction in two sexually or physically 

abused women. Eur J Gastroenterol Hepatol 

1996 Mar; 8(3):235-8. Case- Reports 

379. Berkowitz LR. Case records of the 

Massachusetts General Hospital. Weekly 

clinicopathological exercises. Case 20-2004. 

A 46-year-old woman with pelvic-floor 

relaxation after a second vaginal delivery. N 

Engl J Med 2004 Jun 24; 350(26):2699-706. 

Case-reports 

380. Berlowitz DR, Brand HK, Perkins C. Geriatric 

syndromes as outcome measures of hospital 

care: can administrative data be used? J Am 

Geriatr Soc 1999 Jun; 47(6):692-6. Not 

eligible outcomes 

381. Berlowitz DR, Brandeis GH, Morris JN, et al. 

Deriving a risk-adjustment model for pressure 

ulcer development using the Minimum Data 

Set. J Am Geriatr Soc 2001 Jul; 49(7):866-71. 

Not eligible outcomes 
B-18 

382. Berman CJ, Kreder KJ. Comparative cost 

analysis of collagen injection and fascia lata 

sling cystourethropexy for the treatment of 

type III incontinence in women [ssee 

comments]. J Urol 1997 Jan; 157(1):122-4. 

Not eligible outcomes 

383. Berman IR. Sutureless laparoscopic rectopexy 

for procidentia. Technique and implications. 

Dis Colon Rectum 1992 Jul; 35(7):689-93. 

Case Reports 

384. Bernardi C, Favetta U, Pescatori M. 

Autologous fat injection for treatment of fecal 

incontinence: manometric and echographic 

assessment. Plast Reconstr Surg 1998 Oct; 

102(5):1626-8. Case Reports 

385. Berned Muller E, Nordwall A, von Wendt L. 

The influence of scoliosis brace treatment on 

function in children with myelomeningocele. 

Acta Paediatr 1992 Nov; 81(11):925-8. Not 

eligible target population 

386. Bernier F, Harris L. Treating stress 

incontinence with the bladder neck support 

prosthesis. Urol Nurs 1995 Mar; 15(1):5-9. 

Not eligible exposure 

387. Bernstein IT, Bennicke K, Rordam P, et al. 

Bricker's ileal conduit urinary diversion with a 

simple non-refluxing uretero ileal 

anastomosis. Scand J Urol Nephrol 1991; 

25(1):29-33. Case-series 

388. Berry AR, Souter RG, Campbell WB, et al. 

Endoscopic transanal resection of rectal 

tumours--a preliminary report of its use. Br J 

Surg 1990 Feb; 77(2):134-7. Case-series 

389. Besarani D, Amoroso P, Kirby R. Bladder 

neck contracture after radical retropubic 

prostatectomy. BJU Int 2004 Dec; 94(9):1245-

7. Not eligible outcomes 

390. Bezerra CA, Rodrigues AO, Seo AL, et al. 

Laparoscopic Burch surgery: is there any 

advantage in relation to open approach? Int 

Braz J Urol 2004 May-Jun; 30(3):230-6. 

Case-series 

391. Bezerra CA, Sadi MV. Comparison of vaginal 

wall sling and modified vaginal wall sling for 

stress urinary incontinence. Sao Paulo Med J 

2000 May 4; 118(3):63-8. Not eligible target 

population 

392. Bharucha AE, Fletcher JG, Harper CM, et al. 

Relationship between symptoms and 

disordered continence mechanisms in women 

with idiopathic faecal incontinence. Gut 2005 

Apr; 54(4):546-55. Not eligible level of 

evidence 

393. Bharucha AE, Fletcher JG, Seide B, et al. 

Phenotypic variation in functional disorders of 

defecation. Gastroenterology 2005 May; 

128(5):1199-210. Not eligible target 

population 

394. Bharucha AE, Locke GR, 3rd, Seide BM, et 

al. A new questionnaire for constipation and 

faecal incontinence. Aliment Pharmacol Ther 

2004 Aug 1; 20(3):355-64. Not eligible 

outcomes 

395. Bharucha AE, Zinsmeister AR, Locke GR, et 

al. Symptoms and quality of life in community 

women with fecal incontinence. Clin 

Gastroenterol Hepatol 2006 Aug; 4(8):1004-9. 

Not eligible level of evidence 

396. Bhattacharya S, Mollison J, Pinion S, et al. A 

comparison of bladder and ovarian function 

two years following hysterectomy or 

endometrial ablation. Br J Obstet Gynaecol 

1996 Sep; 103(9):898-903. Not eligible level 

of evidence 

397. Bianco FJ, Jr., Riedel ER, Begg CB, et al. 

Variations among high volume surgeons in the 

rate of complications after radical 

prostatectomy: further evidence that technique 

matters. J Urol 2005 Jun; 173(6):2099-103. 

Not eligible exposure 

398. Bidair M, Tiechman JM, Brodak PP, et al. 

Transrectal ultrasound urodynamics. Urology 

1993 Dec; 42(6):640-4; discussion 4-5. Caseseries 

399. Bidmead J, Cardozo L, McLellan A, et al. A 

comparison of the objective and subjective 

outcomes of colposuspension for stress 

incontinence in women. Bjog 2001 Apr; 

108(4):408-13. Case-series 

400. Bielefeldt K, Enck P, Erckenbrecht JF. 

Sensory and motor function in the 

maintenance of anal continence. Dis Colon 

Rectum 1990 Aug; 33(8):674-8. Not eligible 

outcomes 

401. Bigio EH, Weiner MF, Bonte FJ, et al. 

Familial dementia due to adult polyglucosan 

body disease. Clin Neuropathol 1997 Jul-Aug; 

16(4):227-34. Case-reports 

402. Bignell V. Alleviating the distress of urinary 

incontinence. Community Nurse 1999 Oct; 

5(9):19-20, 2. Comment 

403. Bilali S, Pfeifer J. Anorectal manometry: are 

fatigue rate and fatigue rate index of any 

clinical importance? Tech Coloproctol 2005 

Dec; 9(3):225-8. Not eligible level of evidence 
B-19 

404. Billington A. Incontinence in older women. 

Elder Care 1999 Nov; 11(8):32-3. Comment 

405. Bingol A, Yucemen N, Meco O. Medically 

treated intraspinal "Brucella" granuloma. Surg 

Neurol 1999 Dec; 52(6):570-6. Case- Reports 

406. Binnie F. Incontinent patients take part in test. 

N Z Nurs J 1993 Feb; 86(1):12-4. No 

associative hypothesis tested 

407. Binnie NR, Kawimbe BM, Papachrysostomou 

M, et al. Use of the pudendo-anal reflex in the 

treatment of neurogenic faecal incontinence. 

Gut 1990 Sep; 31(9):1051-5. Case-series 

408. Binstock MA, Semrad N, Dubow L, et al. 

Combined vesicovaginal-ureterovaginal 

fistulas associated with a vaginal foreign 

body. Obstet Gynecol 1990 Nov; 76(5 Pt 

2):918-21. Case Reports 

409. Birnbaum EH, Dreznik Z, Myerson RJ, et al. 

Early effect of external beam radiation therapy 

on the anal sphincter: a study using anal 

manometry and transrectal ultrasound. Dis 

Colon Rectum 1992 Aug; 35(8):757-61. Caseseries 

410. Birnbaum EH, Myerson RJ, Fry RD, et al. 

Chronic effects of pelvic radiation therapy on 

anorectal function. Dis Colon Rectum 1994 

Sep; 37(9):909-15. Case-series 

411. Birnbaum EH, Stamm L, Rafferty JF, et al. 

Pudendal nerve terminal motor latency 

influences surgical outcome in treatment of 

rectal prolapse. Dis Colon Rectum 1996 Nov; 

39(11):1215-21. Case-series 

412. Birnbaum H, Leong S, Kabra A. Lifetime 

medical costs for women: cardiovascular 

disease, diabetes, and stress urinary 

incontinence. Womens Health Issues 2003 

Nov-Dec; 13(6):204-13. Not eligible outcomes 

413. Bishop KR, Dougherty M, Mooney R, et al. 

Effects of age, parity, and adherence on pelvic 

muscle response to exercise. J Obstet Gynecol 

Neonatal Nurs 1992 Sep-Oct; 21(5):401-6. 

Not eligible outcomes 

414. Bittorf B, Stadelmaier U, Gohl J, et al. 

Functional outcome after intersphincteric 

resection of the rectum with coloanal 

anastomosis in low rectal cancer. Eur J Surg 

Oncol 2004 Apr; 30(3):260-5. Case-series 

415. Bittorf B, Stadelmaier U, Merkel S, et al. 

Does anastomotic leakage affect functional 

outcome after rectal resection for cancer? 

Langenbecks Arch Surg 2003 Feb; 387(11-

12):406-10. Case-series 

416. Bjelic-Radisic V, Dorfer M, Greimel E, et al. 

Quality of life and continence 1 year after the 

tension-free vaginal tape operation. Am J 

Obstet Gynecol 2006 Dec; 195(6):1784-8. 

Case-series 

417. Bjelic-Radisic V, Dorfer M, Tamussino K, et 

al. Psychometric properties and validation of 

the German-language King's Health 

Questionnaire in women with stress urinary 

incontinence. Neurourol Urodyn 2005; 

24(1):63-8. Not eligible outcomes 

418. Bjork J, Akerbrant H, Iselius L, et al. 

Outcome of primary and secondary ileal 

pouch-anal anastomosis and ileorectal 

anastomosis in patients with familial 

adenomatous polyposis. Dis Colon Rectum 

2001 Jul; 44(7):984-92. Not eligible target 

population 

419. Bjornland K, Diseth TH, Emblem R. Longterm functional, manometric, and 

endosonographic evaluation of patients 

operated upon with the Duhamel technique. 

Pediatr Surg Int 1998 Jan; 13(1):24-8. Caseseries 

420. Bjornsdottir LT, Geirsson RT, Jonsson PV. 

Urinary incontinence and urinary tract 

infections in octogenarian women. Acta 

Obstet Gynecol Scand 1998 Jan; 77(1):105-9. 

Not eligible level of evidence 

421. Black N, Griffiths J, Pope C. Development of 

a symptom severity index and a symptom 

impact index for stress incontinence in 

women. Neurourol Urodyn 1996; 15(6):630-

40. Not eligible outcomes 

422. Black N, Griffiths J, Pope C, et al. Impact of 

surgery for stress incontinence on morbidity: 

cohort study. BMJ 1997 Dec 6; 

315(7121):1493-8. No associative hypothesis 

tested 

423. Black NA, Bowling A, Griffiths JM, et al. 

Impact of surgery for stress incontinence on 

the social lives of women. Br J Obstet 

Gynaecol 1998 Jun; 105(6):605-12. Caseseries 

424. Black NA, Griffiths JM, Pope C, et al. 

Sociodemographic and symptomatic 

characteristics of women undergoing stress 

incontinence surgery in the UK. Br J Urol 

1996 Dec; 78(6):847-55. Not eligible target 

population 

425. Black SA, Goodwin JS, Markides KS. The 

association between chronic diseases and 

depressive symptomatology in older Mexican 

Americans. J Gerontol A Biol Sci Med Sci 

1998 May; 53(3):M188-94. Not eligible 

outcomes 
B-20 

426. Blair KA, White N. Are older women offered 

adequate health care? J Gerontol Nurs 1998 

Oct; 24(10):39-44. Not eligible outcomes 

427. Blaivas JG, Groutz A. Bladder outlet 

obstruction nomogram for women with lower 

urinary tract symptomatology. Neurourol 

Urodyn 2000; 19(5):553-64. Not eligible 

outcomes 

428. Blaivas JG, Jacobs BZ. Pubovaginal fascial 

sling for the treatment of complicated stress 

urinary incontinence. J Urol 1991 Jun; 

145(6):1214-8. Case-series 

429. Blaivas JG, Weiss JP, Jones M. The 

pathophysiology of lower urinary tract 

symptoms after brachytherapy for prostate 

cancer. BJU Int 2006 Dec; 98(6):1233-7; 

discussion 7. Case-series 

430. Bland DR, Earle BB, Vitolins MZ, et al. Use 

of the Pelvic Organ Prolapse staging system of 

the International Continence Society, 

American Urogynecologic Society, and 

Society of Gynecologic Surgeons in 

perimenopausal women. Am J Obstet Gynecol 

1999 Dec; 181(6):1324-7; discussion 7-8. Not 

eligible level of evidence 

431. Blander DS, Carpiniello VL, Harryhill JF, et 

al. Extraperitoneal laparoscopic urethropexy 

with Marlex mesh. Urology 1999 May; 

53(5):985-9. Not eligible target population 

432. Blander DS, Zimmern PE. Cadaveric fascia 

lata sling: analysis of five recent adverse 

outcomes. Urology 2000 Oct 1; 56(4):596-9. 

Case-series 

433. Blanes L, Pinto Rde C, Santos VL. Urinary 

incontinence knowledge and attitudes in Sao 

Paulo. Ostomy Wound Manage 2001 Dec; 

47(12):43-51. Not eligible level of evidence 

434. Blank LE, Gonzalez Gonzalez D, de Reijke 

TM, et al. Brachytherapy with transperineal 

(125)Iodine seeds for localized prostate 

cancer. Radiother Oncol 2000 Dec; 57(3):307-

13. Not eligible level of evidence 

435. Bliss DP, Jr., Tapper D, Anderson JM, et al. 

Does posterior sagittal anorectoplasty in 

patients with high imperforate anus provide 

superior fecal continence? J Pediatr Surg 1996 

Jan; 31(1):26-30; discussion -2. Not eligible 

target population 

436. Bliss DZ, Fischer LR, Savik K. Managing 

fecal incontinence: self-care practices of older 

adults. J Gerontol Nurs 2005 Jul; 31(7):35-44. 

Not eligible outcomes 

437. Bliss DZ, Johnson S, Savik K, et al. Fecal 

incontinence in hospitalized patients who are 

acutely ill. Nurs Res 2000 Mar-Apr; 

49(2):101-8. Not eligible target population 

438. Bliss DZ, McLaughlin J, Jung HJ, et al. 

Comparison of the nutritional composition of 

diets of persons with fecal incontinence and 

that of age- and gender-matched controls. J 

Wound Ostomy Continence Nurs 2000 Mar; 

27(2):90-1, 3-7. Not eligible outcomes 

439. Bliss DZ, Savik K, Harms S, et al. Prevalence 

and correlates of perineal dermatitis in nursing 

home residents. Nurs Res 2006 Jul-Aug; 

55(4):243-51. Not eligible outcomes 

440. Bliss DZ, Savik K, Jung H, et al. Comparison 

of subjective classification of stool 

consistency and stool water content. J Wound 

Ostomy Continence Nurs 1999 May; 

26(3):137-41. Not eligible outcomes 

441. Bliwise DL, Adelman CL, Ouslander JG. 

Polysomnographic correlates of spontaneous 

nocturnal wetness episodes in incontinent 

geriatric patients. Sleep 2004 Feb 1; 

27(1):153-7. Case-series 

442. Block CA, Cooper CS, Hawtrey CE. Longterm efficacy of periurethral collagen injection 

for the treatment of urinary incontinence 

secondary to myelomeningocele. J Urol 2003 

Jan; 169(1):327-9. Not eligible target 

population 

443. Blonski J. Is tolterodine (Detrol) or 

oxybutynin (Ditropan) the best for treatment 

of urge urinary incontinence? J Fam Pract 

2001 Dec; 50(12):1017. Review 

444. Bo K. Reproducibility of instruments designed 

to measure subjective evaluation of female 

stress urinary incontinence. Scand J Urol 

Nephrol 1994 Mar; 28(1):97-100. 

445. Bo K. Pelvic floor muscle strength and 

response to pelvic floor muscle training for 

stress urinary incontinence. Neurourol Urodyn 

2003; 22(7):654-8. No associative hypothesis 

tested 

446. Bo K, Borgen JS. Prevalence of stress and 

urge urinary incontinence in elite athletes and 

controls. Med Sci Sports Exerc 2001 Nov; 

33(11):1797-802. Not eligible level of 

evidence 

447. Bo K, Finckenhagen HB. Vaginal palpation of 

pelvic floor muscle strength: inter-test 

reproducibility and comparison between 

palpation and vaginal squeeze pressure. Acta 

Obstet Gynecol Scand 2001 Oct; 80(10):883-

7. Not eligible outcomes 

448. Bo K, Finckenhagen HB. Is there any 

difference in measurement of pelvic floor 

muscle strength in supine and standing 

position? Acta Obstet Gynecol Scand 2003 

Dec; 82(12):1120-4. Not eligible outcomes 
B-21 

449. Bo K, Maanum M. Does vaginal electrical 

stimulation cause pelvic floor muscle 

contraction? A pilot study. Scand J Urol 

Nephrol Suppl 1996; 179:39-45. Not eligible 

outcomes 

450. Boccasanta P, Rosati R, Venturi M, et al. 

Surgical treatment of complete rectal prolapse: 

results of abdominal and perineal approaches. 

J Laparoendosc Adv Surg Tech A 1999 Jun; 

9(3):235-8. Case-series 

451. Boccasanta P, Venturi M, Reitano MC, et al. 

Laparotomic vs. laparoscopic rectopexy in 

complete rectal prolapse. Dig Surg 1999; 

16(5):415-9. Case-series 

452. Boccasanta P, Venturi M, Stuto A, et al. 

Stapled transanal rectal resection for outlet 

obstruction: a prospective, multicenter trial. 

Dis Colon Rectum 2004 Aug; 47(8):1285-96; 

discussion 96-7. Not eligible target population 

453. Bochner BH, Figueroa AJ, Skinner EC, et al. 

Salvage radical cystoprostatectomy and 

orthotopic urinary diversion following 

radiation failure. J Urol 1998 Jul; 160(1):29-

33. Case-series 

454. Bodden-Heidrich R, Beckmann MW, Libera 

B, et al. Psychosomatic aspects of urinary 

incontinence. Arch Gynecol Obstet 1999; 

262(3-4):151-8. Not eligible outcomes 

455. Boemers TM, Ludwikowski B, Forstner R, et 

al. Dynamic magnetic resonance imaging of 

the pelvic floor in children and adolescents 

with vesical and anorectal malformations. J 

Pediatr Surg 2006 Jul; 41(7):1267-71. Not 

eligible target population 

456. Bogner HR, Gallo JJ, Swartz KL, et al. 

Anxiety disorders and disability secondary to 

urinary incontinence among adults over age 

50. Int J Psychiatry Med 2002; 32(2):141-54. 

Not eligible level of evidence 

457. Bollard RC, Gardiner A, Duthie GS, et al. 

Anal sphincter injury, fecal and urinary 

incontinence: a 34-year follow-up after 

forceps delivery. Dis Colon Rectum 2003 

Aug; 46(8):1083-8. Not eligible level of 

evidence 

458. Bombier L, Freeman RM, Perkins EP, et al. 

Why do women have voiding dysfunction and 

de novo detrusor instability after 

colposuspension? Bjog 2002 Apr; 109(4):402-

12. Prospective, observational study <100 

459. Bombieri L, Freeman RM. Recurrence of 

stress incontinence after vault suspension: can 

it be prevented? Int Urogynecol J Pelvic Floor 

Dysfunct 1998; 9(1):58-60. Case Reports 

460. Bombieri L, Freeman RM, Perkins EP, et al. 

Objective assessment of bladder neck 

elevation and urethral compression at 

colposuspension. Bjog 2002 Apr; 109(4):395-

401. Not eligible exposure 

461. Bond C, Youngson G, MacPherson I, et al. 

Anal plugs for the management of fecal 

incontinence in children and adults: a 

randomized control trial. J Clin Gastroenterol 

2007 Jan; 41(1):45-53. Not eligible target 

population 

462. Bonetti TR, Erpelding A, Pathak LR. 

Listening to "felt needs": investigating genital 

prolapse in western Nepal. Reprod Health 

Matters 2004 May; 12(23):166-75. Not 

eligible outcomes 

463. Bonnet P, Waltregny D, Reul O, et al. 

Transobturator vaginal tape inside out for the 

surgical treatment of female stress urinary 

incontinence: anatomical considerations. J 

Urol 2005 Apr; 173(4):1223-8. Case-series 

464. Bonney W. Voiding dysfunction and 

incontinence. Iowa Med 1992 Apr; 82(4):173-

5. Case Reports 

465. Bonney WW, Gupta S, Hunter DR, et al. 

Bladder dysfunction in schizophrenia. 

Schizophr Res 1997 Jun 20; 25(3):243-9. Not 

eligible outcomes 

466. Bonvini RF, Camezind E. Electrocardiogram 

artefacts caused by an abdominal 

electrostimulator. Med J Aust 2004 Oct 18; 

181(8):455. Case- Reports 

467. Borchers H, Kirschner-Hermanns R, Brehmer 

B, et al. Permanent 125I-seed brachytherapy 

or radical prostatectomy: a prospective 

comparison considering oncological and 

quality of life results. BJU Int 2004 Oct; 

94(6):805-11. Not eligible level of evidence 

468. BorelloFrance D, Burgio KL, Richter HE, et 

al. Fecal and urinary incontinence in 

primiparous women. Obstetrics and 

gynecology 2006 Oct; 108(4):863-72. Not 

eligible level of evidence 

469. Borello-France DF, Handa VL, Brown MB, et 

al. Pelvic-floor muscle function in women 

with pelvic organ prolapse. Phys Ther 2007 

Apr; 87(4):399-407. Case-series 

470. Borenstein R, Elchalal U, Goldchmit R, et al. 

The importance of the endopelvic fascia repair 

during vaginal hysterectomy. Surg Gynecol 

Obstet 1992 Dec; 175(6):551-4. Not eligible 

target population 

471. Borjesson L, Oresland T, Hulten L. The failed 

pelvic pouch: conversion to a continent 

ileostomy. Tech Coloproctol 2004 Aug; 

8(2):102-5. Case-series 
B-22 

472. Borrie MJ, Valiquette L. Managing adults 

with urinary incontinence. Clinical practice 

guidelines. Can Fam Physician 2002 Jan; 

48:114-6. Guideline 

473. Borstad E, Skrede M, Rud T. Failure to 

predict and attempts to explain urinary stress 

incontinence following vaginal repair in 

continent women by using a modified lateral 

urethrocystography. Acta Obstet Gynecol 

Scand 1991; 70(6):501-6. Case-series 

474. Bortel DT. Candida osteomyelitis pubis 

following a Marshall-Marchetti procedure. 

Orthopedics 1993 Dec; 16(12):1353-5. Case 

Reports 

475. Borup K, Nielsen JB. Results in 32 women 

operated for genuine stress incontinence with 

the pubovaginal sling procedure ad modum Ed 

McGuire. Scand J Urol Nephrol 2002; 

36(2):128-33. Case-series 

476. Bosch JL, Groen J. Sacral (S3) segmental 

nerve stimulation as a treatment for urge 

incontinence in patients with detrusor 

instability: results of chronic electrical 

stimulation using an implantable neural 

prosthesis. J Urol 1995 Aug; 154(2 Pt 1):504-

7. Not eligible target population 

477. Bosch JL, Groen J. Neuromodulation: 

urodynamic effects of sacral (S3) spinal nerve 

stimulation in patients with detrusor instability 

or detrusor hyperflexia. Behav Brain Res 1998 

May; 92(2):141-50. Case-series 

478. Bosch JL, Groen J. Sacral nerve 

neuromodulation in the treatment of patients 

with refractory motor urge incontinence: longterm results of a prospective longitudinal 

study. J Urol 2000 Apr; 163(4):1219-22. Not 

eligible target population 

479. Bosch JL, Klijn AJ, Schroder FH, et al. The 

artificial urinary sphincter in 86 patients with 

intrinsic sphincter deficiency: satisfactory 

actuarial adequate function rates. Eur Urol 

2000 Aug; 38(2):156-60. Case-series 

480. Bose CK, Basu A, Kanjilal S, et al. Giant 

supratrigonal vesicocervicovaginal fistula--a 

case report. MedGenMed 2005; 7(4):74. Case 

report 

481. Botros SM, Abramov Y, Goldberg RP, et al. 

Detrusor overactivity and urge urinary 

incontinence [corrected] following 

midurethral versus bladder sling procedures. 

Am J Obstet Gynecol 2005 Dec; 193(6):2144-

8. Case-series 

482. Botros SM, Abramov Y, Miller JJ, et al. 

Effect of parity on sexual function: an 

identical twin study. Obstet Gynecol 2006 

Apr; 107(4):765-70. Not eligible outcomes 

483. Botros SM, Miller JJ, Goldberg RP, et al. 

Detrusor overactivity and urge urinary 

incontinence following trans obturator versus 

midurethral slings. Neurourol Urodyn 2007; 

26(1):42-5. Case-series 

484. Bottin A, Cescon C, Nowakowski M, et al. 

Non-invasive assessment of the gracilis 

muscle by means of surface electromyography 

electrode arrays. J Surg Res 2006 Aug; 

134(2):265-9. Not eligible outcomes 

485. Botto H, Sebe P, Molinie V, et al. Prostatic 

capsule- and seminal-sparing cystectomy for 

bladder carcinoma: initial results for selected 

patients. BJU Int 2004 Nov; 94(7):1021-5. 

Case-series 

486. Bouchoucha M, Devroede G, Faye A, et al. 

Importance of colonic transit evaluation in the 

management of fecal incontinence. Int J 

Colorectal Dis 2002 Nov; 17(6):412-7; 

discussion 8-9. Case-series 

487. Boulet MJ, Oddens BJ, Lehert P, et al. 

Climacteric and menopause in seven Southeast Asian countries. Maturitas 1994 Oct; 

19(3):157-76. Not eligible level of evidence 

488. Bourne A. Promoting continence in nursing 

homes: responding to government guidelines. 

Nurs Older People 2003 Nov; 15(8):14-6. 

Comment 

489. Bours GJ, De Laat E, Halfens RJ, et al. 

Prevalence, risk factors and prevention of 

pressure ulcers in Dutch intensive care units. 

Results of a cross-sectional survey. Intensive 

Care Med 2001 Oct; 27(10):1599-605. Not 

eligible outcomes 

490. Bowles J, Brooks T, Hayes-Reams P, et al. 

Frailty, family, and church support among 

urban African American elderly. J Health Care 

Poor Underserved 2000 Feb; 11(1):87-99. Not 

eligible outcomes 

491. Boy S, Reitz A, Curt A, et al. A case of 

undiagnosed tethered cord syndrome 

aggravated by transurethral prostate resection. 

Nat Clin Pract Urol 2005 Apr; 2(4):199-204; 

quiz 1 p following Case report 

492. Boyd BG, McCallum SW, Lewis RW, et al. 

Assessment of patient concern and adequacy 

of informed consent regarding infertility 

resulting from prostate cancer treatment. 

Urology 2006 Oct; 68(4):840-4. Not eligible 

outcomes 

493. Boyd SD, Lieskovsky G, Skinner DG. Kock 

pouch bladder replacement. Urol Clin North 

Am 1991 Nov; 18(4):641-8. Case-series 
B-23 

494. Boyington AR, Wildemuth BM, Dougherty 

MC, et al. Development of a computer-based 

system for continence health promotion. Nurs 

Outlook 2004 Sep-Oct; 52(5):241-7. Not 

eligible exposure 

495. Boyles SH, Weber AM, Meyn L. Procedures 

for urinary incontinence in the United States, 

1979-1997. Am J Obstet Gynecol 2003 Jul; 

189(1):70-5. Not eligible outcomes 

496. Boyles SH, Weber AM, Meyn L. Procedures 

for pelvic organ prolapse in the United States, 

1979-1997. Am J Obstet Gynecol 2003 Jan; 

188(1):108-15. Not eligible exposure 

497. Boyles SH, Weber AM, Meyn L. Ambulatory 

procedures for urinary incontinence in the 

United States, 1994-1996. Am J Obstet 

Gynecol 2004 Jan; 190(1):33-6. Not eligible 

level of evidence 

498. Bozier K. Continence. Part of the problem. 

Nurs Times 1992 Mar 25-31; 88(13):84-6. 

Case- Reports 

499. Bradley CS, Nygaard IE. Vaginal wall 

descensus and pelvic floor symptoms in older 

women. Obstet Gynecol 2005 Oct; 

106(4):759-66. Not eligible level of evidence 

500. Bradley CS, Rovner ES. Urodynamically 

defined stress urinary incontinence and 

bladder outlet obstruction coexist in women. J 

Urol 2004 Feb; 171(2 Pt 1):757-60; discussion 

60-1. Not eligible outcomes 

501. Bradley M, Ferris W, Barr O. Continence 

promotion in adults with learning disabilities. 

Nurs Times 1995 Sep 27-Oct 3; 91(39):38-9. 

Case Reports 

502. Bradshaw HD, Radley SC, Rosario DJ, et al. 

Towards a better understanding of involuntary 

detrusor activity. BJU Int 2005 Apr; 

95(6):799-803. Not eligible outcomes 

503. Bradway C. Women's narratives of long-term 

urinary incontinence. Urol Nurs 2005 Oct; 

25(5):337-44. Case-series 

504. Brady CM, Ahmed I, Drumm J, et al. A 

prospective evaluation of the efficiency of 

early postoperative bladder emptying after the 

Stamey procedure or pubovaginal sling for 

stress urinary incontinence. J Urol 2001 May; 

165(5):1601-4. Case-series 

505. Brady CM, Apostolidis AN, Harper M, et al. 

Parallel changes in bladder suburothelial 

vanilloid receptor TRPV1 and pan-neuronal 

marker PGP9.5 immunoreactivity in patients 

with neurogenic detrusor overactivity after 

intravesical resiniferatoxin treatment. BJU Int 

2004 Apr; 93(6):770-6. Not eligible exposure 

506. Brady CM, DasGupta R, Dalton C, et al. An 

open-label pilot study of cannabis-based 

extracts for bladder dysfunction in advanced 

multiple sclerosis. Mult Scler 2004 Aug; 

10(4):425-33. Case-series 

507. Branagan G, Tromans A, Finnis D. Effect of 

stoma formation on bowel care and quality of 

life in patients with spinal cord injury. Spinal 

Cord 2003 Dec; 41(12):680-3. Not eligible 

outcomes 

508. Brandeis GH, Baumann MM, Hossain M, et 

al. The prevalence of potentially remediable 

urinary incontinence in frail older people: a 

study using the Minimum Data Set... 

presented in abstract form at the Annual 

Meeting of the American Geriatrics Society, 

Los Angeles, California, May 20, 1994. 

Journal of the American Geriatrics Society 

1997 Feb; 45(2):179-84. Not eligible level of 

evidence 

509. Brandt FT, Albuquerque CD, Lorenzato FR, et 

al. Perineal assessment of urethrovesical 

junction mobility in young continent females. 

Int Urogynecol J Pelvic Floor Dysfunct 2000; 

11(1):18-22. Not eligible target population 

510. Braslis KG, Bowsher WG, Joyce G, et al. 

Evolving experience with radical 

prostatectomy. Br J Urol 1993 Sep; 72(3):341-

8. Not eligible exposure 

511. Braslis KG, Santa-Cruz C, Brickman AL, et 

al. Quality of life 12 months after radical 

prostatectomy. Br J Urol 1995 Jan; 75(1):48-

53. Case-series 

512. Braslis KG, Stephens DA. Uretero-fallopian 

fistula: an unusual complication of open 

ureterolithotomy. J Urol 1993 Dec; 

150(6):1900-2. Case Reports 

513. Braun J, Treutner KH, Schumpelick V. 

Stapled ileal pouch-anal anastomosis with 

resection of the anal transition zone. Int J 

Colorectal Dis 1995; 10(3):142-7. Case-series 

514. Braun PM, Boschert J, Bross S, et al. Tailored 

laminectomy: a new technique for 

neuromodulator implantation. J Urol 1999 

Nov; 162(5):1607-9. Not eligible target 

population 

515. Braverman DL, Lachmann EA, Tunkel R, et 

al. Multiple sclerosis presenting as a spinal 

cord tumor. Arch Phys Med Rehabil 1997 

Nov; 78(11):1274-6. Not eligible exposure 

516. Bravo Gutierrez A, Madoff RD, Lowry AC, et 

al. Long-term results of anterior 

sphincteroplasty. Dis Colon Rectum 2004 

May; 47(5):727-31; discussion 31-2. Caseseries 
B-24 

517. Bremmer S, Mellgren A, Holmstrom B, et al. 

Peritoneocele: visualization with 

defecography and peritoneography performed 

simultaneously. Radiology 1997 Feb; 

202(2):373-7. Not eligible outcomes 

518. Brendler CB, Walsh PC. The role of radical 

prostatectomy in the treatment of prostate 

cancer. CA Cancer J Clin 1992 Jul-Aug; 

42(4):212-22. Review 

519. Bretagnol F, Rullier E, Laurent C, et al. 

Comparison of functional results and quality 

of life between intersphincteric resection and 

conventional coloanal anastomosis for low 

rectal cancer. Dis Colon Rectum 2004 Jun; 

47(6):832-8. Case-series 

520. Bretagnol F, Troubat H, Laurent C, et al. 

Long-term functional results after sphinctersaving resection for rectal cancer. 

Gastroenterol Clin Biol 2004 Feb; 28(2):155-

9. Case-series 

521. Brett TD. Patients' attitudes to prostate cancer. 

Aust Fam Physician 1998 Jul; 27 Suppl 2:S84-

8. Not eligible outcomes 

522. Breza J, Alemayehu HM, Hornak M, et al. 

Advantages of converting incontinent to 

continent urinary diversion. Int Urol Nephrol 

1994; 26(4):447-53. Case-series 

523. Breza J, Hornak M, Bardos A, et al. 

Transformation of the Bricker to a continent 

urinary reservoir to eliminate severe 

complications of uretero-ileostomy performed 

in eight patients among 200 Bricker. Ann Urol 

(Paris) 1995; 29(4):227-31. Case-series 

524. Brieger G, Korda A. The effect of obesity on 

the outcome of successful surgery for genuine 

stress incontinence. Aust N Z J Obstet 

Gynaecol 1992 Feb; 32(1):71-2. Case-series 

525. Brieger GM, Yip SK, Fung YM, et al. Genital 

prolapse: a legacy of the West? Aust N Z J 

Obstet Gynaecol 1996 Feb; 36(1):52-4. Not 

eligible target population 

526. Briel JW, de Boer LM, Hop WC, et al. 

Clinical outcome of anterior overlapping 

external anal sphincter repair with internal 

anal sphincter imbrication. Dis Colon Rectum 

1998 Feb; 41(2):209-14. Case-series 

527. Briel JW, Schouten WR, Boerma MO. Longterm results of suture rectopexy in patients 

with fecal incontinence associated with 

incomplete rectal prolapse. Dis Colon Rectum 

1997 Oct; 40(10):1228-32. Case-series 

528. Briel JW, Schouten WR, Vlot EA, et al. 

Clinical value of colonic irrigation in patients 

with continence disturbances. Dis Colon 

Rectum 1997 Jul; 40(7):802-5. Case-series 

529. Briel JW, Stoker J, Rociu E, et al. External 

anal sphincter atrophy on endoanal magnetic 

resonance imaging adversely affects 

continence after sphincteroplasty. Br J Surg 

1999 Oct; 86(10):1322-7. Case-series 

530. Briel JW, Zimmerman DD, Stoker J, et al. 

Relationship between sphincter morphology 

on endoanal MRI and histopathological 

aspects of the external anal sphincter. Int J 

Colorectal Dis 2000 Apr; 15(2):87-90. Not 

eligible outcomes 

531. Bright T, Kapoor R, Voyvodich F, et al. The 

use of a balloon catheter to improve 

evaluation in anorectal manometry. Colorectal 

Dis 2005 Jan; 7(1):4-7. Not eligible exposure 

532. Brincat C, Kenton K, Pat Fitzgerald M, et al. 

Sexual activity predicts continued pessary use. 

Am J Obstet Gynecol 2004 Jul; 191(1):198-

200. Not eligible outcomes 

533. Britnell SJ, Cole JV, Isherwood L, et al. 

Postural health in women: the role of 

physiotherapy. J Obstet Gynaecol Can 2005 

May; 27(5):493-510. Practice Guideline 

534. Brittain K. Stroke and continence care. Nurs 

Times 2001 Jul 26-Aug 1; 97(30):57. 

Comment 

535. Brocklehurst J. Constipation and faecal 

incontinence. Nurs Elder 1990 Feb; 2(2):17-8. 

Comment 

536. Brocklehurst J, Dickinson E, Windsor J. 

Laxatives and faecal incontinence in longterm care. Nurs Stand 1999 Sep 15-21; 

13(52):32-6. Not eligible outcomes 

537. Brodak PP, Juma S, Raz S. Levator hernia. J 

Urol 1992 Sep; 148(3):872-3. Case Reports 

538. Brodsky JT, Sloane BB, Khanna OP. Total 

pelvic exenteration with preservation of fecal 

continence. J Surg Oncol 1993 Aug; 

53(4):261-4. Case Reports 

539. Broens P, Van Limbergen E, Penninckx F, et 

al. Clinical and manometric effects of 

combined external beam irradiation and 

brachytherapy for anal cancer. Int J Colorectal 

Dis 1998; 13(2):68-72. Case-series 

540. Brolmann HA, Vervest HA, Heineman MJ. 

Declining trend in major gynaecological 

surgery in The Netherlands during 1991-1998. 

Is there an impact on surgical skills and 

innovative ability? Bjog 2001 Jul; 108(7):743-

8. Not eligible outcomes 

541. Brookes E. Continence--independent means. 

Nurs Times 1997 Jul 23-29; 93(30):68-70, 2-

3. Comment 
B-25 

542. Brooks MJ. Urinary incontinence: assessment, 

treatment, and reimbursement. Home Healthc 

Nurse 1993 Jul-Aug; 11(4):41-6. CaseReports 

543. Brooks MJ. Assessment and nursing 

management of homebound clients with 

urinary incontinence. Home Healthc Nurse 

1995 Sep-Oct; 13(5):11-6; quiz 7-9. Not 

eligible target population 

544. Brooks V. Treat incontinence early. Nurs 

Stand 2002 May 1-7; 16(33):22. Comment 

545. Broome BA. Psychometric analysis of the 

Broome Pelvic Muscle Self-Efficacy Scale in 

African-American women with incontinence. 

Urol Nurs 2001 Aug; 21(4):289-97. Not 

eligible outcomes 

546. Broseta E, Osca JM, Morera J, et al. 

Urological manifestations of herpes zoster. 

Eur Urol 1993; 24(2):244-7. Not eligible 

exposure 

547. Brown AF, Mangione CM, Saliba D, et al. 

Guidelines for improving the care of the older 

person with diabetes mellitus. J Am Geriatr 

Soc 2003 May; 51(5 Suppl Guidelines):S265-

80. Guideline 

548. Brown J, Thomas E, White H, et al. An 

incontinence helpline service. Nurs Stand 

1991 Jun 12-18; 5(38):25-7. Comment 

549. Brown JS. Epidemiology and changing 

demographics of overactive bladder: a focus 

on the postmenopausal woman. Geriatrics 

2002 May; 57 Suppl 1:6-12. Review 

550. Brown JS, McNaughton KS, Wyman JF, et al. 

Measurement characteristics of a voiding 

diary for use by men and women with 

overactive bladder. Urology 2003 Apr; 

61(4):802-9. Not eligible outcomes 

551. Brown JS, Vittinghoff E, Kanaya AM, et al. 

Urinary tract infections in postmenopausal 

women: effect of hormone therapy and risk 

factors. Obstet Gynecol 2001 Dec; 

98(6):1045-52. Not eligible outcomes 

552. Brown JS, Vittinghoff E, Wyman JF, et al. 

Urinary incontinence: does it increase risk for 

falls and fractures? Study of Osteoporotic 

Fractures Research Group. J Am Geriatr Soc 

2000 Jul; 48(7):721-5. Not eligible outcomes 

553. Brown JS, Waetjen LE, Subak LL, et al. 

Pelvic organ prolapse surgery in the United 

States, 1997. Am J Obstet Gynecol 2002 Apr; 

186(4):712-6. Not eligible outcomes 

554. Brown K, Hilton P. The incidence of detrusor 

instability before and after colposuspension: a 

study using conventional and ambulatory 

urodynamic monitoring. BJU Int 1999 Dec; 

84(9):961-5. Not eligible outcomes 

555. Brown S. Winning treatment. Interview by 

Jennifer Taylor. Nurs Times 2002 Nov 12-18; 

98(46):42-3. Interview 

556. Brown S, Lumley J. Physical health problems 

after childbirth and maternal depression at six 

to seven months postpartum. Bjog 2000 Oct; 

107(10):1194-201. Not eligible level of 

evidence 

557. Brown SL, Govier FE. Cadaveric versus 

autologous fascia lata for the pubovaginal 

sling: surgical outcome and patient 

satisfaction. J Urol 2000 Nov; 164(5):1633-7. 

Case-series 

558. Brown WJ, Miller YD. Too wet to exercise? 

Leaking urine as a barrier to physical activity 

in women. J Sci Med Sport 2001 Dec; 

4(4):373-8. Not eligible level of evidence 

559. Browning A. A new technique for the surgical 

management of urinary incontinence after 

obstetric fistula repair. Bjog 2006 Apr; 

113(4):475-8. Comment 

560. Browning A. Risk factors for developing 

residual urinary incontinence after obstetric 

fistula repair. Bjog 2006 Apr; 113(4):482-5. 

Not eligible level of evidence 

561. Browning RH. What's wrong with this 

patient? Rn 2002 Jan; 65(1):47-9. Case-series 

562. Brownlee RD, Clark AW, Sevick RJ, et al. 

Symptomatic hamartoma of the spinal cord 

associated with neurofibromatosis type 1. 

Case report. J Neurosurg 1998 Jun; 

88(6):1099-103. Case report 

563. Brubaker L. Sacrocolpopexy and the anterior 

compartment: support and function. Am J 

Obstet Gynecol 1995 Dec; 173(6):1690-5; 

discussion 5-6. Case-series 

564. Brubaker L, Harris T, Gleason D, et al. The 

external urethral barrier for stress 

incontinence: a multicenter trial of safety and 

efficacy. Miniguard Investigators Group. 

Obstet Gynecol 1999 Jun; 93(6):932-7. Not 

eligible target population 

565. Brubaker L, Retzky S, Smith C, et al. Pelvic 

floor evaluation with dynamic fluoroscopy. 

Obstet Gynecol 1993 Nov; 82(5):863-8. Not 

eligible outcomes 

566. Bruce DG, Casey GP, Grange V, et al. 

Cognitive impairment, physical disability and 

depressive symptoms in older diabetic 

patients: the Fremantle Cognition in Diabetes 

Study. Diabetes Res Clin Pract 2003 Jul; 

61(1):59-67. Not eligible level of evidence 
B-26 

567. Bruce RG, El-Galley RE, Galloway NT. 

Paravaginal defect repair in the treatment of 

female stress urinary incontinence and 

cystocele. Urology 1999 Oct; 54(4):647-51. 

Case-series 

568. Bruce RG, el-Galley RE, Wells J, et al. 

Antegrade continence enema for the treatment 

of fecal incontinence in adults: use of gastric 

tube for catheterizable access to the 

descending colon. J Urol 1999 Jun; 

161(6):1813-6. Case-series 

569. Brunenberg DE, Joore MA, Veraart CP, et al. 

Economic evaluation of duloxetine for the 

treatment of women with stress urinary 

incontinence: a Markov model comparing 

pharmacotherapy with pelvic floor muscle 

training. Clin Ther 2006 Apr; 28(4):604-18. 

Not eligible outcomes 

570. Bruner DW, Hanlon A, Mazzoni S, et al. 

Predictors of preferences and utilities in men 

treated with 3D-CRT for prostate cancer. Int J 

Radiat Oncol Biol Phys 2004 Jan 1; 58(1):34-

42. Case-series 

571. Brusciano L, Ayabaca SM, Pescatori M, et al. 

Reinterventions after complicated or failed 

stapled hemorrhoidopexy. Dis Colon Rectum 

2004 Nov; 47(11):1846-51. Case-series 

572. Bruyere F, Sun J, Cosson JP, et al. 

Incarceration of bowel through opening of a 5-

mm port. J Endourol 2004 Sep; 18(7):675-6. 

Case Reports 

573. Bryant JE, Bueschen AJ, Cohn JH, et al. 

Transurethral prostatectomy: analysis and 

comparison of four clinical series. South Med 

J 1990 Apr; 83(4):386-9. Case Series 

574. Brylewski JE, Wiggs L. A questionnaire 

survey of sleep and night-time behaviour in a 

community-based sample of adults with 

intellectual disability. J Intellect Disabil Res 

1998 Apr; 42 ( Pt 2):154-62. Not eligible level 

of evidence 

575. Buchanan RJ, Wang S, Huang C, et al. 

Analyses of nursing home residents with 

Parkinson's disease using the minimum data 

set. Parkinsonism Relat Disord 2002 Jun; 

8(5):369-80. Not eligible outcomes 

576. Buchsbaum GM, Albushies DT, Schoenecker 

E, et al. Local anesthesia with sedation for 

vaginal reconstructive surgery. Int Urogynecol 

J Pelvic Floor Dysfunct 2006 May; 17(3):211-

4. Case-series 

577. Buchsbaum GM, Duecy EE, Kerr LA, et al. 

Urinary incontinence in nulliparous women 

and their parous sisters. Obstet Gynecol 2005 

Dec; 106(6):1253-8. Not eligible level of 

evidence 

578. Buchsbaum GM, Moll C, Duecy EE. True 

occult bladder perforation during placement of 

tension-free vaginal tape. Int Urogynecol J 

Pelvic Floor Dysfunct 2004 Nov-Dec; 

15(6):432-3. Case report 

579. Buffa P, Torre M, Scarsi PL, et al. Caudal 

regression syndrome: an online multicentre 

survey. Urological long-term results. Eur J 

Pediatr Surg 2002 Dec; 12 Suppl 1:S26-8. Not 

eligible target population 

580. Buie WD, Lowry AC, Rothenberger DA, et al. 

Clinical rather than laboratory assessment 

predicts continence after anterior 

sphincteroplasty. Dis Colon Rectum 2001 

Sep; 44(9):1255-60. Case-series 

581. Bukkapatnam R, Shah S, Raz S, et al. Anterior 

vaginal wall surgery in elderly patients: 

outcomes and assessment. Urology 2005 Jun; 

65(6):1104-8. Case-series 

582. Bulent Tiras M, Sendag F, Dilek U, et al. 

Laparoscopic burch colposuspension: 

comparison of effectiveness of extraperitoneal 

and transperitoneal techniques. Eur J Obstet 

Gynecol Reprod Biol 2004 Sep 10; 116(1):79-

84. Case-series 

583. Bull E, Chilton CP, Gould CA, et al. Singleblind, randomised, parallel group study of the 

Bard Biocath catheter and a silicone elastomer 

coated catheter. Br J Urol 1991 Oct; 

68(4):394-9. Not eligible outcomes 

584. Bullard KM, Madoff RD, Gemlo BT. Is 

ileoanal pouch function stable with time? 

Results of a prospective audit. Dis Colon 

Rectum 2002 Mar; 45(3):299-304. Case-series 

585. Bulmer PJ, James M, Ellis-Jones J, et al. A 

randomized trial comparing the effectiveness 

and preference of a touch-screen computer 

system with a leaflet for providing women 

with information on urinary symptoms 

suggestive of detrusor instability. BJU Int 

2001 Oct; 88(6):532-5. Not eligible outcomes 

586. Bump RC. Racial comparisons and contrasts 

in urinary incontinence and pelvic organ 

prolapse. Obstet Gynecol 1993 Mar; 

81(3):421-5. Not eligible target population 

587. Bump RC. The urethrodetrusor facilitative 

reflex in women: results of urethral perfusion 

studies. Am J Obstet Gynecol 2000 Apr; 

182(4):794-802; discussion -4. Not eligible 

outcomes 

588. Bump RC, Coates KW, Cundiff GW, et al. 

Diagnosing intrinsic sphincteric deficiency: 

comparing urethral closure pressure, urethral 

axis, and Valsalva leak point pressures. Am J 

Obstet Gynecol 1997 Aug; 177(2):303-10. Not 

eligible outcomes 
B-27 

589. Bump RC, Elser DM, Theofrastous JP, et al. 

Valsalva leak point pressures in women with 

genuine stress incontinence: reproducibility, 

effect of catheter caliber, and correlations with 

other measures of urethral resistance. 

Continence Program for Women Research 

Group. Am J Obstet Gynecol 1995 Aug; 

173(2):551-7. Not eligible outcomes 

590. Bump RC, Hurt WG, Addison WA, et al. 

Reliability and correlation of measurements 

during and after bladder neck surgery. The 

Continence Program for Women Research 

Group. Br J Urol 1998 Nov; 82(5):628-33. Not 

eligible outcomes 

591. Bump RC, Hurt WG, Fantl JA, et al. 

Assessment of Kegel pelvic muscle exercise 

performance after brief verbal instruction. Am 

J Obstet Gynecol 1991 Aug; 165(2):322-7; 

discussion 7-9. Case-series 

592. Bump RC, McClish DK. Cigarette smoking 

and urinary incontinence in women. Am J 

Obstet Gynecol 1992 Nov; 167(5):1213-8. Not 

eligible level of evidence 

593. Bump RC, McClish DM. Cigarette smoking 

and pure genuine stress incontinence of urine: 

a comparison of risk factors and determinants 

between smokers and nonsmokers. Am J 

Obstet Gynecol 1994 Feb; 170(2):579-82. Not 

eligible target population 

594. Bump RC, Norton PA, Zinner NR, et al. 

Mixed urinary incontinence symptoms: 

urodynamic findings, incontinence severity, 

and treatment response. Obstet Gynecol 2003 

Jul; 102(1):76-83. Not eligible exposure 

595. Bump RC, Sugerman HJ, Fantl JA, et al. 

Obesity and lower urinary tract function in 

women: effect of surgically induced weight 

loss. Am J Obstet Gynecol 1992 Aug; 

167(2):392-7; discussion 7-9. Case-series 

596. Buntzen S, Rasmussen OO, Ryhammer AM, 

et al. Sacral nerve stimulation for treatment of 

fecal incontinence in a patient with muscular 

dystrophy: report of a case. Dis Colon Rectum 

2004 Aug; 47(8):1409-11. Case-reports 

597. Bunyavejchevin S. Risk factors of female 

urinary incontinence and overactive bladder in 

Thai postmenopausal women. J Med Assoc 

Thai 2005 Sep; 88 Suppl 4:S119-23. Not 

eligible level of evidence 

598. Bunyavejchevin S. Can pre-operative 

urodynamic study predict the successful 

outcome of tension free vaginal tape (TVT) 

operation in Thai women with stress urinary 

incontinence? J Med Assoc Thai 2005 Nov; 

88(11):1493-6. Case-series 

599. Bunyavejchevin S. The impact of overactive 

bladder, stress and mixed urinary incontinence 

on quality of life in Thai postmenopausal 

women. J Med Assoc Thai 2006 Mar; 

89(3):294-8. Not eligible outcomes 

600. Bunyavejchevin S, Santingamkun A, 

Wisawasukmongchol W. The three years 

results of tension free vaginal tape (TVT) for 

the treatment of stress urinary incontinence in 

Thai women. J Med Assoc Thai 2005 Jan; 

88(1):5-8. Case-series 

601. Bunyavejchevin S, Veeranarapanich S. 

Quality of life assessment in Thai 

postmenopausal women with an overactive 

bladder. J Med Assoc Thai 2005 Aug; 

88(8):1023-7. Not eligible outcomes 

602. Bunyavejchevin S, Wisawasukmongchol W. 

Five years follow up of laparoscopic burch 

colposuspension for stress urinary 

incontinence in Thai women. J Med Assoc 

Thai 2005 Sep; 88(9):1182-6. Case-series 

603. Burgio KL. Behavioral training for stress and 

urge incontinence in the community. 

Gerontology 1990; 36 Suppl 2:27-34. No 

associative hypothesis tested 

604. Burgio KL, Engel BT. Biofeedback-assisted 

behavioral training for elderly men and 

women. J Am Geriatr Soc 1990 Mar; 

38(3):338-40. Comment 

605. Burgio KL, Goode PS, Locher JL, et al. 

Predictors of outcome in the behavioral 

treatment of urinary incontinence in women. 

Obstet Gynecol 2003 Nov; 102(5 Pt 1):940-7. 

Review 

606. Burgio KL, Goode PS, Richter HE, et al. 

Global ratings of patient satisfaction and 

perceptions of improvement with treatment for 

urinary incontinence: validation of three 

global patient ratings. Neurourol Urodyn 

2006; 25(5):411-7. Review 

607. Burgio KL, Ives DG, Locher JL, et al. 

Treatment seeking for urinary incontinence in 

older adults. J Am Geriatr Soc 1994 Feb; 

42(2):208-12. Not eligible outcomes 

608. Burgio KL, Locher JL, Goode PS. Combined 

behavioral and drug therapy for urge 

incontinence in older women. J Am Geriatr 

Soc 2000 Apr; 48(4):370-4. Not eligible 

exposure 

609. Burgio KL, Locher JL, Goode PS, et al. 

Behavioral vs drug treatment for urge urinary 

incontinence in older women: a randomized 

controlled trial. JAMA 1998 Dec 16; 

280(23):1995-2000. Secondary data report 
B-28 

610. Burgio KL, Locher JL, Roth DL, et al. 

Psychological improvements associated with 

behavioral and drug treatment of urge 

incontinence in older women. J Gerontol B 

Psychol Sci Soc Sci 2001 Jan; 56(1):P46-51. 

Not eligible outcomes 

611. Burgio LD, Engel BT, Hawkins A, et al. A 

staff management system for maintaining 

improvements in continence with elderly 

nursing home residents. J Appl Behav Anal 

1990 Spring; 23(1):111-8. Case-series 

612. Burke ER, Welvaart K. Complications of 

stapled anastomoses in anterior resection for 

rectal carcinoma: colorectal anastomosis 

versus coloanal anastomosis. J Surg Oncol 

1990 Nov; 45(3):180-3. Case-series 

613. Burnett SJ, Speakman CT, Kamm MA, et al. 

Confirmation of endosonographic detection of 

external anal sphincter defects by 

simultaneous electromyographic mapping. Br 

J Surg 1991 Apr; 78(4):448-50. No associative 

hypothesis tested 

614. Burnett SJ, Spence-Jones C, Speakman CT, et 

al. Unsuspected sphincter damage following 

childbirth revealed by anal endosonography. 

Br J Radiol 1991 Mar; 64(759):225-7. Not 

eligible outcomes 

615. Burns A, Jacoby R, Levy R. Psychiatric 

phenomena in Alzheimer's disease. IV: 

Disorders of behaviour. Br J Psychiatry 1990 

Jul; 157:86-94. Not eligible exposure 

616. Buron C, Le Vu B, Cosset JM, et al. 

Brachytherapy versus prostatectomy in 

localized prostate cancer: results of a French 

multicenter prospective medico-economic 

study. Int J Radiat Oncol Biol Phys 2007 Mar 

1; 67(3):812-22. Case-series 

617. Burt J, Caelli K, Moore K, et al. Radical 

prostatectomy: men's experiences and 

postoperative needs. J Clin Nurs 2005 Aug; 

14(7):883-90. Not eligible outcomes 

618. Busacchi P, De Giorgio R, Santini D, et al. A 

histological and immunohistochemical study 

of neuropeptide containing somatic nerves in 

the levator ani muscle of women with 

genitourinary prolapse. Acta Obstet Gynecol 

Scand 1999 Jan; 78(1):2-5. Not eligible 

outcomes 

619. Busacchi P, Perri T, Paradisi R, et al. 

Abnormalities of somatic peptide-containing 

nerves supplying the pelvic floor of women 

with genitourinary prolapse and stress urinary 

incontinence. Urology 2004 Mar; 63(3):591-5. 

Not eligible outcomes 

620. Bushman W, Steers WD, Meythaler JM. 

Voiding dysfunction in patients with spastic 

paraplegia: urodynamic evaluation and 

response to continuous intrathecal baclofen. 

Neurourol Urodyn 1993; 12(2):163-70. Casereports 

621. But I. Vaginal wall erosion after 

transobturator tape procedure. Int Urogynecol 

J Pelvic Floor Dysfunct 2005 Nov-Dec; 

16(6):506-8. Case-reports 

622. But I, Bratus D, Faganelj M. Prolene tape in 

the bladder wall after TVT procedure--

intramural tape placement or secondary tape 

migration? Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Jan-Feb; 16(1):75-6. Case 

Reports 

623. Butler L, Downe-Wamboldt B, Marsh S, et al. 

Behind the scenes: partners' perceptions of 

quality of life post radical prostatectomy. Urol 

Nurs 2000 Aug; 20(4):254-8. Not eligible 

target population 

624. Butler L, Downe-Wamboldt B, Marsh S, et al. 

Quality of life post radical prostatectomy: a 

male perspective. Urol Nurs 2001 Aug; 

21(4):283-8. Case-series 

625. Butler RN, August P, Ferdinand KC, et al. 

Hypertension: how comorbid disease 

influences the choice of therapy. Part 4 of a 

roundtable discussion. Geriatrics 1999 Aug; 

54(8):34, 9-44. No associative hypothesis 

tested 

626. Butler RN, Maby JI, Montella JM, et al. 

Urinary incontinence: primary care therapies 

for the older woman. Geriatrics 1999 Nov; 

54(11):31-4, 9-40, 3-4. Comment 

627. Butler RN, Maby JI, Montella JM, et al. 

Urinary incontinence: keys to diagnosis of the 

older woman.1. Geriatrics 1999 Oct; 

54(10):22-6, 9-30. Comment 

628. Butler RN, Maby JI, Montella JM, et al. 

Urinary incontinence: when to refer for 

procedural therapies. Geriatrics 1999 Dec; 

54(12):49-54, 6. Case-series 

629. Buttafuoco A, Keighley MR. Cost of pelvic 

floor repair for faecal incontinence. Dig Surg 

2000; 17(6):623-6. Not eligible outcomes 

630. Butteriss D, Soh C. A case of spinal cord 

compression of unknown cause. Br J Radiol 

2006 Sep; 79(945):775-7. Case report 

631. Butturini E. Pants are back in style! N Z 

Health Hospital 1990 May-Jun; 42(3):14, 9. 

Comment 

632. Butturini E. Pants for incontinence patients. N 

Z Nurs J 1990 Oct; 83(9):26. Case-series 
B-29 

633. Byck DB, Varner RE, Clough C. Urinary 

complaints after modified Burch urethropexy: 

an analysis. Am J Obstet Gynecol 1994 Dec; 

171(6):1460-2; discussion 2-4. Case-series 

634. Byers PH, Ryan PA, Regan MB, et al. Effects 

of incontinence care cleansing regimens on 

skin integrity. J Wound Ostomy Continence 

Nurs 1995 Jul; 22(4):187-92. Not eligible 

outcomes 

635. Byrne CM, Solomon MJ, Young JM, et al. 

Biofeedback for fecal incontinence: short-term 

outcomes of 513 consecutive patients and 

predictors of successful treatment. Dis Colon 

Rectum 2007 Apr; 50(4):417-27. Case-series 

636. Cain MP, Casale AJ, King SJ, et al. 

Appendicovesicostomy and newer alternatives 

for the Mitrofanoff procedure: results in the 

last 100 patients at Riley Children's Hospital. J 

Urol 1999 Nov; 162(5):1749-52. Not eligible 

target population 

637. Cam C, Sakalli M, Ay P, et al. Validation of 

the short forms of the incontinence impact 

questionnaire (IIQ-7) and the urogenital 

distress inventory (UDI-6) in a Turkish 

population. Neurourol Urodyn 2007; 

26(1):129-33. Not eligible exposure 

638. Cammu H, Van Nylen M, Blockeel C, et al. 

Who will benefit from pelvic floor muscle 

training for stress urinary incontinence? Am J 

Obstet Gynecol 2004 Oct; 191(4):1152-7. Not 

eligible target population 

639. Cammu H, Van Nylen M, Derde MP, et al. 

Pelvic physiotherapy in genuine stress 

incontinence. Urology 1991 Oct; 38(4):332-7. 

No associative hypothesis tested 

640. Campbell DM, Behan M, Donnelly VS, et al. 

Endosonographic assessment of postpartum 

anal sphincter injury using a 120 degree sector 

scanner. Clin Radiol 1996 Aug; 51(8):559-61. 

Not eligible outcomes 

641. Canning DA. Modification of meatal 

advancement and glanuloplasty for correction 

of distal hypospadias. J Urol 2005 Jun; 

173(6):2144-5. Comment 

642. Capar M. A new retropubic suspension 

operation technique for transvaginal Burch 

operation, using newly developed equipment. 

Acta Obstet Gynecol Scand 2004 Oct; 

83(10):898-903. Case-series 

643. Capitanucci ML, Iacobelli BD, Silveri M, et 

al. Long-term urological follow-up of occult 

spinal dysraphism in children. Eur J Pediatr 

Surg 1996 Dec; 6 Suppl 1:25-6. Not eligible 

target population 

644. Caputo RM, Benson JT, McClellan E. 

Intravaginal maximal electrical stimulation in 

the treatment of urinary incontinence. J 

Reprod Med 1993 Sep; 38(9):667-71. Caseseries 

645. Caquant F, Collinet P, Deruelle P, et al. 

Perineal cellulitis following trans-obturator 

sub-urethral tape Uratape. Eur Urol 2005 Jan; 

47(1):108-10. Case Reports 

646. Caraballo R, Bologna RA, Lukban J, et al. 

Sacral nerve stimulation as a treatment for 

urge incontinence and associated pelvic floor 

disorders at a pelvic floor center: a follow-up 

study. Urology 2001 Jun; 57(6 Suppl 1):121. 

Case-series 

647. Carbone JM, Kavaler E, Hu JC, et al. 

Pubovaginal sling using cadaveric fascia and 

bone anchors: disappointing early results. J 

Urol 2001 May; 165(5):1605-11. Case-series 

648. Cardozo L. Role of estrogens in the treatment 

of female urinary incontinence. J Am Geriatr 

Soc 1990 Mar; 38(3):326-8. Review 

649. Cardozo L, Brindley GS. Endoscopically 

guided bladder neck suspension for continence 

in paraplegic women with implant driven 

micturition. Paraplegia 1992 May; 30(5):336-

8. Case- Reports 

650. Cardozo L, Dixon A. Increased warning time 

with darifenacin: a new concept in the 

management of urinary urgency. J Urol 2005 

Apr; 173(4):1214-8. Not eligible exposure 

651. Cardozo L, Drutz HP, Baygani SK, et al. 

Pharmacological treatment of women awaiting 

surgery for stress urinary incontinence. Obstet 

Gynecol 2004 Sep; 104(3):511-9. Not eligible 

exposure 

652. Cardozo L, Hextall A, Bailey J, et al. 

Colposuspension after previous failed 

incontinence surgery: a prospective 

observational study. Br J Obstet Gynaecol 

1999 Apr; 106(4):340-4. Case-series 

653. Cardozo L, Lisec M, Millard R, et al. 

Randomized, double-blind placebo controlled 

trial of the once daily antimuscarinic agent 

solifenacin succinate in patients with 

overactive bladder. J Urol 2004 Nov; 172(5 Pt 

1):1919-24. Not eligible exposure 

654. Carey JM, Leach GE. Transvaginal surgery in 

the octogenarian using cadaveric fascia for 

pelvic prolapse and stress incontinence: 

minimal one-year results compared to younger 

patients. Urology 2004 Apr; 63(4):665-70. 

Case-series 
B-30 

655. Carey MP, De Jong S, Friedhuber A, et al. A 

prospective evaluation of the pathogenesis of 

detrusor instability in women, using electron 

microscopy and immunohistochemistry. BJU 

Int 2000 Dec; 86(9):970-6. Not eligible 

exposure 

656. Carey MP, Dwyer PL. Position and mobility 

of the urethrovesical junction in continent and 

in stress incontinent women before and after 

successful surgery. Aust N Z J Obstet 

Gynaecol 1991 Aug; 31(3):279-84. Caseseries 

657. Carey MP, Goh JT, Fynes MM, et al. Stress 

urinary incontinence after delayed primary 

closure of genitourinary fistula: a technique 

for surgical management. Am J Obstet 

Gynecol 2002 May; 186(5):948-53. Caseseries 

658. Carini M, Serni S, Lapini A, et al. Second 

stage reconfiguration of Camey I ileal bladder 

improves its urodynamic and clinical 

characteristics. Urology 1994 Sep; 44(3):425-

8. Case-series 

659. Carley ME, Schaffer J. Urinary incontinence 

and pelvic organ prolapse in women with 

Marfan or Ehlers Danlos syndrome. Am J 

Obstet Gynecol 2000 May; 182(5):1021-3. 

Case-series 

660. Carlisle D. Silent suffering. Nurs Times 1998 

Apr 15-21; 94(15):63-4, 7. Comment 

661. Carls C. The prevalence of stress urinary 

incontinence in high school and college-age 

female athletes in the midwest: implications 

for education and prevention. Urol Nurs 2007 

Feb; 27(1):21-4, 39. Not eligible level of 

evidence 

662. Carlsson S, Nilsson A, Wiklund PN. 

Postoperative urinary continence after robotassisted laparoscopic radical prostatectomy. 

Scand J Urol Nephrol 2006; 40(2):103-7. 

Case-series 

663. Carmona JA, Ortiz H, Perez-Cabanas I. 

Alterations in anorectal function after anterior 

resection for cancer of the rectum. Int J 

Colorectal Dis 1991 May; 6(2):108-10. Caseseries 

664. Caro FG, Glickman LL, Ingegneri D, et al. 

The impact of the closing of three 

Massachusetts public chronic disease 

hospitals: a multidimensional perspective. J 

Community Health 1997 Jun; 22(3):155-74. 

Not eligible exposure 

665. Carpelan-Holmstrom M, Kruuna O, Scheinin 

T. Laparoscopic rectal prolapse surgery 

combined with short hospital stay is safe in 

elderly and debilitated patients. Surg Endosc 

2006 Sep; 20(9):1353-9. Case-series 

666. Carr LK, Herschorn S. Periurethral collagen 

injection and pregnancy. J Urol 1996 Mar; 

155(3):1037. Case-reports 

667. Carr M. Continence promotion and 

management. Nurs BC 2004 Apr; 36(2):16-8. 

Comment 

668. Carranza-Lira S, Murillo-Uribe A, MartinezTrejo N, et al. Changes in symptoms, blood 

pressure, glucose, hormones, and lipid levels 

according to weight and body fat distribution 

in climacteric women. Int J Fertil Womens 

Med 1998 Nov-Dec; 43(6):306-11. Question 2 

669. Carriero A, Dal Borgo P, Pucciani F. Stapled 

mucosal prolapsectomy for haemorrhoidal 

prolapse with Lone Star Retractor System. 

Tech Coloproctol 2001 Apr; 5(1):41-6. Caseseries 

670. Carrion R, Arap S, Corcione G, et al. A multiinstitutional study of orthotopic neobladders: 

functional results in men and women. BJU Int 

2004 Apr; 93(6):803-6. Not eligible target 

population 

671. Carta G, Cerrone L, Iovenitti P. Tension-free 

vaginal tape procedure for treatment of USI: 

subjective and objective efficacy evaluation. 

Clin Exp Obstet Gynecol 2002; 29(4):247-50. 

Case-series 

672. Carter D, Green D. Health promotion. 

Applying COPC to incontinence. Nurs Times 

1994 Aug 31-Sep 6; 90(35):44-5. Not 

associative hypothesis tested 

673. Cartier C. From home to hospital and back 

again: economic restructuring, end of life, and 

the gendered problems of place-switching 

health services. Soc Sci Med 2003 Jun; 

56(11):2289-301. Review 

674. Caruana BJ, Wald A, Hinds JP, et al. 

Anorectal sensory and motor function in 

neurogenic fecal incontinence. Comparison 

between multiple sclerosis and diabetes 

mellitus. Gastroenterology 1991 Feb; 

100(2):465-70. Not eligible outcomes 

675. Casal E, San Ildefonso A, Carracedo R, et al. 

Artificial bowel sphincter in severe anal 

incontinence. Colorectal Dis 2004 May; 

6(3):180-4. Case-series 

676. Casillas S, Hull TL, Zutshi M, et al. 

Incontinence after a lateral internal 

sphincterotomy: are we underestimating it? 

Dis Colon Rectum 2005 Jun; 48(6):1193-9. 

Case-series 
B-31 

677. Casper FW, Linn JF, Black P. Obstetrical 

management following incontinence surgery. J 

Obstet Gynaecol Res 1999 Feb; 25(1):51-3. 

Case-series 

678. Cassidy TP, Farquhar DL. The characteristics 

of respite patients. Health Bull (Edinb) 1995 

Jan; 53(1):13-9. Case-series 

679. Castellan M, Gosalbez R, Labbie A, et al. 

Bladder neck sling for treatment of neurogenic 

incontinence in children with augmentation 

cystoplasty: long-term followup. J Urol 2005 

Jun; 173(6):2128-31; discussion 31. Not 

eligible target population 

680. Castera R, Podesta ML, Ruarte A, et al. 10-

Year experience with artificial urinary 

sphincter in children and adolescents. J Urol 

2001 Jun; 165(6 Pt 2):2373-6. Not eligible 

target population 

681. Castillo OA, Bodden E, Olivares RA, et al. 

Intestinal perforation: an infrequent 

complication during insertion of tension-free 

vaginal tape. J Urol 2004 Oct; 172(4 Pt 

1):1364. Case-reports 

682. Castillo OA, Bodden EM, Vitagliano GJ, et al. 

Anterior transanal, transsphincteric sagittal 

approach for fistula repair secondary to 

laparoscopic radical prostatectomy: a simple 

and effective technique. Urology 2006 Jul; 

68(1):198-201. Case-series 

683. Castina S, Boyington A, Dougherty M. 

Urinary incontinence. Am J Nurs 2002 Aug; 

102(8):85, 7. Comment 

684. Catalona WJ, Bigg SW. Nerve-sparing radical 

prostatectomy: evaluation of results after 250 

patients. J Urol 1990 Mar; 143(3):538-43; 

discussion 44. Case Series 

685. Cavallaro A, Fellner F, Matzel KE, et al. Lowfield magnetic resonance imaging of the pelvis 

in patients with anal dynamic graciloplasty: 

initial experience. Magma 1998 Dec; 

7(3):179-83. Not eligible outcomes 

686. Cavanaugh M, Hyman N, Osler T. Fecal 

incontinence severity index after fistulotomy: 

a predictor of quality of life. Dis Colon 

Rectum 2002 Mar; 45(3):349-53. Not eligible 

outcomes 

687. Cavina E. Total anorectal reconstruction after 

abdominoperineal resection. Int J Surg 

Investig 1999; 1(3):262-3. Case-reports 

688. Cavina E, Seccia M, Chiarugi M, et al. 

Laparoscopically assisted abdominoperineal 

resection and simultaneous total anorectal 

reconstruction with electrostimulated staticdynamic graciloplasty. Surg Endosc 1997 

Dec; 11(12):1209-12. Case Reports 

689. Cazemier M, Terra MP, Stoker J, et al. 

Atrophy and defects detection of the external 

anal sphincter: comparison between threedimensional anal endosonography and 

endoanal magnetic resonance imaging. Dis 

Colon Rectum 2006 Jan; 49(1):20-7. Not 

eligible outcomes 

690. Cespedes RD. Anterior approach bilateral 

sacrospinous ligament fixation for vaginal 

vault prolapse. Urology 2000 Dec 4; 56(6 

Suppl 1):70-5. Case-series 

691. Cespedes RD, Cross CA, McGuire EJ. 

Modified Ingelman-Sundberg bladder 

denervation procedure for intractable urge 

incontinence. J Urol 1996 Nov; 156(5):1744-

7. Case-series 

692. Cespedes RD, Cross CA, McGuire EJ. 

Pubovaginal fascial slings. Tech Urol 1997 

Winter; 3(4):195-201. Comment 

693. Cetinel B, Demirkesen O, Kural AR, et al. 

Polypropylene mesh tape for male sphincteric 

incontinence. Scand J Urol Nephrol 2004; 

38(5):396-400. Case-series 

694. Cetinel B, Demirkesen O, Onal B, et al. Are 

there any factors predicting the cure and 

complication rates of tension-free vaginal 

tape? Int Urogynecol J Pelvic Floor Dysfunct 

2004 May-Jun; 15(3):188-93. Case-series 

695. Cetinel B, Demirkesen O, Talat Z, et al. 

Application of continent retubularized ileal 

stoma (Monti procedure) to an ileocecal 

pouch. Urology 2000 Feb; 55(2):286. Casereports 

696. Ceulemans R, Creve U, Van Hee R, et al. 

Benefit of emergency haemorrhoidectomy: a 

comparison with results after elective 

operations. Eur J Surg 2000 Oct; 166(10):808-

12; discussion 13. Not eligible outcomes 

697. Chadburn S, Haggar V, Gooch S. Developing 

a continence care programme. Prof Nurse 

1998 Oct; 14(1):31-3. Case Reports 

698. Chaikin DC, Blaivas JG, Rosenthal JE, et al. 

Results of pubovaginal sling for stress 

incontinence: a prospective comparison of 4 

instruments for outcome analysis. J Urol 1999 

Nov; 162(5):1670-3. Not eligible outcomes 

699. Chaikin DC, Groutz A, Blaivas JG. Predicting 

the need for anti-incontinence surgery in 

continent women undergoing repair of severe 

urogenital prolapse. J Urol 2000 Feb; 

163(2):531-4. Case-series 

700. Chait PG, Shandling B, Richards HM, et al. 

Fecal incontinence in children: treatment with 

percutaneous cecostomy tube placement--a 

prospective study. Radiology 1997 Jun; 

203(3):621-4. Not eligible target population 
B-32 

701. Chait PG, Shlomovitz E, Connolly BL, et al. 

Percutaneous cecostomy: updates in technique 

and patient care. Radiology 2003 Apr; 

227(1):246-50. Not eligible target population 

702. Chaliha C, Bland JM, Monga A, et al. 

Pregnancy and delivery: a urodynamic 

viewpoint. Bjog 2000 Nov; 107(11):1354-9. 

Not eligible level of evidence 

703. Chaliha C, Digesu A, Hutchings A, et al. 

Caesarean section is protective against stress 

urinary incontinence: an analysis of women 

with multiple deliveries. Bjog 2004 Jul; 

111(7):754-5. Not eligible level of evidence 

704. Chaliha C, Khullar V, Stanton SL, et al. 

Urinary symptoms in pregnancy: are they 

useful for diagnosis? Bjog 2002 Oct; 

109(10):1181-3. Not eligible outcomes 

705. Chaliha C, Stanton SL. The ethnic cultural and 

social aspects of incontinence--a pilot study. 

Int Urogynecol J Pelvic Floor Dysfunct 1999; 

10(3):166-70. Case-series 

706. Challacombe B, Kelleher C, Sami T, et al. 

Laparoscopic nephroureterectomy for adult 

incontinence caused by functioning ectopic 

pelvic kidney draining into vagina. J Endourol 

2004 Jun; 18(5):447-8. Case Reports 

707. Chambers K. Continence. Regained dignity. 

Nurs Times 1993 Nov 24-30; 89(47):65-6. 

Case Reports 

708. Chan CL, Facer P, Davis JB, et al. Sensory 

fibres expressing capsaicin receptor TRPV1 in 

patients with rectal hypersensitivity and faecal 

urgency. Lancet 2003 Feb 1; 361(9355):385-

91. Not eligible outcomes 

709. Chan CL, Lunniss PJ, Wang D, et al. Rectal 

sensorimotor dysfunction in patients with urge 

faecal incontinence: evidence from prolonged 

manometric studies. Gut 2005 Sep; 

54(9):1263-72. Not eligible outcomes 

710. Chan KM, Lim PH, Chee YC, et al. Urinary 

symptoms and urodynamic diagnosis of 

patients in one geriatric department. Ann Acad 

Med Singapore 1992 Nov; 21(6):813-7. Caseseries 

711. Chan LW, Pang MW, Yip SK. Arcus 

tendineus levator ani tear causing pelvic 

hematoma after tension-free vaginal tape 

insertion. Gynecol Obstet Invest 2002; 

54(2):118. Case Reports 

712. Chan LW, Tse VW. Unrecognized bladder 

perforation while placing a suburethral 

synthetic sling: a minimally invasive 

technique for removing an intravesical sling 

segment. BJU Int 2005 Jan; 95(1):187-8. Case 

Reports 

713. Chan MK, Tjandra JJ. Injectable silicone 

biomaterial (PTQ) to treat fecal incontinence 

after hemorrhoidectomy. Dis Colon Rectum 

2006 Apr; 49(4):433-9. Case-series 

714. Chan PT, Fournier C, Corcos J. Short-term 

complications of pubovaginal sling procedure 

for genuine stress incontinence in women. 

Urology 2000 Feb; 55(2):207-11. Case-series 

715. Chance R. A problem we need not take for 

granted. Prof Nurse 1994 Apr; 9(7):498, 500, 

2 passim. Comment 

716. Chancellor MB, Gajewski J, Ackman CF, et 

al. Long-term followup of the North American 

multicenter UroLume trial for the treatment of 

external detrusor-sphincter dyssynergia. J Urol 

1999 May; 161(5):1545-50. Not eligible target 

population 

717. Chancellor MB, Hong RD, Rivas DA, et al. 

Gracilis urethromyoplasty--an autologous 

urinary sphincter for neurologically impaired 

patients with stress incontinence. Spinal Cord 

1997 Aug; 35(8):546-9. Case-reports 

718. Chancellor MB, Rivas DA, Abdill CK, et al. 

Management of sphincter dyssynergia using 

the sphincter stent prosthesis in chronically 

catheterized SCI men. J Spinal Cord Med 

1995 Apr; 18(2):88-94. Not eligible target 

population 

719. Chancellor MB, Rivas DA, Watanabe T, et al. 

Reversible clinical outcome after sphincter 

stent removal. J Urol 1996 Jun; 155(6):1992-

4. Not eligible target population 

720. Chancellor MB, Strup S, Rivas DA, et al. 

Rectus urethromyoplasty of radical 

prostatectomy anastomosis decreases 

postoperative incontinence and anastomotic 

stricture; technique and preliminary results. J 

Urol 1997 Jan; 157(1):371-5. Not eligible 

target population 

721. Chancellor MB, Watanabe T, Rivas DA, et al. 

Gracilis urethral myoplasty: preliminary 

experience using an autologous urinary 

sphincter for post-prostatectomy incontinence. 

J Urol 1997 Oct; 158(4):1372-5. Case Reports 

722. Chander J, Gupta U, Mehra R, et al. Safety 

and efficacy of transurethral resection of the 

prostate under sedoanalgesia. BJU Int 2000 

Aug; 86(3):220-2. Not eligible outcomes 

723. Chang HC, Chang SC, Kuo HC, et al. 

Transrectal sonographic cystourethrography: 

studies in stress urinary incontinence. Urology 

1990 Dec; 36(6):488-92. Case-series 

724. Chang PL, Tsai LH, Huang ST, et al. The 

early effect of pelvic floor muscle exercise 

after transurethral prostatectomy. J Urol 1998 

Aug; 160(2):402-5. Case-series 
B-33 

725. Chang SC, Lin JK. Change in anal continence 

after surgery for intersphincteral anal fistula: a 

functional and manometric study. Int J 

Colorectal Dis 2003 Mar; 18(2):111-5. Caseseries 

726. Chao R, Mayo ME. Incontinence after radical 

prostatectomy: detrusor or sphincter causes. J 

Urol 1995 Jul; 154(1):16-8. Case-series 

727. Chapelle T, Reher S, Denis B. Surgical 

extraction of a bladder stone due to a foreign 

body. Acta Urol Belg 1992; 60(1):85-7. Casereports 

728. Chapman SM, Wemyss-Holden GD, Clarke 

NW. Urinary incontinence following urethral 

Wallstent insertion. Br J Urol 1994 May; 

73(5):586. Case Reports 

729. Chapple CR, Abrams P. Comparison of 

darifenacin and oxybutynin in patients with 

overactive bladder: assessment of ambulatory 

urodynamics and impact on salivary flow. Eur 

Urol 2005 Jul; 48(1):102-9. Not eligible 

exposure 

730. Chapple CR, Haab F, Cervigni M, et al. An 

open, multicentre study of NASHA/Dx Gel 

(Zuidex) for the treatment of stress urinary 

incontinence. Eur Urol 2005 Sep; 48(3):488-

94. Not eligible target population 

731. Chapple CR, Martinez-Garcia R, Selvaggi L, 

et al. A comparison of the efficacy and 

tolerability of solifenacin succinate and 

extended release tolterodine at treating 

overactive bladder syndrome: results of the 

STAR trial. Eur Urol 2005 Sep; 48(3):464-70. 

Not eligible exposure 

732. Chapple CR, Patroneva A, Raines SR. Effect 

of an ATP-sensitive potassium channel opener 

in subjects with overactive bladder: a 

randomized, double-blind, placebo-controlled 

study (ZD0947IL/0004). Eur Urol 2006 May; 

49(5):879-86. Not eligible exposure 

733. Chapron C, Dubuisson JB, Ansquer Y, et al. 

Hysterectomy with adnexectomy. Can 

operative laparoscopy offer advantages? J 

Reprod Med 1997 Apr; 42(4):201-6. Caseseries 

734. Chartier-Kastler EJ, Mongiat-Artus P, Bitker 

MO, et al. Long-term results of augmentation 

cystoplasty in spinal cord injury patients. 

Spinal Cord 2000 Aug; 38(8):490-4. Caseseries 

735. Chartier-Kastler EJ, Mozer P, Denys P, et al. 

Neurogenic bladder management and 

cutaneous non-continent ileal conduit. Spinal 

Cord 2002 Sep; 40(9):443-8. Case-series 

736. Chartier-Kastler EJ, Ruud Bosch JL, Perrigot 

M, et al. Long-term results of sacral nerve 

stimulation (S3) for the treatment of 

neurogenic refractory urge incontinence 

related to detrusor hyperreflexia. J Urol 2000 

Nov; 164(5):1476-80. Not eligible target 

population 

737. Chartrand-Lefebvre C, Heppell J, Davignon I, 

et al. Dietary habits after ileal pouch-anal 

anastomosis. Can J Surg 1990 Apr; 33(2):101-

5. Case-series 

738. Chatterjee US, Mandal MK, Basu S, et al. 

Comparative study of dartos fascia and tunica 

vaginalis pedicle wrap for the tubularized 

incised plate in primary hypospadias repair. 

BJU Int 2004 Nov; 94(7):1102-4. Not eligible 

target population 

739. Chatwin NA, Ribordy M, Givel JC. Clinical 

outcomes and quality of life after low anterior 

resection for rectal cancer. Eur J Surg 2002; 

168(5):297-301. Case-series 

740. Chatzopoulos C, Lorge FJ, Opsomer RJ, et al. 

Transurethral ultrasound-guided laser-induced 

prostatectomy: a critical evaluation. J 

Endourol 1996 Oct; 10(5):463-7. Case-series 

741. Chavis PS, Tabbara KF. Demyelination of 

retinal myelinated nerve fibers in Behcet's 

disease. Doc Ophthalmol 1998; 95(2):157-64. 

Case-reports 

742. Cheater F. Promoting urinary continence 

(continuing education credit). Nurs Stand 

1996 Jul 10; 10(42):47-51; quiz 3-4. Case 

Reports 

743. Cheetham MJ, Kamm MA, Phillips RK. 

Topical phenylephrine increases anal canal 

resting pressure in patients with faecal 

incontinence. Gut 2001 Mar; 48(3):356-9. Not 

eligible outcomes 

744. Cheetham MJ, Mortensen NJ, Nystrom PO, et 

al. Persistent pain and faecal urgency after 

stapled haemorrhoidectomy. Lancet 2000 Aug 

26; 356(9231):730-3. No associative 

hypothesis tested 

745. Chelvanayagam S, Norton C. Quality of life 

with faecal continence problems. Nurs Times 

2000 Aug 3; 96(31 Suppl):15-7. Comment 

746. Chelvanayagam S, Stern J. Using therapeutic 

groups to support women with faecal 

incontinence. Br J Nurs 2007 Feb 22-Mar 7; 

16(4):214-8. No associative hypothesis tested 

747. Chen B, Wen Y, Polan ML. Elastolytic 

activity in women with stress urinary 

incontinence and pelvic organ prolapse. 

Neurourol Urodyn 2004; 23(2):119-26. Not 

eligible outcomes 
B-34 

748. Chen B, Wen Y, Yu X, et al. Elastin 

metabolism in pelvic tissues: is it modulated 

by reproductive hormones? Am J Obstet 

Gynecol 2005 May; 192(5):1605-13. Not 

eligible outcomes 

749. Chen B, Wen Y, Zhang Z, et al. Microarray 

analysis of differentially expressed genes in 

vaginal tissues from women with stress 

urinary incontinence compared with 

asymptomatic women. Hum Reprod 2006 Jan; 

21(1):22-9. Not eligible outcomes 

750. Chen BH, Wen Y, Li H, et al. Collagen 

metabolism and turnover in women with stress 

urinary incontinence and pelvic prolapse. Int 

Urogynecol J Pelvic Floor Dysfunct 2002; 

13(2):80-7; discussion 7. Not eligible 

outcomes 

751. Chen CF, Chang MC, Liu CL, et al. Acute 

noncontiguous multiple-level thoracic disc 

herniations with myelopathy: a case report. 

Spine 2004 Apr 15; 29(8):E157-60. Casereports 

752. Chen CH, Lee YH, Tzeng WS, et al. A patient 

with urgency, frequency, and low serum C 

reactive protein concentration. Postgrad Med J 

2005 Feb; 81(952):139-40. Case Reports 

753. Chen GD, Lin LY, Gardner JD. The results of 

laparoscopic adhesiolysis for intractable 

urinary frequency. J Urol 1997 Nov; 

158(5):1714-6. Not eligible target population 

754. Chen H, Humphreys MS, Kettlewell MG, et 

al. Anal ultrasound predicts the response to 

nonoperative treatment of fecal incontinence 

in men. Ann Surg 1999 May; 229(5):739-43; 

discussion 43-4. Case-series 

755. Chen HH, Iroatulam A, Alabaz O, et al. 

Associations of defecography and physiologic 

findings in male patients with rectocele. Tech 

Coloproctol 2001 Dec; 5(3):157-61. Not 

eligible outcomes 

756. Chen HY, Huang YL, Hung YC, et al. 

Evaluation of stress urinary incontinence by 

computer-aided vector-based perineal 

ultrasound. Acta Obstet Gynecol Scand 2006; 

85(10):1259-64. Not eligible outcomes 

757. Chen JS, March LM, Schwarz J, et al. A 

multivariate regression model predicted falls 

in residents living in intermediate hostel care. 

J Clin Epidemiol 2005 May; 58(5):503-8. Not 

eligible outcomes 

758. Chen KK, Chang LS, Chen MT. Neobladder 

construction using completely detubularized 

sigmoid colon after radical 

cystoprostatectomy. J Urol 1991 Aug; 

146(2):311-5. Case-series 

759. Chen KK, Chang LS, Chen MT, et al. Clinical 

experience of Kock pouch continent urinary 

diversion. Urology 1990 Apr; 35(4):317-20. 

Case-series 

760. Chen TY, Ponsot Y, Carmel M, et al. Multicentre study of intraurethral valve-pump 

catheter in women with a hypocontractile or 

acontractile bladder. Eur Urol 2005 Oct; 

48(4):628-33. Not eligible target population 

761. Chen Y, DeSautel M, Anderson A, et al. 

Collagen synthesis is not altered in women 

with stress urinary incontinence. Neurourol 

Urodyn 2004; 23(4):367-73. Not eligible 

outcomes 

762. Cheong DM, Vaccaro CA, Salanga VD, et al. 

Electrodiagnostic evaluation of fecal 

incontinence. Muscle Nerve 1995 Jun; 

18(6):612-9. Not eligible outcomes 

763. Chester F. Promoting urinary continence 

(continuing education credit). Nurs Stand 

1993 May 12-18; 7(34):31-6. Case Reports 

764. Chew SB, Tindal DS. Colonic J-pouch as a 

neorectum: functional assessment. Aust N Z J 

Surg 1997 Sep; 67(9):607-10. Case-series 

765. Chew SS, Rieger NA. Transperineal repair of 

obstetric-related anovaginal fistula. Aust N Z J 

Obstet Gynaecol 2004 Feb; 44(1):68-71. 

Case-series 

766. Chiara G, Piccioni V, Perino M, et al. 

Psychological investigation in female patients 

suffering from urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 1998; 

9(2):73-7. Not eligible outcomes 

767. Chiarelli P, Brown WJ. Leaking urine in 

Australian women: prevalence and associated 

conditions. Women Health 1999; 29(1):1-13. 

Not eligible level of evidence 

768. Chiarelli P, Campbell E. Incontinence during 

pregnancy. Prevalence and opportunities for 

continence promotion. Aust N Z J Obstet 

Gynaecol 1997 Feb; 37(1):66-73. Not eligible 

level of evidence 

769. Chiarelli P, Murphy B, Cockburn J. Women's 

knowledge, practises, and intentions regarding 

correct pelvic floor exercises. Neurourol 

Urodyn 2003; 22(3):246-9. Not eligible 

outcomes 

770. Chiarioni G, Bassotti G, Stanganini S, et al. 

Sensory retraining is key to biofeedback 

therapy for formed stool fecal incontinence. 

Am J Gastroenterol 2002 Jan; 97(1):109-17. 

Not eligible target population 
B-35 

771. Chiarioni G, Scattolini C, Bonfante F, et al. 

Liquid stool incontinence with severe 

urgency: anorectal function and effective 

biofeedback treatment. Gut 1993 Nov; 

34(11):1576-80. Not eligible outcomes 

772. Chien GW, Tawadroas M, Kaptein JS, et al. 

Surgical treatment for stress urinary 

incontinence with urethral hypermobility: 

what is the best approach? World J Urol 2002 

Sep; 20(4):234-9. Case-series 

773. Chin HY, Chen MC, Liu YH, et al. 

Postpartum urinary incontinence: a 

comparison of vaginal delivery, elective, and 

emergent cesarean section. Int Urogynecol J 

Pelvic Floor Dysfunct 2006 Nov; 17(6):631-5. 

Not eligible level of evidence 

774. Chin JL, McLoughlin RF, Downey DB. 

Three-dimensional ultrasound and magnetic 

resonance imaging of pelvic anatomy: 

potential for complications from minimally 

invasive procedures. J Endourol 1999 JulAug; 13(6):451-9. Case-series 

775. Chiou RK, Grune M, Rosinsky D, et al. 

Repair of extensive traumatic membranous 

urethral disruption with endourethroplasty and 

artificial sphincter: case report. J Endourol 

1995 Dec; 9(6):509-12. Case-reports 

776. Chiverton PA, Wells TJ, Brink CA, et al. 

Psychological factors associated with urinary 

incontinence. Clin Nurse Spec 1996 Sep; 

10(5):229-33. Not eligible outcomes 

777. Cho CY, Alessi CA, Cho M, et al. The 

association between chronic illness and 

functional change among participants in a 

comprehensive geriatric assessment program. 

J Am Geriatr Soc 1998 Jun; 46(6):677-82. Not 

eligible outcomes 

778. Choe JM. Preventing urethral obstruction 

using the 6-point fixation and weight-adjusted 

spacing nomogram during sling surgery. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 

12(2):122-8. Not eligible target population 

779. Choe JM. Pubovaginal sling surgery without 

using abdominal leak point pressure: an 

outcomes analysis. Adv Exp Med Biol 2003; 

539(Pt A):467-80. Not eligible outcomes 

780. Choe JM, Battino BS, Bell TE. Retrograde 

perfusion sphincterometry with a flexible 

cystoscope: method of troubleshooting the 

AMS 800. Urology 2000 Aug 1; 56(2):317-9. 

Case-series 

781. Choe JM, Gallo ML, Staskin DR. A 

provocative maneuver to elicit cystometric 

instability: measuring instability at maximum 

infusion. J Urol 1999 May; 161(5):1541-4. 

Not eligible outcomes 

782. Choe JM, Ogan K, Bennett S. Antibacterial 

mesh sling: a prospective outcome analysis. 

Urology 2000 Apr; 55(4):515-20. Case-series 

783. Choe JM, Staskin DR. Gore-Tex patch sling: 7 

years later. Urology 1999 Oct; 54(4):641-6. 

Case-series 

784. Choi JS, Hwang YH, Salum MR, et al. 

Outcome and management of patients with 

large rectoanal intussusception. Am J 

Gastroenterol 2001 Mar; 96(3):740-4. Caseseries 

785. Choo MS, Song C, Kim JH, et al. Changes in 

overactive bladder symptoms after 

discontinuation of successful 3-month 

treatment with an antimuscarinic agent: a 

prospective trial. J Urol 2005 Jul; 174(1):201-

4. Not eligible target population 

786. Choo R, Hruby G, Hong J, et al. Positive 

resection margin and/or pathologic T3 

adenocarcinoma of prostate with undetectable 

postoperative prostate-specific antigen after 

radical prostatectomy: to irradiate or not? Int J 

Radiat Oncol Biol Phys 2002 Mar 1; 

52(3):674-80. Case-series 

787. Chou EC, Flisser AJ, Panagopoulos G, et al. 

Effective treatment for mixed urinary 

incontinence with a pubovaginal sling. J Urol 

2003 Aug; 170(2 Pt 1):494-7. Case-series 

788. Chou Q, Weber AM, Piedmonte MR. Clinical 

presentation of enterocele. Obstet Gynecol 

2000 Oct; 96(4):599-603. Not eligible level of 

evidence 

789. Chou TP, Gorton E, Stanton SL, et al. Can 

uroflowmetry patterns in women be reliably 

interpreted? Int Urogynecol J Pelvic Floor 

Dysfunct 2000 Jun; 11(3):142-7. Not eligible 

outcomes 

790. Chou YC, Yu KJ. Entrapped vaginal pessary 

presented with frequency and urge 

incontinence. J Chin Med Assoc 2003 Mar; 

66(3):181-3. Case-reports 

791. Chow SH, LaSalle MD, Rosenberg GS. 

Urinary incontinence secondary to a vaginal 

pessary. Urology 1997 Mar; 49(3):458-9. 

Case Reports 

792. Christensen P, Buntzen S, Krogh K, et al. Ileal 

neoappendicostomy for antegrade colonic 

irrigation. Br J Surg 2001 Dec; 88(12):1637-8. 

Case-series 

793. Christensen P, Kvitzau B, Krogh K, et al. 

Neurogenic colorectal dysfunction - use of 

new antegrade and retrograde colonic washout methods. Spinal Cord 2000 Apr; 

38(4):255-61. Not eligible target population 
B-36 

794. Christensen P, Olsen N, Krogh K, et al. 

Scintigraphic assessment of retrograde colonic 

washout in fecal incontinence and 

constipation. Dis Colon Rectum 2003 Jan; 

46(1):68-76. Not eligible outcomes 

795. Christensen P, Olsen N, Krogh K, et al. 

Scintigraphic assessment of antegrade colonic 

irrigation through an appendicostomy or a 

neoappendicostomy. Br J Surg 2002 Oct; 

89(10):1275-80. Case-series 

796. Christiansen J. Advances in the surgical 

management of anal incontinence. Chirurgie 

1992; 118(5):277-82; discussion 82-3. Caseseries 

797. Christiansen J, Hansen CR, Rasmussen O. 

Bilateral gluteus maximus transposition for 

anal incontinence. Br J Surg 1995 Jul; 

82(7):903-5. Case-series 

798. Christiansen J, Hesselfeldt P, Sorensen M. 

Treatment of internal rectal intussusception in 

patients with chronic constipation. Scand J 

Gastroenterol 1995 May; 30(5):470-2. Caseseries 

799. Christiansen J, Rasmussen OO, LindorffLarsen K. Dynamic graciloplasty for severe 

anal incontinence. Br J Surg 1998 Jan; 

85(1):88-91. Case-series 

800. Christiansen J, Rasmussen OO, LindorffLarsen K. Long-term results of artificial anal 

sphincter implantation for severe anal 

incontinence. Ann Surg 1999 Jul; 230(1):45-8. 

Case-series 

801. Christiansen J, Roed-Petersen K. Clinical 

assessment of the anal continence plug. Dis 

Colon Rectum 1993 Aug; 36(8):740-2. Caseseries 

802. Christiansen J, Ronholt C. Treatment of 

recurrent high anal fistula by total excision 

and primary sphincter reconstruction. Int J 

Colorectal Dis 1995; 10(4):207-9. Case-series 

803. Christiansen J, Sorensen M, Rasmussen OO. 

Gracilis muscle transposition for faecal 

incontinence. Br J Surg 1990 Sep; 77(9):1039-

40. Case-reports 

804. Christiansen J, Sparso B. Treatment of anal 

incontinence by an implantable prosthetic anal 

sphincter. Ann Surg 1992 Apr; 215(4):383-6. 

Case-series 

805. Christie D, Denham J, Steigler A, et al. 

Delayed rectal and urinary symptomatology in 

patients treated for prostate cancer by 

radiotherapy with or without short term neoadjuvant androgen deprivation. Radiother 

Oncol 2005 Nov; 77(2):117-25. Not eligible 

outcomes 

806. Chu LW, Pei CK. Risk factors for early 

emergency hospital readmission in elderly 

medical patients. Gerontology 1999 Jul-Aug; 

45(4):220-6. Not eligible outcomes 

807. Chua JJ, Tan PK, Seow WT. Leptomeningeal 

metastasis with urological presentation. 

Singapore Med J 1997 Jun; 38(6):266-7. 

Case-reports 

808. Chua K, Chuo A, Kong KH. Urinary 

incontinence after traumatic brain injury: 

incidence, outcomes and correlates. Brain Inj 

2003 Jun; 17(6):469-78. Case-series 

809. Chua KS, Kong KH. Functional outcome in 

brain stem stroke patients after rehabilitation. 

Arch Phys Med Rehabil 1996 Feb; 77(2):194-

7. Case-series 

810. Chuang TY, Yu KJ, Penn IW, et al. 

Neurourological changes before and after 

radical hysterectomy in patients with cervical 

cancer. Acta Obstet Gynecol Scand 2003 Oct; 

82(10):954-9. Case-series 

811. Chun AB, Rose S, Mitrani C, et al. Anal 

sphincter structure and function in 

homosexual males engaging in anoreceptive 

intercourse. Am J Gastroenterol 1997 Mar; 

92(3):465-8. Not eligible outcomes 

812. Chung BS, Lee T, Kim JS, et al. Occult 

intraperitoneal bladder injury after a tensionfree vaginal tape procedure. Yonsei Med J 

2005 Dec 31; 46(6):874-6. Case Reports 

813. Chung MK, Chung RP. Comparison of 

laparoscopic Burch and tension-free vaginal 

tape in treating stress urinary incontinence in 

obese patients. Jsls 2002 Jan-Mar; 6(1):17-21. 

Case-series 

814. Chung SY, Franks M, Smith CP, et al. 

Technique of combined pubovaginal sling and 

cystocele repair using a single piece of 

cadaveric dermal graft. Urology 2002 Apr; 

59(4):538-41. Case-series 

815. Cimentepe E, Unsal A, Saglam R. 

Randomized clinical trial comparing 

transurethral needle ablation with transurethral 

resection of the prostate for the treatment of 

benign prostatic hyperplasia: results at 18 

months. J Endourol 2003 Mar; 17(2):103-7. 

Not eligible exposure 

816. Cimic J, Meuleman EJ, Oosterhof GO, et al. 

Urological complications in renal 

transplantation. A comparison between livingrelated and cadaveric grafts. Eur Urol 1997; 

31(4):433-5. Not eligible level of evidence 

817. Cindolo L, Salzano L, Rota G, et al. Tensionfree transobturator approach for female stress 

urinary incontinence. Minerva Urol Nefrol 

2004 Mar; 56(1):89-98. Case-series 
B-37 

818. Cirocco WC, Brown AC. Anterior resection 

for the treatment of rectal prolapse: a 20-year 

experience. Am Surg 1993 Apr; 59(4):265-9. 

Case-series 

819. Cisternino A, Passerini-Glazel G. Bladder 

dysfunction in children. Scand J Urol Nephrol 

Suppl 1995; 173:25-8; discussion 9. Not 

eligible target population 

820. Citterio A, Franceschini M, Spizzichino L, et 

al. Nontraumatic spinal cord injury: an Italian 

survey. Arch Phys Med Rehabil 2004 Sep; 

85(9):1483-7. Not eligible target population 

821. Clague MB, Heald RJ. Achievement of stomal 

continence in one-third of colostomies by use 

of a new disposable plug. Surg Gynecol 

Obstet 1990 May; 170(5):390-4. Case-series 

822. Clancy B, Malone-Lee J. Reducing the 

leakage of body-worn incontinence pads. J 

Adv Nurs 1991 Feb; 16(2):187-93. Not 

eligible outcomes 

823. Clark A, Romm J. Effect of urinary 

incontinence on sexual activity in women. J 

Reprod Med 1993 Sep; 38(9):679-83. Not 

eligible outcomes 

824. Clark AL, Gregory T, Smith VJ, et al. 

Epidemiologic evaluation of reoperation for 

surgically treated pelvic organ prolapse and 

urinary incontinence. Am J Obstet Gynecol 

2003 Nov; 189(5):1261-7. Not eligible level of 

evidence 

825. Clark JA, Bokhour BG, Inui TS, et al. 

Measuring patients' perceptions of the 

outcomes of treatment for early prostate 

cancer. Med Care 2003 Aug; 41(8):923-36. 

Not eligible outcomes 

826. Clark JA, Inui TS, Silliman RA, et al. Patients' 

perceptions of quality of life after treatment 

for early prostate cancer. J Clin Oncol 2003 

Oct 15; 21(20):3777-84. Not eligible outcomes 

827. Clark JA, Talcott JA. Symptom indexes to 

assess outcomes of treatment for early prostate 

cancer. Med Care 2001 Oct; 39(10):1118-30. 

Not eligible outcomes 

828. Clark MH, Benson JT. Fecal incontinence and 

the menstrual cycle: a case report. Int 

Urogynecol J Pelvic Floor Dysfunct 1999; 

10(5):344-5. Case Reports 

829. Clarke-O'Neill S, Pettersson L, Fader M, et al. 

A multicenter comparative evaluation: 

disposable pads for women with light 

incontinence. J Wound Ostomy Continence 

Nurs 2004 Jan-Feb; 31(1):32-42. Not eligible 

outcomes 

830. Clarke-O'Neill S, Pettersson L, Fader M, et al. 

A multicentre comparative evaluation: 

washable pants with an integral pad for light 

incontinence. J Clin Nurs 2002 Jan; 11(1):79-

89. Not eligible outcomes 

831. Clemens JQ, Stern JA, Bushman WA, et al. 

Long-term results of the Stamey bladder neck 

suspension: direct comparison with the 

Marshall-Marchetti-Krantz procedure. J Urol 

1998 Aug; 160(2):372-6. Not eligible 

outcomes 

832. Clemesha L, Davies E. Educating home carers 

on faecal continence in people with dementia. 

Nurs Stand 2004 May 5-11; 18(34):33-40. Not 

eligible target population 

833. Clemons JL, Aguilar VC, Sokol ER, et al. 

Suburethral sling treatment of occult stress 

incontinence and intrinsic sphincter deficiency 

in women with severe vaginal prolapse of the 

anterior vs posterior/apical compartment. Am 

J Obstet Gynecol 2005 May; 192(5):1566-72. 

Case-series 

834. Clemons JL, Aguilar VC, Tillinghast TA, et 

al. Patient satisfaction and changes in prolapse 

and urinary symptoms in women who were 

fitted successfully with a pessary for pelvic 

organ prolapse. Am J Obstet Gynecol 2004 

Apr; 190(4):1025-9. Not eligible outcomes 

835. Clever K, Smith G, Bowser C, et al. 

Evaluating the efficacy of a uniquely 

delivered skin protectant and its effect on the 

formation of sacral/buttock pressure ulcers. 

Ostomy Wound Manage 2002 Dec; 48(12):60-

7. Not eligible outcomes 

836. Clow WM, Joannides T, Saleem AK, et al. An 

unusual cause of postmenopausal bleeding and 

incontinence of urine: primary lymphoma of 

the vagina. Br J Obstet Gynaecol 1995 Feb; 

102(2):164-5. Case Reports 

837. Clyne OJ, O'Sullivan O, Flood HD. 

Pubovaginal sling for urodynamic stress 

incontinence: effect on patient quality of life. 

Ir Med J 2005 Mar; 98(3):75-7. Case-series 

838. Coakley FV, Eberhardt S, Kattan MW, et al. 

Urinary continence after radical retropubic 

prostatectomy: relationship with membranous 

urethral length on preoperative endorectal 

magnetic resonance imaging. J Urol 2002 Sep; 

168(3):1032-5. Case-Series 

839. Cobb WS, Lokey JS, Schwab DP, et al. Handassisted laparoscopic colectomy: a singleinstitution experience. Am Surg 2003 Jul; 

69(7):578-80. Case-series 

840. Cochran A. Fatal attraction: Foley catheters. 

Ostomy Wound Manage 1991 Sep-Oct; 36:40-

1, 3-4. Case-reports 
B-38 

841. Cochran A. Don't ask, don't tell: the 

incontinence conspiracy. Manag Care Q 2000 

Winter; 8(1):44-52. Comment 

842. Cochran I, Flynn CA, Goetz G, et al. Stroke 

care--piecing together the long-term picture. 

Nursing 1994 Jun; 24(6):34-41; quiz 2. Case 

Reports 

843. Cochrane DD, Irwin B, Chambers K. Clinical 

outcomes that fetal surgery for 

myelomeningocele needs to achieve. Eur J 

Pediatr Surg 2001 Dec; 11 Suppl 1:S18-20. 

Not eligible target population 

844. Cockell SJ, Oates-Johnson T, Gilmour DT, et 

al. Postpartum flatal and Fecal Incontinence 

Quality-of-Life Scale: a disease- and 

population-specific measure. Qual Health Res 

2003 Oct; 13(8):1132-44. Case-series 

845. Coffey SW, Wilder E, Majsak MJ, et al. The 

effects of a progressive exercise program with 

surface electromyographic biofeedback on an 

adult with fecal incontinence. Phys Ther 2002 

Aug; 82(8):798-811. Case-reports 

846. Cogan SL, Weber AM, Hammel JP. Is 

urethral mobility really being assessed by the 

pelvic organ prolapse quantification (POP-Q) 

system? Obstet Gynecol 2002 Mar; 99(3):473-

6. Not eligible outcomes 

847. Cohen HA, Abarbanel J, Ashkenasi A, et al. 

Urodynamic manifestations associated with 

Ramsay-Hunt syndrome. Case report. Scand J 

Urol Nephrol 1993; 27(1):129-31. Casereports 

848. Cohen SJ, Robinson D, Dugan E, et al. 

Communication between older adults and their 

physicians about urinary incontinence. J 

Gerontol A Biol Sci Med Sci 1999 Jan; 

54(1):M34-7. Not eligible level of evidence 

849. Cohn JH, El-Galley R. Radical prostatectomy 

in a community practice. J Urol 2002 Jan; 

167(1):224-8. Case Series 

850. Col C, Hasdemir O, Yalcin E, et al. The 

assessment of urinary function following 

extended lymph node dissection for colorectal 

cancer. Eur J Surg Oncol 2005 Apr; 

31(3):237-41. Not eligible level of evidence 

851. Colakoglu M, Capar M, Kilic M, et al. A new 

needle suspension procedure for genuine 

stress incontinence and anterior vaginal wall 

prolapse. Int Urogynecol J Pelvic Floor 

Dysfunct 1996; 7(2):64-7; discussion 7-8. 

Case-series 

852. Cole EE, Adams MC, Brock JW, 3rd, et al. 

Outcome of continence procedures in the 

pediatric patient: a single institutional 

experience. J Urol 2003 Aug; 170(2 Pt 1):560-

3; discussion 3. Not eligible target population 

853. Cole EE, Kaufman MR, Scarpero HM, et al. 

The effects of isolated posterior compartment 

defects on lower urinary tract symptoms and 

urodynamic findings. BJU Int 2006 May; 

97(5):1024-6. Case-series 

854. Colley W. Products to help men manage 

incontinence. Nurs Times 2002 Oct 22-28; 

98(43):52-4. Comment 

855. Colley W. Developing continence services 

through partnership. Nurs Times 2002 Apr 23-

29; 98(17):63-4. Comment 

856. Colley W. Continence services in a changing 

NHS. Nurs Times 2002 Apr 23-29; 98(17):58-

9. Comment 

857. Collinet P, Belot F, Debodinance P, et al. 

Transvaginal mesh technique for pelvic organ 

prolapse repair: mesh exposure management 

and risk factors. Int Urogynecol J Pelvic Floor 

Dysfunct 2006 Jun; 17(4):315-20. Not eligible 

outcomes 

858. Colling J, McCreedy M, Owen T. Urinary 

tract infection rates among incontinent nursing 

home and community dwelling elderly. Urol 

Nurs 1994 Sep; 14(3):117-9. Not eligible 

outcomes 

859. Colling J, Owen TR, McCreedy M, et al. The 

effects of a continence program on frail 

community-dwelling elderly persons. Urol 

Nurs 2003 Apr; 23(2):117-22, 27-31. Caseseries 

860. Colling JC, Owen TR, McCreedy MR. Urine 

volumes and voiding patterns among 

incontinent nursing home residents. Residents 

at highest risk for dehydration are often the 

most difficult to track. Geriatr Nurs 1994 JulAug; 15(4):188-92. Not eligible level of 

evidence 

861. Collings S, Norton C. Women's experiences of 

faecal incontinence: a study. Br J Community 

Nurs 2004 Dec; 9(12):520-3. No associative 

hypothesis tested 

862. Coloby P, Gattegno B, Fourcade RO, et al. 

Bladder reconstruction with ileum after 

cystoprostatectomy for bladder cancer: 

analysis of the micturition and continence of 

44 consecutive patients. Jpn J Clin Oncol 

1992 Apr; 22(2):122-30. Case-series 

863. Colombo T, Augustin H, Breinl E, et al. The 

use of polydimethylsiloxane in the treatment 

of incontinence after radical prostatectomy. Br 

J Urol 1997 Dec; 80(6):923-6. Case-series 
B-39 

864. Colquhoun P, Kaiser R, Weiss EG, et al. 

Correlating the Fecal Incontinence Quality-ofLife Score and the SF-36 to a proposed 

Ostomy Function Index in patients with a 

stoma. Ostomy Wound Manage 2006 Dec; 

52(12):68-74. Not eligible outcomes 

865. Comiter CV. The male sling for stress urinary 

incontinence: a prospective study. J Urol 2002 

Feb; 167(2 Pt 1):597-601. Case-series 

866. Comiter CV. The male perineal sling: 

intermediate-term results. Neurourol Urodyn 

2005; 24(7):648-53. Case-series 

867. Comiter CV, Colegrove PM. High rate of 

vaginal extrusion of silicone-coated polyester 

sling. Urology 2004 Jun; 63(6):1066-70. Not 

eligible target population 

868. Comiter CV, Sullivan MP, Yalla SV. 

Retrograde leak point pressure for evaluating 

postradical prostatectomy incontinence. 

Urology 1997 Feb; 49(2):231-6. Case-series 

869. Comiter CV, Sullivan MP, Yalla SV. 

Correlation among maximal urethral closure 

pressure, retrograde leak point pressure, and 

abdominal leak point pressure in men with 

postprostatectomy stress incontinence. 

Urology 2003 Jul; 62(1):75-8. Not eligible 

outcomes 

870. Conaghan P, Farouk R. Sacral nerve 

stimulation can be successful in patients with 

ultrasound evidence of external anal sphincter 

disruption. Dis Colon Rectum 2005 Aug; 

48(8):1610-4. Case-series 

871. Connell K, Guess MK, La Combe J, et al. 

Evaluation of the role of pudendal nerve 

integrity in female sexual function using 

noninvasive techniques. Am J Obstet Gynecol 

2005 May; 192(5):1712-7. Not eligible 

outcomes 

872. Connolly TP. Necrotizing surgical site 

infection after tension-free vaginal tape. 

Obstet Gynecol 2004 Dec; 104(6):1275-6. 

Case-reports 

873. Connor JP, Betrus G, Fleming P, et al. Early 

cystometrograms can predict the response to 

intravesical instillation of oxybutynin chloride 

in myelomeningocele patients. J Urol 1994 

Apr; 151(4):1045-7. Case-series 

874. Constantini E, Mearini L, Biscotto S, et al. 

Impact of different sized catheters on 

pressure-flow studies in women with lower 

urinary tract symptoms. Neurourol Urodyn 

2005; 24(2):106-10. Not eligible exposure 

875. Coolen JC, Florisson JM, Bissett IP, et al. 

Evaluation of knowledge and anxiety level of 

patients visiting the colorectal pelvic floor 

clinic. Colorectal Dis 2006 Mar; 8(3):208-11. 

Not eligible outcomes 

876. Coombes GM, Millard RJ. Urinary urge 

incontinence: randomised crossover trials of 

penthienate versus placebo and propantheline. 

Med J Aust 1996 Nov 4; 165(9):473-6. Not 

eligible exposure 

877. Cooper P, Gray D. Comparison of two skin 

care regimes for incontinence. Br J Nurs 2001 

Mar; 10(6 Suppl):S6, S8, S10 passim. Not 

eligible outcomes 

878. Cooperberg MR, Master VA, Carroll PR. 

Health related quality of life significance of 

single pad urinary incontinence following 

radical prostatectomy. J Urol 2003 Aug; 170(2 

Pt 1):512-5. Case-Series 

879. Copas P, Bukovsky A, Asbury B, et al. 

Estrogen, progesterone, and androgen receptor 

expression in levator ani muscle and fascia. J 

Womens Health Gend Based Med 2001 Oct; 

10(8):785-95. Not eligible outcomes 

880. Cor A, Barbic M, Kralj B. Differences in the 

quantity of elastic fibres and collagen type I 

and type III in endopelvic fascia between 

women with stress urinary incontinence and 

controls. Urol Res 2003 Jun; 31(2):61-5. Not 

eligible outcomes 

881. Coran AG. A personal experience with 100 

consecutive total colectomies and straight 

ileoanal endorectal pull-throughs for benign 

disease of the colon and rectum in children 

and adults. Ann Surg 1990 Sep; 212(3):242-7; 

discussion 7-8. Not eligible target population 

882. Corcos J, Casey R, Patrick A, et al. A doubleblind randomized dose-response study 

comparing daily doses of 5, 10 and 15 mg 

controlled-release oxybutynin: balancing 

efficacy with severity of dry mouth. BJU Int 

2006 Mar; 97(3):520-7. Not eligible exposure 

883. Corcos J, Fournier C. Periurethral collagen 

injection for the treatment of female stress 

urinary incontinence: 4-year follow-up results. 

Urology 1999 Nov; 54(5):815-8. No 

associative hypothesis tested 

884. Cornacchia M, Zenorini A, Perobelli S, et al. 

Prevalence of urinary incontinence in women 

with cystic fibrosis. BJU Int 2001 Jul; 

88(1):44-8. Not eligible level of evidence 
B-40 

885. Cornel EB, de Wit R, Witjes JA. Evaluation of 

early pelvic floor physiotherapy on the 

duration and degree of urinary incontinence 

after radical retropubic prostatectomy in a 

non-teaching hospital. World J Urol 2005 

Nov; 23(5):353-5. Not eligible outcomes 

886. Cortes E, Singh K, Reid WM. Anorexia 

nervosa and pelvic floor dysfunction. Int 

Urogynecol J Pelvic Floor Dysfunct 2003 Oct; 

14(4):254-5; discussion 5. Case Reports 

887. Cosimo O, Pierluigi P, Angelo ZM, et al. A 

clinical and urodynamic study of patients with 

varying degrees of cystocele. Maturitas 1997 

Jun; 27(2):125-32. Not eligible target 

population 

888. Cosson M, Boukerrou M, Narducci F, et al. 

Long-term results of the Burch procedure 

combined with abdominal sacrocolpopexy for 

treatment of vault prolapse. Int Urogynecol J 

Pelvic Floor Dysfunct 2003 Jun; 14(2):104-7. 

Case-series 

889. Cosson M, Lambaudie E, Boukerrou M, et al. 

A biomechanical study of the strength of 

vaginal tissues. Results on 16 postmenopausal patients presenting with genital 

prolapse. Eur J Obstet Gynecol Reprod Biol 

2004 Feb 10; 112(2):201-5. Not eligible 

outcomes 

890. Costa JA, Kreder KJ, Howe JR. Combined 

urinary and fecal diversion using a no bowel 

anastomosis technique. J Urol 2002 May; 

167(5):2063-5. Case-series 

891. Costa P, Grise P, Droupy S, et al. Surgical 

treatment of female stress urinary 

incontinence with a trans-obturator-tape 

(T.O.T.) Uratape: short term results of a 

prospective multicentric study. Eur Urol 2004 

Jul; 46(1):102-6; discussion 6-7. Not eligible 

target population 

892. Costantini E, Lombi R, Micheli C, et al. 

Colposacropexy with Gore-tex mesh in 

marked vaginal and uterovaginal prolapse. Eur 

Urol 1998 Aug; 34(2):111-7. Case-series 

893. Costantini E, Mearini L, Mearini E, et al. 

Assessing outcome after a modified vaginal 

wall sling for stress incontinence with intrinsic 

sphincter deficiency. Int Urogynecol J Pelvic 

Floor Dysfunct 2005 Mar-Apr; 16(2):138-46; 

discussion 46. Case-series 

894. Costantini E, Pajoncini C, Zucchi A, et al. 

Four-corner colposuspension: clinical and 

functional results. Int Urogynecol J Pelvic 

Floor Dysfunct 2003 Jun; 14(2):113-8. Caseseries 

895. Costantini S, Mistrangelo E, Francioso R, et 

al. Vaginal versus transabdominal 

hysterectomy: is mode of hysterectomy to 

influence pelvic statics or is pelvic statics to 

influence mode of hysterectomy? Acta Obstet 

Gynecol Scand 2005 Apr; 84(4):376-9. Caseseries 

896. Costanzo ES, Antes LM, Christensen AJ. 

Behavioral and medical treatment of chronic 

polydipsia in a patient with schizophrenia and 

diabetes insipidus. Psychosom Med 2004 

Mar-Apr; 66(2):283-6. Case-reports 

897. Couillard DR, Deckard-Janatpour KA, Stone 

AR. The vaginal wall sling: a compressive 

suspension procedure for recurrent 

incontinence in elderly patients. Urology 1994 

Feb; 43(2):203-8. Case-series 

898. Couillard DR, Vapnek JM, Stone AR. 

Proximal artificial sphincter cuff repositioning 

for urethral atrophy incontinence. Urology 

1995 Apr; 45(4):653-6. Not eligible target 

population 

899. Couzens S. The perioperative practitioner. Br 

J Perioper Nurs 2004 Jul; 14(7):317-8, 20-1; 

discussion 22-3. Case Reports 

900. Coward RT, Horne C, Peek CW. Predicting 

nursing home admissions among incontinent 

older adults: a comparison of residential 

differences across six years. Gerontologist 

1995 Dec; 35(6):732-43. Not eligible 

outcomes 

901. Coyne KS, Matza LS, Thompson CL, et al. 

Determining the importance of change in the 

overactive bladder questionnaire. J Urol 2006 

Aug; 176(2):627-32; discussion 32. Not 

eligible outcomes 

902. Coyne KS, Payne C, Bhattacharyya SK, et al. 

The impact of urinary urgency and frequency 

on health-related quality of life in overactive 

bladder: results from a national community 

survey. Value Health 2004 Jul-Aug; 7(4):455-

63. Not eligible outcomes 

903. Coyne KS, Zyczynski T, Margolis MK, et al. 

Validation of an overactive bladder awareness 

tool for use in primary care settings. Adv Ther 

2005 Jul-Aug; 22(4):381-94. Not eligible 

outcomes 

904. Craggs MD. Objective measurement of 

bladder sensation: use of a new patientactivated device and response to 

neuromodulation. BJU Int 2005 Sep; 96 Suppl 

1:29-36. Not eligible outcomes 

905. Craig DI. Spinal cord injury and pregnancy: 

the stories of two women. SCI Nurs 1994 Dec; 

11(4):100-4. Case-reports 
B-41 

906. Cramer EH, Jones P, Keenan NL, et al. Is 

naturopathy as effective as conventional 

therapy for treatment of menopausal 

symptoms? J Altern Complement Med 2003 

Aug; 9(4):529-38. Not eligible exposure 

907. Creasey GH, Dahlberg JE. Economic 

consequences of an implanted neuroprosthesis 

for bladder and bowel management. Arch 

Phys Med Rehabil 2001 Nov; 82(11):1520-5. 

Not eligible outcomes 

908. Creasey GH, Grill JH, Korsten M, et al. An 

implantable neuroprosthesis for restoring 

bladder and bowel control to patients with 

spinal cord injuries: a multicenter trial. Arch 

Phys Med Rehabil 2001 Nov; 82(11):1512-9. 

Case-series 

909. Cronje HS. Colposacrosuspension for severe 

genital prolapse. Int J Gynaecol Obstet 2004 

Apr; 85(1):30-5. Case-series 

910. Cronje HS, De Beer JA, Bam R. The 

pathophysiology of an enterocele and its 

management. J Obstet Gynaecol 2004 Jun; 

24(4):408-13. Case-series 

911. Crosbie JJ, Eguare E, McGovern B, et al. The 

influence of bladder filling on anorectal 

function. Colorectal Dis 2003 May; 5(3):251-

5. Not eligible exposure 

912. Cross CA, Cespedes RD, McGuire EJ. 

Treatment results using pubovaginal slings in 

patients with large cystoceles and stress 

incontinence. J Urol 1997 Aug; 158(2):431-4. 

Case-series 

913. Cross CA, Cespedes RD, McGuire EJ. Our 

experience with pubovaginal slings in patients 

with stress urinary incontinence. J Urol 1998 

Apr; 159(4):1195-8. Case-series 

914. Crossland J. Continence. Strictly personal. 

Nurs Times 1994 Apr 13-19; 90(15):74-6. 

Comment 

915. Crowder H. Incontinence: the secret problem. 

N Z Nurs J 1991 Mar; 84(2):19-21. No 

associative hypothesis tested 

916. Crowell MD, Lacy BE, Schettler VA, et al. 

Subtypes of anal incontinence associated with 

bowel dysfunction: clinical, physiologic, and 

psychosocial characterization. Dis Colon 

Rectum 2004 Oct; 47(10):1627-35. Caseseries 

917. Cruikshank SH, Muniz M. Outcomes study: A 

comparison of cure rates in 695 patients 

undergoing sacrospinous ligament fixation 

alone and with other site-specific procedures--

a 16-year study. Am J Obstet Gynecol 2003 

Jun; 188(6):1509-12; discussion 12-5. Caseseries 

918. Csata S, Repassy D. Ureter and bladder 

replacement following radical cystectomy. 

Acta Chir Hung 1998; 37(1-2):107-10. Case 

Reports 

919. Cucchi A. Sequential changes in voiding 

dynamics related to the development of 

detrusor instability in women with stress 

urinary incontinence. Neurourol Urodyn 1999; 

18(2):73-80. Case-series 

920. Cucchi A, Siracusano S, Di Benedetto P, et al. 

Urgency of voiding and abdominal pressure 

transmission in women with mixed urinary 

incontinence. Neurourol Urodyn 2004; 

23(1):43-7. Not eligible outcomes 

921. Cuesta MA, Meijer S, Derksen EJ, et al. Anal 

sphincter imaging in fecal incontinence using 

endosonography. Dis Colon Rectum 1992 Jan; 

35(1):59-63. Not eligible outcomes 

922. Cugudda A, Terrone C, Crivellaro S, et al. 

Long-term results of Burch colposuspension 

and anterior colpoperineorraphy in the 

treatment of stress urinary incontinence and 

cystocele. Ann Urol (Paris) 2002 May; 

36(3):176-81. Case-series 

923. Culbert P, Gillett H, Ferguson A. Highly 

effective new oral therapy for faecal 

impaction. Br J Gen Pract 1998 Sep; 

48(434):1599-600. Case-series 

924. Cullen JJ, Kelly KA. Prospectively evaluating 

anal sphincter function after ileal pouch-anal 

canal anastomosis. Am J Surg 1994 Jun; 

167(6):558-61. Case-series 

925. Culligan PJ, Myers JA, Goldberg RP, et al. 

Elective cesarean section to prevent anal 

incontinence and brachial plexus injuries 

associated with macrosomia--a decision 

analysis. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Jan-Feb; 16(1):19-28; 

discussion Not eligible outcomes 

926. Cummings JM, Houston K. The treatment of 

urinary incontinence. Hosp Pract (Off Ed) 

1994 Feb 15; 29(2):97-9, 103, 7. Comment 

927. Cummings V, Holt R, van der Sloot C, et al. 

Costs and management of urinary 

incontinence in long-term care. J Wound 

Ostomy Continence Nurs 1995 Jul; 22(4):193-

8. Not eligible outcomes 

928. Cundall JD, Gardiner A, Chin K, et al. 

Hyperbaric oxygen in the treatment of fecal 

incontinence secondary to pudendal 

neuropathy. Dis Colon Rectum 2003 Nov; 

46(11):1549-54. Not eligible target population 
B-42 

929. Cundiff GW, Bent AE. The contribution of 

urethrocystoscopy to evaluation of lower 

urinary tract dysfunction in women. Int 

Urogynecol J Pelvic Floor Dysfunct 1996; 

7(6):307-11. Not eligible outcomes 

930. Cundiff GW, Weidner AC, Visco AG, et al. 

An anatomic and functional assessment of the 

discrete defect rectocele repair. Am J Obstet 

Gynecol 1998 Dec; 179(6 Pt 1):1451-6; 

discussion 6-7. Case-series 

931. Cunha DF, Frota RB, Arruda MS, et al. 

Pressure sores among malnourished 

necropsied adults--preliminary data. Rev Hosp 

Clin Fac Med Sao Paulo 2000 May-Jun; 

55(3):79-82. Not eligible outcomes 

932. Cunningham RS. Clinical practice guideline 

use by oncology advanced practice nurses. 

Appl Nurs Res 2006 Aug; 19(3):126-33. Not 

eligible outcomes 

933. Cunsolo A, Bragaglia RB, Manara G, et al. 

Urogenital dysfunction after 

abdominoperineal resection for carcinoma of 

the rectum. Dis Colon Rectum 1990 Nov; 

33(11):918-22. Case-series 

934. Curran FT, Hill GL. Results of 50 ileoanal J 

pouch operations. Aust N Z J Surg 1990 Aug; 

60(8):579-83. Case-series 

935. Currie CJ, McEwan P, Poole CD, et al. The 

impact of the overactive bladder on healthrelated utility and quality of life. BJU Int 2006 

Jun; 97(6):1267-72. Not eligible outcomes 

936. Currie I, Drutz HP, Deck J, et al. Adipose 

tissue and lipid droplet embolism following 

periurethral injection of autologous fat: case 

report and review of the literature. Int 

Urogynecol J Pelvic Floor Dysfunct 1997; 

8(6):377-80. Case Reports 

937. Curry JI, Osborne A, Malone PS. The MACE 

procedure: experience in the United Kingdom. 

J Pediatr Surg 1999 Feb; 34(2):338-40. Not 

eligible target population 

938. Cuschieri A, Shimi SM, Vander Velpen G, et 

al. Laparoscopic prosthesis fixation rectopexy 

for complete rectal prolapse. Br J Surg 1994 

Jan; 81(1):138-9. Case-series 

939. Cutner A, Cardozo LD, Wise BG. The effects 

of pregnancy on previous incontinence 

surgery. Case report. Br J Obstet Gynaecol 

1991 Nov; 98(11):1181-3. Case-reports 

940. Cuzzell JZ. Practical tips for incontinence. 

Home Care Provid 1997 Dec; 2(6):286-7. 

Comment 

941. Da Ros CT, Teloken C, Busatto WF, Jr., et al. 

Endoscopic suspension of the prolapsed 

vaginal dome. Tech Urol 1998 Mar; 4(1):25-8. 

Case-series 

942. da Silva GM, Gurland B, Sleemi A, et al. 

Posterior vaginal wall prolapse does not 

correlate with fecal symptoms or objective 

measures of anorectal function. Am J Obstet 

Gynecol 2006 Dec; 195(6):1742-7. Not 

eligible level of evidence 

943. da Silva GM, Jorge JM, Belin B, et al. New 

surgical options for fecal incontinence in 

patients with imperforate anus. Dis Colon 

Rectum 2004 Feb; 47(2):204-9. Not eligible 

target population 

944. Daher N, Boulanger JC, Ulmsten U. Pre-pubic 

TVT: an alternative to classic TVT in selected 

patients with urinary stress incontinence. Eur J 

Obstet Gynecol Reprod Biol 2003 Apr 25; 

107(2):205-7. Case-series 

945. Dahm P, Silverstein AD, Weizer AZ, et al. A 

longitudinal assessment of bowel related 

symptoms and fecal incontinence following 

radical perineal prostatectomy. J Urol 2003 

Jun; 169(6):2220-4. Case-series 

946. Daley J, Delbanco TL, Hartman EE. An 89-

year-old woman with urinary incontinence, 1 

year later. Jama 1997 Aug 27; 278(8):679. 

Case-reports 

947. D'Alfonso A, Iovenitti P, Carta G. Urinary 

disorders during pregnancy and postpartum: 

our experience. Clin Exp Obstet Gynecol 

2006; 33(1):23-5. Case-series 

948. Dalkin BL, Christopher BA, Shawler D. 

Health related quality of life outcomes after 

radical prostatectomy: attention to study 

design and the patient-based importance of 

single-surgeon studies. Urol Oncol 2006 JanFeb; 24(1):28-32. Case Series 

949. Dalkin BL, Wessells H, Cui H. A national 

survey of urinary and health related quality of 

life outcomes in men with an artificial urinary 

sphincter for post-radical prostatectomy 

incontinence. J Urol 2003 Jan; 169(1):237-9. 

Case Series 

950. Dallosso H. Lower urinary tract symptoms: 

why incidence rates are vital. Nurs Times 

2001 May 17-23; 97(20):72. Not associative 

hypothesis tested 

951. Dallosso HM, Matthews RJ, McGrother CW, 

et al. An investigation into nonresponse bias 

in a postal survey on urinary symptoms. BJU 

Int 2003 May; 91(7):631-6. Not eligible level 

of evidence 

952. Dallosso HM, Matthews RJ, McGrother CW, 

et al. The association of diet and other lifestyle 

factors with the onset of overactive bladder: a 

longitudinal study in men. Public Health Nutr 

2004 Oct; 7(7):885-91. Not eligible outcomes 
B-43 

953. Dallosso HM, McGrother CW, Matthews RJ, 

et al. Nutrient composition of the diet and the 

development of overactive bladder: a 

longitudinal study in women. Neurourol 

Urodyn 2004; 23(3):204-10. Not eligible 

target population 

954. Damani N, Wilson SR. Nongynecologic 

applications of transvaginal US. 

Radiographics 1999 Oct; 19 Spec No:S179-

200; quiz S65-6. Not eligible outcomes 

955. Damon H, Bretones S, Henry L, et al. Longterm consequences of first vaginal deliveryinduced anal sphincter defect. Dis Colon 

Rectum 2005 Sep; 48(9):1772-6. Not eligible 

outcomes 

956. Damon H, Dumas P, Mion F. Impact of anal 

incontinence and chronic constipation on 

quality of life. Gastroenterol Clin Biol 2004 

Jan; 28(1):16-20. Not eligible outcomes 

957. Damon H, Henry L, Barth X, et al. Fecal 

incontinence in females with a past history of 

vaginal delivery: significance of anal sphincter 

defects detected by ultrasound. Dis Colon 

Rectum 2002 Nov; 45(11):1445-50; 

discussion 50-1. Not eligible outcomes 

958. Damon H, Henry L, Bretones S, et al. 

Postdelivery anal function in primiparous 

females: ultrasound and manometric study. 

Dis Colon Rectum 2000 Apr; 43(4):472-7. Not 

eligible outcomes 

959. Damon H, Henry L, Roman S, et al. Influence 

of rectal prolapse on the asymmetry of the 

anal sphincter in patients with anal 

incontinence. BMC Gastroenterol 2003 Aug 

19; 3:23. Not eligible outcomes 

960. Dandapat MC, Mishra JN, Das RP. 

Abdominal suture proctopexy for complete 

prolapse of rectum. J Indian Med Assoc 1991 

Dec; 89(12):331-3. Case-series 

961. Danek A, Uttner I, Yoursry T, et al. Lyme 

neuroborreliosis disguised as normal pressure 

hydrocephalus. Neurology 1996 Jun; 

46(6):1743-5. Case-reports 

962. Daneshgari F, Moore C, Frinjari H, et al. 

Patient related risk factors for recurrent stress 

urinary incontinence surgery in women treated 

at a tertiary care center. J Urol 2006 Oct; 

176(4 Pt 1):1493-9. Not eligible level of 

evidence 

963. Darai E, Jeffry L, Deval B, et al. Results of 

tension-free vaginal tape in patients with or 

without vaginal hysterectomy. Eur J Obstet 

Gynecol Reprod Biol 2002 Jul 10; 

103(2):163-7. Case-series 

964. Darkow T, Fontes CL, Williamson TE. Costs 

associated with the management of overactive 

bladder and related comorbidities. 

Pharmacotherapy 2005 Apr; 25(4):511-9. Not 

eligible outcomes 

965. Das A, Kennett K, Fraundorfer M, et al. 

Holmium laser resection of the prostate 

(HoLRP): 2-year follow-up data. Tech Urol 

2001 Dec; 7(4):252-5. Case-Series 

966. Das AK, Carlson AM, Hull M. Improvement 

in depression and health-related quality of life 

after sacral nerve stimulation therapy for 

treatment of voiding dysfunction. Urology 

2004 Jul; 64(1):62-8. Not eligible target 

population 

967. Das S. Dynamic suburethral suspension with 

pedicled external oblique aponeurosis in the 

management of female urinary incontinence. J 

Urol 1999 Aug; 162(2):469-73. Case-series 

968. Das S, Palmer JK. Laparoscopic colposuspension. J Urol 1995 Sep; 154(3):1119-21. 

Case-series 

969. Dattoli M, Wallner K, Sorace R, et al. 103Pd 

brachytherapy and external beam irradiation 

for clinically localized, high-risk prostatic 

carcinoma. Int J Radiat Oncol Biol Phys 1996 

Jul 15; 35(5):875-9. Case-series 

970. David G, Durr A, Stevanin G, et al. Molecular 

and clinical correlations in autosomal 

dominant cerebellar ataxia with progressive 

macular dystrophy (SCA7). Hum Mol Genet 

1998 Feb; 7(2):165-70. Not eligible outcomes 

971. David-Montefiore E, Garbin O, Hummel M, et 

al. Sacro-spinous ligament fixation perioperative complications in 195 cases: visual 

approach versus digital approach of the sacrospinous ligament. Eur J Obstet Gynecol 

Reprod Biol 2004 Sep 10; 116(1):71-8. Caseseries 

972. Davidson HA, Borrie MJ, Crilly RG. Copy 

task performance and urinary incontinence in 

Alzheimer's disease. J Am Geriatr Soc 1991 

May; 39(5):467-71. Question 2 

973. Davidson PJ, van den Ouden D, Schroeder 

FH. Radical prostatectomy: prospective 

assessment of mortality and morbidity. Eur 

Urol 1996; 29(2):168-73. Case-Series 

974. Davies MC, Crouch NS, Woodhouse CR, et 

al. Congenital adrenal hyperplasia and lower 

urinary tract symptoms. BJU Int 2005 Jun; 

95(9):1263-6. Not eligible level of evidence 
B-44 

975. Davila GW, Daugherty CA, Sanders SW. A 

short-term, multicenter, randomized doubleblind dose titration study of the efficacy and 

anticholinergic side effects of transdermal 

compared to immediate release oral 

oxybutynin treatment of patients with urge 

urinary incontinence. J Urol 2001 Jul; 

166(1):140-5. Not eligible exposure 

976. Davila GW, Ghoniem GM, Kapoor DS, et al. 

Pelvic floor dysfunction management practice 

patterns: a survey of members of the 

International Urogynecological Association. 

Int Urogynecol J Pelvic Floor Dysfunct 2002; 

13(5):319-25. Not eligible target population 

977. Davila GW, Neal D, Horbach N, et al. A 

bladder-neck support prosthesis for women 

with stress and mixed incontinence. Obstet 

Gynecol 1999 Jun; 93(6):938-42. Not eligible 

target population 

978. Davila GW, Ostermann KV. The bladder neck 

support prosthesis: a nonsurgical approach to 

stress incontinence in adult women. Am J 

Obstet Gynecol 1994 Jul; 171(1):206-11. Not 

eligible target population 

979. Davila GW, Stanford E, Korn A. Prospective 

trial of gasless laparoscopic Burch 

colposuspension using conventional surgical 

instruments. J Am Assoc Gynecol Laparosc 

2004 May; 11(2):197-203. Not eligible target 

population 

980. Davis G, Sherman R, Wong MF, et al. Urinary 

incontinence among female soldiers. Mil Med 

1999 Mar; 164(3):182-7. Not eligible level of 

evidence 

981. Davis JW, Schellhammer PF. Collagen mass 

in prostatic bed after radical retropubic 

prostatectomy. Urology 1997 Jul; 50(1):121. 

Case-reports 

982. Davis K, Kumar D, Poloniecki J. Preliminary 

evaluation of an injectable anal sphincter 

bulking agent (Durasphere) in the 

management of faecal incontinence. Aliment 

Pharmacol Ther 2003 Jul 15; 18(2):237-43. 

Case-series 

983. Davis K, Kumar D, Stanton SL, et al. 

Symptoms and anal sphincter morphology 

following primary repair of third-degree tears. 

Br J Surg 2003 Dec; 90(12):1573-9. Caseseries 

984. Davis NS, Bavendam TG. Use of a urethral 

occlusion device for treatment of incontinence 

in a patient with heterotopic urinary diversion. 

Tech Urol 2001 Sep; 7(3):246-8. Case-reports 

985. Davison BJ, Goldenberg SL. Decisional regret 

and quality of life after participating in 

medical decision-making for early-stage 

prostate cancer. BJU Int 2003 Jan; 91(1):14-7. 

Not eligible outcomes 

986. Day PL. Findings of a three-year retrospective 

study to investigate prevalence and incidence 

of urinary incontinence and overactive bladder 

in a typical managed care setting. Pharm Pract 

Manag Q 2000 Apr; 20(1):1-11. Not eligible 

outcomes 

987. Dayton MT, Morrell DG. Factors associated 

with nighttime incontinence following 

ileoanal pullthrough. Am J Surg 1991 Dec; 

162(6):599-602. Case-series 

988. de Aloysio D, Altieri P, Penacchioni P, et al. 

Premenopause-dependent changes. Gynecol 

Obstet Invest 1996; 42(2):120-7. Not eligible 

level of evidence 

989. De Deyn PP, Carrasco MM, Deberdt W, et al. 

Olanzapine versus placebo in the treatment of 

psychosis with or without associated 

behavioral disturbances in patients with 

Alzheimer's disease. Int J Geriatr Psychiatry 

2004 Feb; 19(2):115-26. Not eligible exposure 

990. De Ganck J, Everaert K, Van Laecke E, et al. 

A high easy-to-treat complication rate is the 

price for a continent stoma. BJU Int 2002 

Aug; 90(3):240-3. Case-series 

991. de Graaf EJ, Gilberts EC, Schouten WR. Role 

of segmental colonic transit time studies to 

select patients with slow transit constipation 

for partial left-sided or subtotal colectomy. Br 

J Surg 1996 May; 83(5):648-51. Not eligible 

outcomes 

992. de la Rosette JJ, Witjes WP, Schafer W, et al. 

Relationships between lower urinary tract 

symptoms and bladder outlet obstruction: 

results from the ICS-"BPH" study. Neurourol 

Urodyn 1998; 17(2):99-108. Not eligible 

outcomes 

993. de Leval J. Novel surgical technique for the 

treatment of female stress urinary 

incontinence: transobturator vaginal tape 

inside-out. Eur Urol 2003 Dec; 44(6):724-30. 

No associative hypothesis tested 

994. De Looze D, Van Laere M, De Muynck M, et 

al. Constipation and other chronic 

gastrointestinal problems in spinal cord injury 

patients. Spinal Cord 1998 Jan; 36(1):63-6. 

Case-series 
B-45 

995. de Mooij Y, Burger MP, Schilthuis MS, et al. 

Partial urethral resection in the surgical 

treatment of vulvar cancer does not have a 

significant impact on urinary continence. A 

confirmation of an authority-based opinion. 

Int J Gynecol Cancer 2007 Jan-Feb; 

17(1):294-7. Case-series 

996. de Parades V, Etienney I, Bauer P, et al. 

Formalin application in the treatment of 

chronic radiation-induced hemorrhagic 

proctitis--an effective but not risk-free 

procedure: a prospective study of 33 patients. 

Dis Colon Rectum 2005 Aug; 48(8):1535-41. 

Not eligible target population 

997. De Ridder D, Chandiramani V, Dasgupta P, et 

al. Intravesical capsaicin as a treatment for 

refractory detrusor hyperreflexia: a dual center 

study with long-term followup. J Urol 1997 

Dec; 158(6):2087-92. Not eligible target 

population 

998. De Serres G, Shadmani R, Duval B, et al. 

Morbidity of pertussis in adolescents and 

adults. J Infect Dis 2000 Jul; 182(1):174-9. 

Not eligible target population 

999. de Stefani S, Liguori G, Ciampalini S, et al. 

AMS 800 artificial sphincter: an unusual case 

of circumscribed peritonitis due to prosthetic 

reservoir infection. Arch Esp Urol 1999 May; 

52(4):412-5. Case-reports 

1000. de Tayrac R, Gervaise A, ChauveaudLambling A, et al. Combined genital prolapse 

repair reinforced with a polypropylene mesh 

and tension-free vaginal tape in women with 

genital prolapse and stress urinary 

incontinence: a retrospective case-control 

study with short-term follow-up. Acta Obstet 

Gynecol Scand 2004 Oct; 83(10):950-4. Not 

eligible target population 

1001. de Tayrac R, Picone O, Chauveaud-Lambling 

A, et al. A 2-year anatomical and functional 

assessment of transvaginal rectocele repair 

using a polypropylene mesh. Int Urogynecol J 

Pelvic Floor Dysfunct 2006 Feb; 17(2):100-5. 

Case Reports 

1002. de Tayrac R, Salet-Lizee D, Villet R. 

Comparison of anterior colporrhaphy versus 

Bologna procedure in women with genuine 

stress incontinence. Int Urogynecol J Pelvic 

Floor Dysfunct 2002; 13(1):36-9. Case-series 

1003. De Vocht TF, van Venrooij GE, Boon TA. 

Self-expanding stent insertion for urethral 

strictures: a 10-year follow-up. BJU Int 2003 

May; 91(7):627-30. Not eligible target 

population 

1004. Dealey C. Pressure sores and incontinence: a 

study evaluating the use of topical agents in 

skin care. J Wound Care 1995 Mar; 4(3):103-

5. Not eligible outcomes 

1005. Debaere C, Rigauts H, Steyaert L, et al. MR 

imaging of a diverticulum in a female urethra. 

J Belge Radiol 1995 Dec; 78(6):345-6. Case 

Reports 

1006. Decter RM. Use of the fascial sling for 

neurogenic incontinence: lessons learned. J 

Urol 1993 Aug; 150(2 Pt 2):683-6. Caseseries 

1007. Deen KI. Faecal incontinence after vaginal 

delivery. Ceylon Med J 2003 Mar; 48(1):1-3. 

Question 2 

1008. Deen KI, Kumar D, Williams JG, et al. The 

prevalence of anal sphincter defects in faecal 

incontinence: a prospective endosonic study. 

Gut 1993 May; 34(5):685-8. Not eligible 

outcomes 

1009. Deen KI, Kumar D, Williams JG, et al. Anal 

sphincter defects. Correlation between 

endoanal ultrasound and surgery. Ann Surg 

1993 Aug; 218(2):201-5. Not eligible 

outcomes 

1010. Deffieux X, Donnadieu AC, Porcher R, et al. 

Long-term results of tension-free vaginal tape 

for female urinary incontinence: Follow up 

over 6 years. Int J Urol 2007 Jun; 14(6):521-6. 

Not eligible level of evidence 

1011. Defloor T, Schoonhoven L, Katrien V, et al. 

Reliability of the European Pressure Ulcer 

Advisory Panel classification system. J Adv 

Nurs 2006 Apr; 54(2):189-98. Not eligible 

outcomes 

1012. Defraigne JO, Otto B, Sakalihasan N, et al. 

Spinal ischaemia after surgery for abdominal 

infrarenal aortic aneurysm. Diagnosis with 

nuclear magnetic resonance. Acta Chir Belg 

1997 Oct; 97(5):250-6. Case Reports 

1013. Defreitas GA, Lemack GE, Zimmern PE, et al. 

Distinguishing neurogenic from nonneurogenic detrusor overactivity: a 

urodynamic assessment of lower urinary tract 

symptoms in patients with and without 

Parkinson's disease. Urology 2003 Oct; 

62(4):651-5. Not eligible target population 

1014. Defreitas GA, Wilson TS, Zimmern PE, et al. 

Three-dimensional ultrasonography: an 

objective outcome tool to assess collagen 

distribution in women with stress urinary 

incontinence. Urology 2003 Aug; 62(2):232-6. 

Not eligible target population 
B-46 

1015. Dehni N, McNamara DA, Schlegel RD, et al. 

Clinical effects of preoperative radiation 

therapy on anorectal function after 

proctectomy and colonic J-pouch-anal 

anastomosis. Dis Colon Rectum 2002 Dec; 

45(12):1635-40. Case-series 

1016. Dehni N, Schlegel D, Tiret E, et al. Effects of 

aging on the functional outcome of coloanal 

anastomosis with colonic J-pouch. Am J Surg 

1998 Mar; 175(3):209-12. Case-series 

1017. Deindl FM, Vodusek DB, Hesse U, et al. 

Pelvic floor activity patterns: comparison of 

nulliparous continent and parous urinary stress 

incontinent women. A kinesiological EMG 

study. Br J Urol 1994 Apr; 73(4):413-7. Caseseries 

1018. Del Carro U, Riva D, Comi GC, et al. 

Neurophysiological evaluation in detrusor 

instability. Neurourol Urodyn 1993; 

12(5):455-62. Not eligible outcomes 

1019. Del Priore G, Taylor SY, Esdaile BA, et al. 

Urinary incontinence in gynecological 

oncology patients. Int J Gynecol Cancer 2005 

Sep-Oct; 15(5):911-4. Case control < 100 

patients 

1020. Del Ser T, Hachinski V, Merskey H, et al. 

Clinical and pathologic features of two groups 

of patients with dementia with Lewy bodies: 

effect of coexisting Alzheimer-type lesion 

load. Alzheimer Dis Assoc Disord 2001 JanMar; 15(1):31-44. Not eligible target 

population 

1021. DeLancey JO. Structural support of the 

urethra as it relates to stress urinary 

incontinence: the hammock hypothesis. Am J 

Obstet Gynecol 1994 Jun; 170(6):1713-20; 

discussion 20-3. Not eligible target population 

1022. Delancey JO. Fascial and muscular 

abnormalities in women with urethral 

hypermobility and anterior vaginal wall 

prolapse. Am J Obstet Gynecol 2002 Jul; 

187(1):93-8. Not eligible outcomes 

1023. DeLancey JO, Morley GW. Total colpocleisis 

for vaginal eversion. Am J Obstet Gynecol 

1997 Jun; 176(6):1228-32; discussion 32-5. 

Case-series 

1024. DeLancey JO, Nygaard I. Exercise-associated 

urinary incontinence. Jama 1991 Jan 23-30; 

265(4):514. Case-reports 

1025. Delechenaut P, Leroi AM, Weber J, et al. 

Relationship between clinical symptoms of 

anal incontinence and the results of anorectal 

manometry. Dis Colon Rectum 1992 Sep; 

35(9):847-9. Not eligible outcomes 

1026. Delemarre JB, Gooszen HG, Kruyt RH, et al. 

The effect of posterior rectopexy on fecal 

continence. A prospective study. Dis Colon 

Rectum 1991 Apr; 34(4):311-6. Case-series 

1027. D'Elia G, Pahernik S, Fisch M, et al. Mainz 

Pouch II technique: 10 years' experience. BJU 

Int 2004 May; 93(7):1037-42. Case-series 

1028. Delmas V. Anatomical risks of transobturator 

suburethral tape in the treatment of female 

stress urinary incontinence. Eur Urol 2005 

Nov; 48(5):793-8. Not eligible target 

population 

1029. Delodovici ML, Fowler CJ. Clinical value of 

the pudendal somatosensory evoked potential. 

Electroencephalogr Clin Neurophysiol 1995 

Nov; 96(6):509-15. Not eligible target 

population 

1030. Delorme E, Droupy S, de Tayrac R, et al. 

Transobturator tape (Uratape): a new 

minimally-invasive procedure to treat female 

urinary incontinence. Eur Urol 2004 Feb; 

45(2):203-7. Case-series 

1031. Del-Ser T, Munoz DG, Hachinski V. 

Temporal pattern of cognitive decline and 

incontinence is different in Alzheimer's 

disease and diffuse Lewy body disease. 

Neurology 1996 Mar; 46(3):682-6. Caseseries 

1032. Demaria F, Porcher R, Ismael SS, et al. Using 

intercostal muscle EMG to quantify maternal 

expulsive efforts during vaginal delivery: a 

pilot study. Neurourol Urodyn 2004; 

23(7):675-8; discussion 9. Not eligible 

outcomes 

1033. Demirci F, Kuyumcuoglu U, Kekovali M, et 

al. Perineal ultrasonography in postoperative 

assessment of two different surgical 

procedures for stress urinary incontinence. Int 

Urol Nephrol 1995; 27(3):279-87. Case-series 

1034. Demirci F, Kuyumcuoglu U, Uludogan M, et 

al. Evaluation of urethrovesical junction 

mobility by perineal ultrasonography in stress 

urinary incontinence. J Pak Med Assoc 1996 

Jan; 46(1):2-5. Not eligible outcomes 

1035. Demirci F, Ozdemir I, Somunkiran A, et al. 

Abdominal sacrohysteropexy in young women 

with uterovaginal prolapse: results of 20 cases. 

J Reprod Med 2006 Jul; 51(7):539-43. Caseseries 

1036. Demirci F, Ozden S, Alpay Z, et al. The 

effects of abdominal hysterectomy on bladder 

neck and urinary incontinence. Aust N Z J 

Obstet Gynaecol 1999 May; 39(2):239-42. 

Not eligible outcomes 
B-47 

1037. Demirci F, Ozden S, Alpay Z, et al. The 

effects of vaginal delivery and cesarean 

section on bladder neck mobility and stress 

urinary incontinence. Int Urogynecol J Pelvic 

Floor Dysfunct 2001; 12(2):129-33. Question 

2 

1038. Demirci F, Yucel O, Eren S, et al. Long-term 

results of Burch colposuspension. Gynecol 

Obstet Invest 2001; 51(4):243-7. Case-series 

1039. Denays R, Tondeur M, Noel P, et al. Bilateral 

cerebral mediofrontal hypoactivity in Tc-99m 

HMPAO SPECT imaging. Clin Nucl Med 

1994 Oct; 19(10):873-6. Not eligible outcomes 

1040. Denberg TD, Flanigan RC, Kim FJ, et al. Selfreported volume of radical prostatectomies 

among urologists in the USA. BJU Int 2007 

Feb; 99(2):339-43. Not eligible outcomes 

1041. Denewer A. A low-pressure rectosigmoid 

pouch created by side-to-side anastomosis 

with a stapling technique and sigmoid colon 

intussusception as an antireflux procedure. Br 

J Urol 1998 Jun; 81(6):856-61. Case-series 

1042. Deng J, Hall-Craggs MA, Craggs MD, et al. 

Three-dimensional MRI of the male urethrae 

with implanted artificial sphincters: initial 

results. Br J Radiol 2006 Jun; 79(942):455-63. 

Not eligible outcomes 

1043. Deniz N, Perk H, Serel T, et al. Urethral coitus 

and urinary incontinence in a case of MayerRokitansky syndrome: an alternative surgical 

procedure. Eur J Obstet Gynecol Reprod Biol 

2002 Jun 10; 103(1):95-6. Case Reports 

1044. Dennis PJ, Rohner TJ, Jr., Hu TW, et al. 

Simple urodynamic evaluation of incontinent 

elderly female nursing home patients. A 

descriptive analysis. Urology 1991 Feb; 

37(2):173-9. Not eligible target population 

1045. Desai MM, Zhang P, Hennessy CH. 

Surveillance for morbidity and mortality 

among older adults--United States, 1995-

1996. MMWR CDC Surveill Summ 1999 Dec 

17; 48(8):7-25. Review 

1046. Desautel MG, Kapoor R, Badlani GH. 

Sphincteric incontinence: the primary cause of 

post-prostatectomy incontinence in patients 

with prostate cancer. Neurourol Urodyn 1997; 

16(3):153-60. Case-series 

1047. deSouza NM, Daniels OJ, Williams AD, et al. 

Female urinary genuine stress incontinence: 

anatomic considerations at MR imaging of the 

paravaginal fascia and urethra initial 

observations. Radiology 2002 Nov; 

225(2):433-9. Not eligible outcomes 

1048. deSouza NM, Puni R, Kmiot WA, et al. MRI 

of the anal sphincter. J Comput Assist Tomogr 

1995 Sep-Oct; 19(5):745-51. Question 4 

1049. deSouza NM, Puni R, Zbar A, et al. MR 

imaging of the anal sphincter in multiparous 

women using an endoanal coil: correlation 

with in vitro anatomy and appearances in fecal 

incontinence. AJR Am J Roentgenol 1996 

Dec; 167(6):1465-71. Question 4 

1050. deSouza NM, Williams AD, Wilson HJ, et al. 

Fecal incontinence in scleroderma: assessment 

of the anal sphincter with thin-section 

endoanal MR imaging. Radiology 1998 Aug; 

208(2):529-35. Not eligible outcomes 

1051. Deutekom M, Dobben AC, Dijkgraaf MG, et 

al. Costs of outpatients with fecal 

incontinence. Scand J Gastroenterol 2005 

May; 40(5):552-8. Not eligible outcomes 

1052. Deutekom M, Terra MP, Dijkgraaf MG, et al. 

Patients' perception of tests in the assessment 

of faecal incontinence. Br J Radiol 2006 Feb; 

79(938):94-100. Not eligible outcomes 

1053. Deutekom M, Terra MP, Dobben AC, et al. 

Impact of faecal incontinence severity on 

health domains. Colorectal Dis 2005 May; 

7(3):263-9. Case-series 

1054. Deutekom M, Terra MP, Dobben AC, et al. 

Selecting an outcome measure for evaluating 

treatment in fecal incontinence. Dis Colon 

Rectum 2005 Dec; 48(12):2294-301. Not 

eligible target population 

1055. Deval B, Ferchaux J, Berry R, et al. Objective 

and subjective cure rates after trans-obturator 

tape (OBTAPE) treatment of female urinary 

incontinence. Eur Urol 2006 Feb; 49(2):373-7. 

Not eligible target population 

1056. Deval B, Levardon M, Samain E, et al. A 

French multicenter clinical trial of SPARC for 

stress urinary incontinence. Eur Urol 2003 

Aug; 44(2):254-8; discussion 8-9. Not eligible 

target population 

1057. Devarajan R, Bishop MC, Sands KA. Hepatic 

abscess: a tertiary complication of Mitrofanoff 

continent urinary diversion. Br J Urol 1997 

Jan; 79(1):137-8. Case Reports 

1058. Devesa JM, Madrid JM, Gallego BR, et al. 

Bilateral gluteoplasty for fecal incontinence. 

Dis Colon Rectum 1997 Aug; 40(8):883-8. 

Case-series 

1059. Devesa JM, Rey A, Hervas PL, et al. Artificial 

anal sphincter: complications and functional 

results of a large personal series. Dis Colon 

Rectum 2002 Sep; 45(9):1154-63. Not eligible 

target population 
B-48 

1060. Devesa JM, Vicente E, Enriquez JM, et al. 

Total fecal incontinence--a new method of 

gluteus maximus transposition: preliminary 

results and report of previous experience with 

similar procedures. Dis Colon Rectum 1992 

Apr; 35(4):339-49. Case-series 

1061. Devreese A, Staes F, De Weerdt W, et al. 

Clinical evaluation of pelvic floor muscle 

function in continent and incontinent women. 

Neurourol Urodyn 2004; 23(3):190-7. Not 

eligible outcomes 

1062. deVries CR, Anderson RU. Endoscopic 

urethroplasty: an improved technique. J Urol 

1990 Jun; 143(6):1225-6. Case Reports 

1063. Devroey D, Van Casteren V, Buntinx F. 

Registration of stroke through the Belgian 

sentinel network and factors influencing 

stroke mortality. Cerebrovasc Dis 2003; 

16(3):272-9. Not eligible outcomes 

1064. Dhaenens G, Emblem R, Ganes T. Fibre 

density in idiopathic ano-rectal incontinence. 

Electromyogr Clin Neurophysiol 1995 AugSep; 35(5):285-90. Not eligible outcomes 

1065. D'Hoore A, Cadoni R, Penninckx F. Longterm outcome of laparoscopic ventral 

rectopexy for total rectal prolapse. Br J Surg 

2004 Nov; 91(11):1500-5. Case-series 

1066. Di Carlo A, Lamassa M, Baldereschi M, et al. 

Sex differences in the clinical presentation, 

resource use, and 3-month outcome of acute 

stroke in Europe: data from a multicenter 

multinational hospital-based registry. Stroke 

2003 May; 34(5):1114-9. Not eligible level of 

evidence 

1067. Di Carlo A, Lamassa M, Pracucci G, et al. 

Stroke in the very old : clinical presentation 

and determinants of 3-month functional 

outcome: A European perspective. European 

BIOMED Study of Stroke Care Group. Stroke 

1999 Nov; 30(11):2313-9. Not eligible level of 

evidence 

1068. Di Gangi Herms AM, Pinggera GM, De Jonge 

P, et al. Assessing health care needs and 

clinical outcome with urological case 

complexity: a study using INTERMED. 

Psychosomatics 2003 May-Jun; 44(3):196-

203. Not eligible outcomes 

1069. Di Gangi Herms AM, Veit R, Reisenauer C, et 

al. Functional imaging of stress urinary 

incontinence. Neuroimage 2006 Jan 1; 

29(1):267-75. Case-series 

1070. Di Giorgio A, Biacchi D, Sibio S, et al. 

Abdominal rectopexy for complete rectal 

prolapse: preliminary results of a new 

technique. Int J Colorectal Dis 2005 Mar; 

20(2):180-9. Case-series 

1071. Diana M, Zoppe C, Mastrangeli B. Treatment 

of vaginal vault prolapse with abdominal 

sacral colpopexy using prolene mesh. Am J 

Surg 2000 Feb; 179(2):126-8. Case-series 

1072. Dichgans M, Mayer M, Uttner I, et al. The 

phenotypic spectrum of CADASIL: clinical 

findings in 102 cases. Ann Neurol 1998 Nov; 

44(5):731-9. Not eligible level of evidence 

1073. Dietz HP, Clarke B, Vancaillie TG. Vaginal 

childbirth and bladder neck mobility. Aust N 

Z J Obstet Gynaecol 2002 Nov; 42(5):522-5. 

Not eligible level of evidence 

1074. Dietz HP, Eldridge A, Grace M, et al. Does 

pregnancy affect pelvic organ mobility? Aust 

N Z J Obstet Gynaecol 2004 Dec; 44(6):517-

20. Not eligible outcomes 

1075. Dietz HP, Eldridge A, Grace M, et al. Pelvic 

organ descent in young nulligravid women. 

Am J Obstet Gynecol 2004 Jul; 191(1):95-9. 

Not eligible outcomes 

1076. Dietz HP, Hansell NK, Grace ME, et al. 

Bladder neck mobility is a heritable trait. Bjog 

2005 Mar; 112(3):334-9. Not eligible 

exposure 

1077. Dietz HP, Haylen BT. Symptoms of voiding 

dysfunction: what do they really mean? Int 

Urogynecol J Pelvic Floor Dysfunct 2005 JanFeb; 16(1):52-5; discussion 5. Not eligible 

outcomes 

1078. Dietz HP, Jarvis SK, Vancaillie TG. The 

assessment of levator muscle strength: a 

validation of three ultrasound techniques. Int 

Urogynecol J Pelvic Floor Dysfunct 2002; 

13(3):156-9; discussion 9. Not eligible 

outcomes 

1079. Dietz HP, Lanzarone V. Levator trauma after 

vaginal delivery. Obstet Gynecol 2005 Oct; 

106(4):707-12. Case-series 

1080. Dietz HP, Mouritsen L, Ellis G, et al. Does the 

tension-free vaginal tape stay where you put 

it? Am J Obstet Gynecol 2003 Apr; 

188(4):950-3. Not eligible outcomes 

1081. Dietz HP, Mouritsen L, Ellis G, et al. How 

important is TVT location? Acta Obstet 

Gynecol Scand 2004 Oct; 83(10):904-8. Not 

eligible outcomes 

1082. Dietz HP, Steensma AB. The prevalence of 

major abnormalities of the levator ani in 

urogynaecological patients. Bjog 2006 Feb; 

113(2):225-30. Not eligible outcomes 

1083. Dietz HP, Wilson PD. The influence of 

bladder volume on the position and mobility 

of the urethrovesical junction. Int Urogynecol 

J Pelvic Floor Dysfunct 1999; 10(1):3-6. Not 

eligible target population 
B-49 

1084. Dietz HP, Wilson PD. Colposuspension 

success and failure: a long-term objective 

follow-up study. Int Urogynecol J Pelvic Floor 

Dysfunct 2000 Dec; 11(6):346-51. Case-series 

1085. Dietz HP, Wilson PD. Laparoscopic 

colposuspension versus urethropexy: a casecontrol series. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Jan-Feb; 16(1):15-8; 

discussion 8. Not eligible target population 

1086. Dietz HP, Wilson PD, Clarke B. The use of 

perineal ultrasound to quantify levator activity 

and teach pelvic floor muscle exercises. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 

12(3):166-8; discussion 8-9. Case-series 

1087. Digesu GA, Chaliha C, Salvatore S, et al. The 

relationship of vaginal prolapse severity to 

symptoms and quality of life. Bjog 2005 Jul; 

112(7):971-6. Not eligible outcomes 

1088. Digesu GA, Khullar V, Cardozo L, et al. 

Preoperative pressure-flow studies: useful 

variables to predict the outcome of continence 

surgery. BJU Int 2004 Dec; 94(9):1296-9. Not 

eligible outcomes 

1089. Diggs C, Meyer WA, Langenberg P, et al. 

Assessing urgency in interstitial 

cystitis/painful bladder syndrome. Urology 

2007 Feb; 69(2):210-4. Not eligible outcomes 

1090. Dijkema HE, Weil EH, Mijs PT, et al. 

Neuromodulation of sacral nerves for 

incontinence and voiding dysfunctions. 

Clinical results and complications. Eur Urol 

1993; 24(1):72-6. Case-series 

1091. Dikranian AH, Chang JH, Rhee EY, et al. The 

male perineal sling: comparison of sling 

materials. J Urol 2004 Aug; 172(2):608-10. 

Case-series 

1092. Diller LM. Post-TURP incontinence. Urol 

Nurs 2000 Feb; 20(1):54. Case report 

1093. Dimachkie MM, Ohanian S, Groves MD, et 

al. Peripheral nerve injury after brief 

lithotomy for transurethral collagen injection. 

Urology 2000 Oct 1; 56(4):669. Case-reports 

1094. DiMarco DS, Elliott DS. Tandem cuff 

artificial urinary sphincter as a salvage 

procedure following failed primary sphincter 

placement for the treatment of postprostatectomy incontinence. J Urol 2003 Oct; 

170(4 Pt 1):1252-4. Case-series 

1095. Dimitri M. TURP with the new superpulsed 

radiofrequency energy: More than a gold 

standard. Eur Urol 1999 Oct; 36(4):331-4. Not 

eligible outcomes 

1096. Ding YY, Jayaratnam FJ. Urinary 

incontinence in the hospitalised elderly--a 

largely reversible disorder. Singapore Med J 

1994 Apr; 35(2):167-70. Not eligible target 

population 

1097. Ding YY, Sahadevan S, Pang WS, et al. 

Clinical utility of a portable ultrasound 

scanner in the measurement of residual urine 

volume. Singapore Med J 1996 Aug; 

37(4):365-8. Not eligible outcomes 

1098. Dingwall L, McLafferty E. Do nurses promote 

urinary continence in hospitalized older 

people?: An exploratory study. J Clin Nurs 

2006 Oct; 15(10):1276-86. Not eligible target 

population 

1099. Diokno A, Lee P, Zorn BH, et al. Factors 

associated with clinical assessment of 

overactive bladder and selection of treatment. 

Clin Ther 2001 Sep; 23(9):1542-51. Not 

eligible target population 

1100. Diokno A, Sand P, Labasky R, et al. Longterm safety of extended-release oxybutynin 

chloride in a community-dwelling population 

of participants with overactive bladder: a oneyear study. Int Urol Nephrol 2002; 34(1):43-9. 

Not eligible outcomes 

1101. Diokno A, Yuhico M, Jr. Preference, 

compliance and initial outcome of therapeutic 

options chosen by female patients with urinary 

incontinence. J Urol 1995 Nov; 154(5):1727-

30; discussion 31. Not eligible outcomes 

1102. Diokno AC. Epidemiology and psychosocial 

aspects of incontinence. Urol Clin North Am 

1995 Aug; 22(3):481-5. Comment 

1103. Diokno AC, Appell RA, Sand PK, et al. 

Prospective, randomized, double-blind study 

of the efficacy and tolerability of the 

extended-release formulations of oxybutynin 

and tolterodine for overactive bladder: results 

of the OPERA trial. Mayo Clin Proc 2003 Jun; 

78(6):687-95. Not eligible exposure 

1104. Diokno AC, Brown MB, Herzog AR. Sexual 

function in the elderly. Arch Intern Med 1990 

Jan; 150(1):197-200. Not eligible outcomes 

1105. Diokno AC, Burgio K, Fultz H, et al. 

Prevalence and outcomes of continence 

surgery in community dwelling women. J Urol 

2003 Aug; 170(2 Pt 1):507-11. Not eligible 

level of evidence 

1106. Diokno AC, Burgio K, Fultz NH, et al. 

Medical and self-care practices reported by 

women with urinary incontinence. Am J 

Manag Care 2004 Feb; 10(2 Pt 1):69-78. Not 

eligible level of evidence 
B-50 

1107. Dippel DW, Habbema JD. Probabilistic 

diagnosis of normal pressure hydrocephalus 

and other treatable cerebral lesions in 

dementia. J Neurol Sci 1993 Nov; 119(2):123-

33. Not eligible outcomes 

1108. Discolo CM, Akst LM, Schlossberg L, et al. 

Anterior cranial fossa glioblastoma with sleep 

apnea as the initial manifestation. Am J 

Otolaryngol 2005 Sep-Oct; 26(5):327-9. Casereports 

1109. Diseth TH. Dissociation following traumatic 

medical treatment procedures in childhood: a 

longitudinal follow-up. Dev Psychopathol 

2006 Winter; 18(1):233-51. Not eligible target 

population 

1110. Diseth TH, Bjordal R, Schultz A, et al. 

Somatic function, mental health and 

psychosocial functioning in 22 adolescents 

with bladder exstrophy and epispadias. J Urol 

1998 May; 159(5):1684-9; discussion 9-90. 

Not eligible target population 

1111. Diseth TH, Bjornland K, Novik TS, et al. 

Bowel function, mental health, and 

psychosocial function in adolescents with 

Hirschsprung's disease. Arch Dis Child 1997 

Feb; 76(2):100-6. Not eligible target 

population 

1112. Diseth TH, Egeland T, Emblem R. Effects of 

anal invasive treatment and incontinence on 

mental health and psychosocial functioning of 

adolescents with Hirschsprung's disease and 

low anorectal anomalies. J Pediatr Surg 1998 

Mar; 33(3):468-75. Not eligible target 

population 

1113. Diseth TH, Emblem R. Somatic function, 

mental health, and psychosocial adjustment of 

adolescents with anorectal anomalies. J 

Pediatr Surg 1996 May; 31(5):638-43. Not 

eligible target population 

1114. Dixon GR, Friedman JA, Luetmer PH, et al. 

Use of cerebrospinal fluid flow rates measured 

by phase-contrast MR to predict outcome of 

ventriculoperitoneal shunting for idiopathic 

normal-pressure hydrocephalus. Mayo Clin 

Proc 2002 Jun; 77(6):509-14. Case-series 

1115. Dixon PJ, Christmas TJ, Chapple CR. Stress 

incontinence due to pelvic floor muscle 

involvement in limb-girdle muscular 

dystrophy. Br J Urol 1990 Jun; 65(6):653-4. 

Case Reports 

1116. Djaladat H, Mehrsai A, Saraji A, et al. 

Suprapubic prostatectomy with a novel 

catheter. J Urol 2006 Jun; 175(6):2083-6. Not 

eligible exposure 

1117. Dmochowski R. Urinary frequency: event 

measure, outcome significance? Curr Urol 

Rep 2005 Mar; 6(2):87-8. No associative 

hypothesis tested 

1118. Dmochowski RR. Management of 

postoperative overactive bladder 

complications. Geriatrics 2002 May; 57 Suppl 

1:18-23. Review 

1119. Dmochowski RR, Avon M, Ross J, et al. 

Transvaginal radio frequency treatment of the 

endopelvic fascia: a prospective evaluation for 

the treatment of genuine stress urinary 

incontinence. J Urol 2003 Mar; 169(3):1028-

32. Not eligible target population 

1120. Dmochowski RR, Davila GW, Zinner NR, et 

al. Efficacy and safety of transdermal 

oxybutynin in patients with urge and mixed 

urinary incontinence. J Urol 2002 Aug; 

168(2):580-6. Not eligible exposure 

1121. Dmochowski RR, Miklos JR, Norton PA, et 

al. Duloxetine versus placebo for the treatment 

of North American women with stress urinary 

incontinence. J Urol 2003 Oct; 170(4 Pt 

1):1259-63. Not eligible exposure 

1122. Dmochowski RR, Nitti V, Staskin D, et al. 

Transdermal oxybutynin in the treatment of 

adults with overactive bladder: combined 

results of two randomized clinical trials. 

World J Urol 2005 Sep; 23(4):263-70. Not 

eligible exposure 

1123. Dmochowski RR, Sand PK, Zinner NR, et al. 

Comparative efficacy and safety of 

transdermal oxybutynin and oral tolterodine 

versus placebo in previously treated patients 

with urge and mixed urinary incontinence. 

Urology 2003 Aug; 62(2):237-42. Not eligible 

exposure 

1124. Dmochowski RR, Zimmern PE, Ganabathi K, 

et al. Role of the four-corner bladder neck 

suspension to correct stress incontinence with 

a mild to moderate cystocele. Urology 1997 

Jan; 49(1):35-40. Not eligible target 

population 

1125. Doan T, Patterson R, Greenberger PA. Cough 

variant asthma: usefulness of a diagnostictherapeutic trial with prednisone. Ann Allergy 

1992 Dec; 69(6):505-9. Not eligible target 

population 

1126. Dobben AC, Terra MP, Berghmans B, et al. 

Functional changes after physiotherapy in 

fecal incontinence. Int J Colorectal Dis 2006 

Sep; 21(6):515-21. Case-series 
B-51 

1127. Dobben AC, Terra MP, Slors JF, et al. 

External anal sphincter defects in patients with 

fecal incontinence: comparison of endoanal 

MR imaging and endoanal US. Radiology 

2007 Feb; 242(2):463-71. Not eligible 

outcomes 

1128. Dobben AC, Wiersma TG, Janssen LW, et al. 

Prospective assessment of interobserver 

agreement for defecography in fecal 

incontinence. AJR Am J Roentgenol 2005 

Nov; 185(5):1166-72. Not eligible outcomes 

1129. Docimo SG, Remmenga S, Segne R, et al. 

Hysterectomy by the transvaginal approach 

after intestinal bladder augmentation and 

psoas hitch reimplantation. J Am Coll Surg 

1995 May; 180(5):610-2. Case Reports 

1130. Dodi G, Pietroletti R, Milito G, et al. 

Bleeding, incontinence, pain and constipation 

after STARR transanal double stapling 

rectotomy for obstructed defecation. Tech 

Coloproctol 2003 Oct; 7(3):148-53. Caseseries 

1131. Dogan AS, Kirchner PT. Hepatobiliary 

excretion of MAG3. Simulation of a urinary 

leak. Clin Nucl Med 1993 Sep; 18(9):746-50. 

Case Reports 

1132. Dogra PN, Ansari MS. Spinning top urethra 

and lower urinary tract dysfunction in a young 

female. ScientificWorldJournal 2004 Jun 7; 4 

Suppl 1:108-10. Case-reports 

1133. Dogra PN, Prashad R, Goel R, et al. 

Paradoxical incontinence caused by "invisible 

dysplastic" kidneys: role of laparoscopy. Int 

Urol Nephrol 2002; 34(1):17-8. Case Reports 

1134. Doherty W. TENA flex: a new concept in 

disposable incontinence pads. Br J Nurs 2003 

Mar 13-26; 12(5):327-8, 30. Comment 

1135. Dolan LM, Hosker GL, Mallett VT, et al. 

Stress incontinence and pelvic floor 

neurophysiology 15 years after the first 

delivery. Bjog 2003 Dec; 110(12):1107-14. 

Not eligible target population 

1136. Dolman M, Chase J. Comparison between the 

Health Belief Model and Subjective Expected 

Utility Theory: predicting incontinence 

prevention behaviour in post-partum women. J 

Eval Clin Pract 1996 Aug; 2(3):217-22. Not 

eligible outcomes 

1137. Donaldson MM, Thompson JR, Matthews RJ, 

et al. The natural history of overactive bladder 

and stress urinary incontinence in older 

women in the community: a 3-year 

prospective cohort study. Neurourol Urodyn 

2006; 25(7):709-16. Not eligible outcomes 

1138. Donato DM, Waller-Smith S. The vaginalpsoas suspension repair of uterovaginal 

prolapse. J Am Coll Surg 2002 Jul; 195(1):51-

4. Case-series 

1139. Dong D, Xu Z, Shi B, et al. Urodynamic study 

in the neurogenic bladder dysfunction caused 

by intervertebral disk hernia. Neurourol 

Urodyn 2006; 25(5):446-50. Case-series 

1140. Doniec JM, Schniewind B, Kovacs G, et al. 

Multimodal therapy of anal cancer added by 

new endosonographic-guided brachytherapy. 

Surg Endosc 2006 Apr; 20(4):673-8. Caseseries 

1141. Donnellan SM, Duncan HJ, MacGregor RJ, et 

al. Prospective assessment of incontinence 

after radical retropubic prostatectomy: 

objective and subjective analysis. Urology 

1997 Feb; 49(2):225-30. Not eligible 

outcomes 

1142. Donnelly MJ, Powell-Morgan S, Olsen AL, et 

al. Vaginal pessaries for the management of 

stress and mixed urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2004 

Sep-Oct; 15(5):302-7. Not eligible outcomes 

1143. Donnelly V, O'Connell PR, O'Herlihy C. The 

influence of oestrogen replacement on faecal 

incontinence in postmenopausal women. Br J 

Obstet Gynaecol 1997 Mar; 104(3):311-5. Not 

eligible target population 

1144. Dooneief G, Marlink R, Bell K, et al. 

Neurologic consequences of HTLV-II 

infection in injection-drug users. Neurology 

1996 Jun; 46(6):1556-60. Not eligible 

exposure 

1145. Doran CM, Chiarelli P, Cockburn J. Economic 

costs of urinary incontinence in communitydwelling Australian women. Med J Aust 2001 

May 7; 174(9):456-8. Secondary data analysis 

1146. Dorey G, Feneley RC, Speakman MJ, et al. 

Pelvic floor muscle exercises and manometric 

biofeedback for erectile dysfunction and 

postmicturition dribble: three case studies. J 

Wound Ostomy Continence Nurs 2003 Jan; 

30(1):44-51; discussion -2. Case-reports 

1147. Dornan PR. Incontinence--an aggressive 

approach to treatment: a case series. J Sci Med 

Sport 2005 Dec; 8(4):458-62. Case-series 

1148. Douard R, Frileux P, Brunel M, et al. 

Functional results after the Orr-Loygue 

transabdominal rectopexy for complete rectal 

prolapse. Dis Colon Rectum 2003 Aug; 

46(8):1089-96. Case-series 
B-52 

1149. Dougherty MC, Dwyer JW, Pendergast JF, et 

al. Community-based nursing: continence care 

for older rural women. Nurs Outlook 1998 

Sep-Oct; 46(5):233-44. No associative 

hypothesis tested 

1150. Dovey S, McNaughton T, Tilyard M, et al. 

General practitioners' opinions of continence 

care training. N Z Med J 1996 Sep 13; 

109(1029):340-3. Not eligible target 

population 

1151. Dowd T, Kolcaba K, Steiner R. Correlations 

among measures of bladder function and 

comfort. J Nurs Meas 2002 Spring-Summer; 

10(1):27-38. Not eligible outcomes 

1152. Dowd T, Kolcaba K, Steiner R. The addition 

of coaching to cognitive strategies: 

interventions for persons with compromised 

urinary bladder syndrome. J Wound Ostomy 

Continence Nurs 2003 Mar; 30(2):90-9. Not 

eligible outcomes 

1153. Dowd TT, Campbell JM. Urinary 

incontinence in an acute care setting. Urol 

Nurs 1995 Sep; 15(3):82-5. Not eligible target 

population 

1154. Dowell CJ, Bryant CM, Moore KH, et al. 

Calculating the direct costs of urinary 

incontinence: a new test instrument. BJU Int 

1999 Apr; 83(6):596-606. Not eligible 

outcomes 

1155. Downs TM, Sadetsky N, Pasta DJ, et al. 

Health related quality of life patterns in 

patients treated with interstitial prostate 

brachytherapy for localized prostate cancer--

data from CaPSURE. J Urol 2003 Nov; 

170(5):1822-7. Case Series 

1156. Dowse J, Fordham S, Mackender J. Back to 

basics continence. Nurs Times Nurs Homes 

1999 Nov-Dec; 1(4):23-5, 7. Comment 

1157. Dowse J, Mackender J. Back to basics: 

continence. Nurs Times 2000 Jul 27; 96(30 

Suppl):7-9. Comment 

1158. Drachman DA, O'Donnell BF, Lew RA, et al. 

The prognosis in Alzheimer's disease. 'How 

far' rather than 'how fast' best predicts the 

course. Arch Neurol 1990 Aug; 47(8):851-6. 

Case-series 

1159. Drago JR, Badalament RA, Nesbitt JA. 

Radical prostatectomy 1972-1987 single 

institutional experience: comparison of 

standard radical prostatectomy and nervesparing technique. Urology 1990 May; 

35(5):377-80. Case-series 

1160. Drago JR, Badalament RA, Nesbitt JA, et al. 

Radical nerve-sparing prostatectomy with 

epidural anaesthesia in 100 patients. Br J Urol 

1990 May; 65(5):517-9. Case-series 

1161. Drent ML, van der Veen EA. Lipase 

inhibition: a novel concept in the treatment of 

obesity. Int J Obes Relat Metab Disord 1993 

Apr; 17(4):241-4. Not eligible outcomes 

1162. Drutz HP, Appell RA, Gleason D, et al. 

Clinical efficacy and safety of tolterodine 

compared to oxybutynin and placebo in 

patients with overactive bladder. Int 

Urogynecol J Pelvic Floor Dysfunct 1999; 

10(5):283-9. Not eligible exposure 

1163. Dubbs J. Addressing an urgent need. Rehab 

Manag 2006 Aug-Sep; 19(7):32-4, 6-7. 

Comment 

1164. DuBeau C. Urinary incontinence: taking 

action against this 'silent epidemic'. Interview 

by Marc E. Weksler. Geriatrics 1996 Apr; 

51(4):47-51. Interview 

1165. DuBeau CE. The continuum of urinary 

incontinence in an aging population. 

Geriatrics 2002 May; 57 Suppl 1:12-7. 

Comment 

1166. DuBeau CE, Khullar V, Versi E. "Unblinding" 

in randomized controlled drug trials for 

urinary incontinence: Implications for 

assessing outcomes when adverse effects are 

evident. Neurourol Urodyn 2005; 24(1):13-20. 

Not eligible exposure 

1167. DuBeau CE, Kiely DK, Resnick NM. Quality 

of life impact of urge incontinence in older 

persons: a new measure and conceptual 

structure. J Am Geriatr Soc 1999 Aug; 

47(8):989-94. Not eligible outcomes 

1168. Dubeau CE, Simon SE, Morris JN. The effect 

of urinary incontinence on quality of life in 

older nursing home residents. J Am Geriatr 

Soc 2006 Sep; 54(9):1325-33. Not eligible 

outcomes 

1169. Dubernard G, Rouzier R, Haddad B, et al. 

Correction of uterine prolapse by the vaginal 

route using the uterosacral ligaments: 

Shirodkar procedure. Eur J Obstet Gynecol 

Reprod Biol 2003 Aug 15; 109(2):214-8. 

Case-series 

1170. Duchesne GM, Dowling C, Frydenberg M, et 

al. Outcome, morbidity, and prognostic factors 

in post-prostatectomy radiotherapy: an 

Australian multicenter study. Urology 2003 

Jan; 61(1):179-83. Not eligible level of 

evidence 

1171. Duckett JR, Tamilselvi A. Effect of tensionfree vaginal tape in women with a urodynamic 

diagnosis of idiopathic detrusor overactivity 

and stress incontinence. Bjog 2006 Jan; 

113(1):30-3. Not eligible outcomes 
B-53 

1172. Duckett JR, Tamilselvi A, Jain S. Foley 

catheter tamponade of bleeding in the cave of 

Retzius after a Tension Free Vaginal Tape 

procedure. J Obstet Gynaecol 2005 Jan; 

25(1):80-1. Case- Reports 

1173. Duckett JR, Vella M, Kavalakuntla G, et al. 

Tolerability and efficacy of duloxetine in a 

nontrial situation. BJOG 2007 May; 

114(5):543-7. Not eligible outcomes 

1174. Dudderidge TJ, Haynes SV, Davies AJ, et al. 

Vesicocervical fistula: rare complication of 

cesarean section demonstrated by magnetic 

resonance imaging. Urology 2005 Jan; 

65(1):174. Case Reports 

1175. Duel BP, Gonzalez R. The button cecostomy 

for management of fecal incontinence. Pediatr 

Surg Int 1999; 15(8):559-61. Case-series 

1176. Duffau H, Capelle L. Incontinence after brain 

glioma surgery: new insights into the cortical 

control of micturition and continence. Case 

report. J Neurosurg 2005 Jan; 102(1):148-51. 

Case Reports 

1177. Duffy LM. Continence management for the 

frail elderly and cognitively impaired. Urol 

Nurs 1992 Jun; 12(2):66-8. Comment 

1178. Dugan E, Cohen SJ, Bland DR, et al. The 

association of depressive symptoms and 

urinary incontinence among older adults. J 

Am Geriatr Soc 2000 Apr; 48(4):413-6. Not 

eligible outcomes 

1179. Duggan PM, Wilson PD, Norton P, et al. 

Utilization of preoperative urodynamic 

investigations by gynecologists who 

frequently operate for female urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Oct; 14(4):282-7; discussion 6-

7. Not eligible outcomes 

1180. Duldulao KE, Diokno AC, Mitchell B. Value 

of urinary cytology in women presenting with 

urge incontinence and/or irritative voiding 

symptoms. J Urol 1997 Jan; 157(1):113-6. Not 

eligible outcomes 

1181. Dumoulin C, Seaborne DE, QuirionDeGirardi C, et al. Pelvic-floor rehabilitation, 

Part 2: Pelvic-floor reeducation with 

interferential currents and exercise in the 

treatment of genuine stress incontinence in 

postpartum women--a cohort study. Phys Ther 

1995 Dec; 75(12):1075-81. Case-reports 

1182. Dumoulin C, Seaborne DE, QuirionDeGirardi C, et al. Pelvic-floor rehabilitation, 

Part 1: Comparison of two surface electrode 

placements during stimulation of the pelvicfloor musculature in women who are continent 

using bipolar interferential currents. Phys Ther 

1995 Dec; 75(12):1067-74. Not eligible 

outcomes 

1183. Dumville JC, Manca A, Kitchener HC, et al. 

Cost-effectiveness analysis of open 

colposuspension versus laparoscopic 

colposuspension in the treatment of 

urodynamic stress incontinence. Bjog 2006 

Sep; 113(9):1014-22. Not eligible outcomes 

1184. Dunn JS, Jr., Gruber D, Broberg J, et al. 

Urogynecology practice patterns among Air 

Force obstetricians and gynecologists: survey 

results. Int Urogynecol J Pelvic Floor 

Dysfunct 2006 Nov; 17(6):598-603. Not 

eligible target population 

1185. Dunn KL, Galka ML. A comparison of the 

effectiveness of Therevac SB and bisacodyl 

suppositories in SCI patients' bowel programs. 

Rehabil Nurs 1994 Nov-Dec; 19(6):334-8. Not 

eligible outcomes 

1186. Duong TH, Korn AP. A comparison of urinary 

incontinence among African American, Asian, 

Hispanic, and white women. Am J Obstet 

Gynecol 2001 May; 184(6):1083-6. Not 

eligible target population 

1187. Durgun V, Perek A, Kapan M, et al. Partial 

fistulotomy and modified cutting seton 

procedure in the treatment of high 

extrasphincteric perianal fistulae. Dig Surg 

2002; 19(1):56-8. Case-series 

1188. Duru S, Ceylan S, Ceylan S. Optic chiasm 

diastasis in a pituitary tumor. Case illustration. 

J Neurosurg 1999 Feb; 90(2):363. Case 

Reports 

1189. Duso S. Product notebook: a new fecal 

containment device. A case study describing 

one use of the Bard FCD fecal containment 

device. Ostomy Wound Manage 1992 Jun; 

38(5):38-41. Case- Reports 

1190. Duthie GS, Bartolo DC. Abdominal rectopexy 

for rectal prolapse: a comparison of 

techniques. Br J Surg 1992 Feb; 79(2):107-13. 

Case-series 

1191. Dwyer PL, Carey MP, Rosamilia A. Suture 

injury to the urinary tract in urethral 

suspension procedures for stress incontinence. 

Int Urogynecol J Pelvic Floor Dysfunct 1999; 

10(1):15-21. Not eligible target population 

1192. Dwyer PL, Desmedt E. Impaired bladder 

emptying in women. Aust N Z J Obstet 

Gynaecol 1994 Feb; 34(1):73-8. Question 1 
B-54 

1193. Dwyer PL, Teele JS. Prazosin: a neglected 

cause of genuine stress incontinence. Obstet 

Gynecol 1992 Jan; 79(1):117-21. Not eligible 

target population 

1194. Dykes EH, Duffy PG, Ransley PG. The use of 

the Mitrofanoff principle in achieving clean 

intermittent catheterisation and urinary 

continence in children. J Pediatr Surg 1991 

May; 26(5):535-8. Not eligible target 

population 

1195. Eason EL, Feldman P. Contact dermatitis 

associated with the use of Always sanitary 

napkins. Cmaj 1996 Apr 15; 154(8):1173-6. 

Not eligible outcomes 

1196. Easton BT. Is hormone replacement therapy 

(estrogen plus progestin) effective for the 

treatment of urinary incontinence in 

postmenopausal women? J Fam Pract 2001 

May; 50(5):470. Comment 

1197. Eastwood S, Kralik D, Koch T. 

Compromising and containing: selfmanagement strategies used by men and 

women who live with multiple sclerosis and 

urinary incontinence. Aust J Holist Nurs 2002 

Apr; 9(1):33-43. Not eligible outcomes 

1198. Eberle CM, Winsemius D, Garibaldi RA. Risk 

factors and consequences of bacteriuria in 

non-catheterized nursing home residents. J 

Gerontol 1993 Nov; 48(6):M266-71. Not 

eligible outcomes 

1199. Ebrahim S, Patel N, Coats M, et al. Prevalence 

and severity of morbidity among Gujarati 

Asian elders: a controlled comparison. Fam 

Pract 1991 Mar; 8(1):57-62. Not eligible level 

of evidence 

1200. Eccersley AJ, Lunniss PJ, Williams NS. 

Unstimulated graciloplasty in traumatic faecal 

incontinence. Br J Surg 1999 Aug; 

86(8):1071-2. Comment 

1201. Eckardt VF, Jung B, Fischer B, et al. Anal 

endosonography in healthy subjects and 

patients with idiopathic fecal incontinence. 

Dis Colon Rectum 1994 Mar; 37(3):235-42. 

Not eligible outcomes 

1202. Edwall L, Carlstrom K, Jonasson AF. Markers 

of collagen synthesis and degradation in 

urogenital tissue from women with and 

without stress urinary incontinence. Neurourol 

Urodyn 2005; 24(4):319-24. Not eligible level 

of evidence 

1203. Eekhof J, De Bock G, Schaapveld K, et al. 

Effects of screening for disorders among the 

elderly: an intervention study in general 

practice. Fam Pract 2000 Aug; 17(4):329-33. 

Not eligible level of evidence 

1204. Efron JE, Corman ML, Fleshman J, et al. 

Safety and effectiveness of temperaturecontrolled radio-frequency energy delivery to 

the anal canal (Secca procedure) for the 

treatment of fecal incontinence. Dis Colon 

Rectum 2003 Dec; 46(12):1606-16; discussion 

16-8. Not eligible target population 

1205. Efthimiadis C, Basdanis G, Zatagias A, et al. 

Manometric and clinical evaluation of patients 

after low anterior resection for rectal cancer. 

Tech Coloproctol 2004 Nov; 8 Suppl 1:s205-

7. No associative hypothesis tested 

1206. Egawa S, Kuruma H, Suyama K, et al. 

Delayed recovery of urinary continence after 

laparoscopic radical prostatectomy. Int J Urol 

2003 Apr; 10(4):207-12. Case-series 

1207. Egawa S, Minei S, Iwamura M, et al. Urinary 

continence following radical prostatectomy. 

Jpn J Clin Oncol 1997 Apr; 27(2):71-5. Caseseries 

1208. Egon G, Barat M, Colombel P, et al. 

Implantation of anterior sacral root stimulators 

combined with posterior sacral rhizotomy in 

spinal injury patients. World J Urol 1998; 

16(5):342-9. Case-series 

1209. Eguare EI, Neary P, Crosbie J, et al. Dynamic 

magnetic resonance imaging of the pelvic 

floor in patients with idiopathic combined 

fecal and urinary incontinence. J Gastrointest 

Surg 2004 Jan; 8(1):73-82; discussion Not 

eligible outcomes 

1210. Eire PF, Cives RV, Gago MC. Faecal 

incontinence in children with spina bifida: the 

best conservative treatment. Spinal Cord 1998 

Nov; 36(11):774-6. Case-series 

1211. Eisenberger CF, Schoenberg M, Fitter D, et al. 

Orthotopic ileocolic neobladder reconstruction 

following radical cystectomy: history, 

technique and results of the Johns Hopkins 

experience, 1986-1998. Urol Clin North Am 

1999 Feb; 26(1):149-56, ix. Case-series 

1212. Eisenstein SM, Engelbrecht DJ, el Masry WS. 

Low back pain and urinary incontinence. A 

hypothetical relationship. Spine 1994 May 15; 

19(10):1148-52. Case-series 

1213. Eisman E, Tries J. A new probe for measuring 

electromyographic activity from multiple sites 

in the anal canal. Dis Colon Rectum 1993 Oct; 

36(10):946-52. Case-series 

1214. Elabbady AA, Elabbasy WI, Arafa AF, et al. 

A simple technique for urinary diversion: the 

dismembered detubularized rectosigmoid 

bladder with distal colorectostomy. J Urol 

1998 Sep; 160(3 Pt 1):714-7. Case-series 
B-55 

1215. Elard S, Cicco A, Salomon L, et al. 

Embolization for arterial injury incurred 

during tension-free vaginal tape procedure. J 

Urol 2002 Oct; 168(4 Pt 1):1503. CaseReports 

1216. Elbadawi A, Hailemariam S, Yalla SV, et al. 

Structural basis of geriatric voiding 

dysfunction. VII. Prospective 

ultrastructural/urodynamic evaluation of its 

natural evolution. J Urol 1997 May; 

157(5):1814-22. Not eligible outcomes 

1217. Elbadawi A, Hailemariam S, Yalla SV, et al. 

Structural basis of geriatric voiding 

dysfunction. VI. Validation and update of 

diagnostic criteria in 71 detrusor biopsies. J 

Urol 1997 May; 157(5):1802-13. Not eligible 

outcomes 

1218. Elbadawi A, Yalla SV, Resnick NM. 

Structural basis of geriatric voiding 

dysfunction. III. Detrusor overactivity. J Urol 

1993 Nov; 150(5 Pt 2):1668-80. Not eligible 

outcomes 

1219. el-Bahnasawy MS, Gomha MA, Shaaban AA. 

Urethral pressure profile following orthotopic 

neobladder: differences between nerve sparing 

and standard radical cystectomy techniques. J 

Urol 2006 May; 175(5):1759-63; discussion 

63. Case-series 

1220. Eldar R, Ring H, Tshuwa M, et al. Quality of 

care for urinary incontinence in a 

rehabilitation setting for patients with stroke. 

Simultaneous monitoring of process and 

outcome. Int J Qual Health Care 2001 Feb; 

13(1):57-61. Case-series 

1221. Elder JS. Periurethral and puboprostatic sling 

repair for incontinence in patients with 

myelodysplasia. J Urol 1990 Aug; 144(2 Pt 

2):434-7; discussion 43-4. Not eligible target 

population 

1222. Eldridge GD, Walker JR, Holborn SW. 

Cognitive-behavioral treatment for panic 

disorder with gastrointestinal symptoms: a 

case study. J Behav Ther Exp Psychiatry 1993 

Dec; 24(4):367-71. Case- Reports 

1223. Elgamasy AN, Lewis V, Hassouna ME, et al. 

Effect of transvaginal stimulation in the 

treatment of detrusor instability. Urol Nurs 

1996 Dec; 16(4):127-30. Not eligible target 

population 

1224. ElHajj, II, El-Zahabi LM, Abdul-Baki H, et al. 

Fecal impaction and systemic inflammatory 

response syndrome in a young male with 

cerebral palsy. South Med J 2006 May; 

99(5):521-4. Case Reports 

1225. Elia G, Bergman A. Pelvic muscle exercises: 

when do they work? Obstet Gynecol 1993 

Feb; 81(2):283-6. Case-series 

1226. Elia G, Bergman A. Periurethral collagen 

implant: ultrasound assessment and prediction 

of outcome. Int Urogynecol J Pelvic Floor 

Dysfunct 1996; 7(6):335-8. Case-series 

1227. Elia G, Bergman J, Dye TD. Familial 

incidence of urinary incontinence. Am J 

Obstet Gynecol 2002 Jul; 187(1):53-5. Not 

eligible level of evidence 

1228. Elia G, Stewart S, Makhuli ZN, et al. 

Metastatic breast cancer diagnosed during a 

work-up for urinary incontinence: a case 

report. Int Urogynecol J Pelvic Floor Dysfunct 

1999; 10(1):39-42. Case Reports 

1229. Eliasson K, Larsson T, Mattsson E. 

Prevalence of stress incontinence in 

nulliparous elite trampolinists. Scand J Med 

Sci Sports 2002 Apr; 12(2):106-10. Caseseries 

1230. Eliasson K, Nordlander I, Mattsson E, et al. 

Prevalence of urinary leakage in nulliparous 

women with respect to physical activity and 

micturition habits. Int Urogynecol J Pelvic 

Floor Dysfunct 2004 May-Jun; 15(3):149-53. 

Not eligible level of evidence 

1231. El-Lamie IK. Preliminary experience with 

Mainz type II pouch in gynecologic oncology 

patients. Eur J Gynaecol Oncol 2001; 

22(1):77-80. Case-series 

1232. Ellerkmann RM, Dunn JS, McBride AW, et 

al. A comparison of anticipated pain before 

and pain rating after the procedure in patients 

who undergo cystourethroscopy. Am J Obstet 

Gynecol 2003 Jul; 189(1):66-9. Not eligible 

outcomes 

1233. Ellerkmann RM, McBride AW, Dunn JS, et 

al. A comparison of anticipatory and 

postprocedure pain perception in patients who 

undergo urodynamic procedures. Am J Obstet 

Gynecol 2004 Apr; 190(4):1034-8. Not 

eligible outcomes 

1234. Elliott DS, Boone TB. Is fascia lata allograft 

material trustworthy for pubovaginal sling 

repair? Urology 2000 Nov 1; 56(5):772-6. 

Case-series 

1235. Ellsworth PI, Webb HW, Crump JM, et al. 

The Malone antegrade colonic enema 

enhances the quality of life in children 

undergoing urological incontinence 

procedures. J Urol 1996 Apr; 155(4):1416-8. 

Not eligible target population 
B-56 

1236. Ellul J, Watkins C, Barer D. Estimating total 

Barthel scores from just three items: the 

European Stroke Database 'minimum dataset' 

for assessing functional status at discharge 

from hospital. Age Ageing 1998 Mar; 

27(2):115-22. Not eligible exposure 

1237. Elsergany R, Elgamasy AN, Ghoniem GM. 

Transurethral collagen injection for female 

stress incontinence. Int Urogynecol J Pelvic 

Floor Dysfunct 1998; 9(1):13-8. Not eligible 

target population 

1238. Elsergany R, Ghoniem GM. Collagen 

injection for intrinsic sphincteric deficiency in 

men: a reasonable option in selected patients. 

J Urol 1998 May; 159(5):1504-6. Not eligible 

target population 

1239. Elsharaby M, Abo-Farha O, Rasheed M, et al. 

A new technique for treatment of simple postprostatectomy urinary incontinence: 

preliminary experience. J Urol 1996 Dec; 

156(6):1972-4. Case-series 

1240. El-Sibai O, Shafik AA. Cauterizationplication operation in the treatment of 

complete rectal prolapse. Tech Coloproctol 

2002 Apr; 6(1):51-4; discussion 4. Case-series 

1241. Elton C, Stoodley BJ. Anterior anal sphincter 

repair: results in a district general hospital. 

Ann R Coll Surg Engl 2002 Sep; 84(5):321-4. 

Case-series 

1242. el-Toukhy TA, Davies AE. The efficacy of 

laparoscopic mesh colposuspension: results of 

a prospective controlled study. BJU Int 2001 

Sep; 88(4):361-6. Not eligible target 

population 

1243. El-Toukhy TA, Hefni M, Davies A, et al. The 

effect of different types of hysterectomy on 

urinary and sexual functions: a prospective 

study. J Obstet Gynaecol 2004 Jun; 24(4):420-

5. Not eligible level of evidence 

1244. Elzevier HW, Venema PL, Lycklama a 

Nijeholt AA. Sexual function after tensionfree vaginal tape (TVT) for stress 

incontinence: results of a mailed 

questionnaire. Int Urogynecol J Pelvic Floor 

Dysfunct 2004 Sep-Oct; 15(5):313-8. Not 

eligible outcomes 

1245. Emblem R, Dhaenens G, Stien R, et al. The 

importance of anal endosonography in the 

evaluation of idiopathic fecal incontinence. 

Dis Colon Rectum 1994 Jan; 37(1):42-8. Not 

eligible outcomes 

1246. Emir L, Erol D, Ak H, et al. A new technique 

combining both polypropylene and vaginal 

wall sling procedures: can it minimize the risk 

of urethral and vaginal erosion occurring with 

synthetic materials? World J Urol 2005 Jul; 

23(3):221-4. Case-series 

1247. Emiroglu R, Karakayall H, Sevmis S, et al. 

Urologic complications in 1275 consecutive 

renal transplantations. Transplant Proc 2001 

Feb-Mar; 33(1-2):2016-7. Not eligible level of 

evidence 

1248. Enck P, Daublin G, Lubke HJ, et al. Longterm efficacy of biofeedback training for fecal 

incontinence. Dis Colon Rectum 1994 Oct; 

37(10):997-1001. Case-series 

1249. Engberg S, McDowell BJ, Donovan N, et al. 

Treatment of urinary incontinence in 

homebound older adults: interface between 

research and practice. Ostomy Wound 

Manage 1997 Nov-Dec; 43(10):18-22, 4-6. No 

associative hypothesis tested 

1250. Engberg S, McDowell BJ, Weber E, et al. 

Assessment and management of urinary 

incontinence among homebound older adults: 

a clinical trial protocol. Adv Pract Nurs Q 

1997 Fall; 3(2):48-56. No associative 

hypothsis tested 

1251. Engberg SJ, Bender MA, Stilley CS. Kegels 

and communication. Am J Nurs 2003 Jul; 

103(7):93-4. Case- Reports 

1252. Engberg SJ, McDowell BJ, Burgio KL, et al. 

Self-care behaviors of older women with 

urinary incontinence. J Gerontol Nurs 1995 

Aug; 21(8):7-14. Not eligible outcomes 

1253. Engberg SJ, Organist L, Lafayette-Lucey A, et 

al. Treatment of urinary incontinence among 

caregiver-dependent adults. Urol Nurs 1998 

Jun; 18(2):131-6, 55. No associative 

hypothesis tested 

1254. Engel AF, Brummelkamp WH. Secondary 

surgery after failed postanal or anterior 

sphincter repair. Int J Colorectal Dis 1994; 

9(4):187-90. Case-series 

1255. Engel AF, Kamm MA. The acute effect of 

straining on pelvic floor neurological function. 

Int J Colorectal Dis 1994 Apr; 9(1):8-12. Not 

eligible outcomes 

1256. Engel AF, Kamm MA, Bartram CI. Unwanted 

anal penetration as a physical cause of faecal 

incontinence. Eur J Gastroenterol Hepatol 

1995 Jan; 7(1):65-7. Case Reports 

1257. Engel AF, Kamm MA, Bartram CI, et al. 

Relationship of symptoms in faecal 

incontinence to specific sphincter 

abnormalities. Int J Colorectal Dis 1995; 

10(3):152-5. Not eligible outcomes 
B-57 

1258. Engel AF, Kamm MA, Sultan AH, et al. 

Anterior anal sphincter repair in patients with 

obstetric trauma. Br J Surg 1994 Aug; 

81(8):1231-4. Case-series 

1259. Engel AF, Kamm MA, Talbot IC. Progressive 

systemic sclerosis of the internal anal 

sphincter leading to passive faecal 

incontinence. Gut 1994 Jun; 35(6):857-9. 

Case Reports 

1260. Engel AF, Lunniss PJ, Kamm MA, et al. 

Sphincteroplasty for incontinence after 

surgery for idiopathic fistula in ano. Int J 

Colorectal Dis 1997; 12(6):323-5. Case-series 

1261. Engel AF, van Baal SJ, Brummelkamp WH. 

Late results of anterior sphincter plication for 

traumatic faecal incontinence. Eur J Surg 1994 

Nov; 160(11):633-6. Case-series 

1262. Engel AF, van Baal SJ, Brummelkamp WH. 

Late results of postanal repair for idiopathic 

faecal incontinence. Eur J Surg 1994 Nov; 

160(11):637-40. Case-series 

1263. Engel BT, Burgio LD, McCormick KA, et al. 

Behavioral treatment of incontinence in the 

long-term care setting. J Am Geriatr Soc 1990 

Mar; 38(3):361-3. No associative hypothesis 

tested 

1264. Engel JD, Jacobs D, Konsur B, et al. 

Urodynamic evaluation of the human bladder 

response to an increase in outlet resistance. 

Neurourol Urodyn 2002; 21(6):524-8. Caseseries 

1265. Engst C, Chhokar R, Robinson D, et al. 

Implementation of a scheduled toileting 

program in a long term care facility: 

evaluating the impact on injury risk to 

caregiving staff. Aaohn J 2004 Oct; 

52(10):427-35. Not eligible outcomes 

1266. Engstrom G, Henningsohn L, Steineck G, et 

al. Self-assessed health, sadness and happiness 

in relation to the total burden of symptoms 

from the lower urinary tract. BJU Int 2005 

Apr; 95(6):810-5. Not eligible outcomes 

1267. Engstrom G, Walker-Engstrom ML, 

Henningsohn L, et al. Prevalence of distress 

and symptom severity from the lower urinary 

tract in men: a population-based study with 

the DAN-PSS questionnaire. Fam Pract 2004 

Dec; 21(6):617-22. Not eligible outcomes 

1268. Enriquez-Navascues JM, Devesa-Mugica JM. 

Traumatic anal incontinence. Role of 

unilateral gluteus maximus transposition 

supplementing and supporting direct anal 

sphincteroplasty. Dis Colon Rectum 1994 

Aug; 37(8):766-9. Case-reports 

1269. Enzelsberger H, Helmer H, Kurz C. 

Intravesical instillation of oxybutynin in 

women with idiopathic detrusor instability: a 

randomised trial. Br J Obstet Gynaecol 1995 

Nov; 102(11):929-30. Not eligible exposure 

1270. Enzelsberger H, Helmer H, Schatten C. 

Comparison of Burch and lyodura sling 

procedures for repair of unsuccessful 

incontinence surgery. Obstet Gynecol 1996 

Aug; 88(2):251-6. Not eligible target 

population 

1271. Epanomeritakis E, Koutsoumbi P, Tsiaoussis 

I, et al. Impairment of anorectal function in 

diabetes mellitus parallels duration of disease. 

Dis Colon Rectum 1999 Nov; 42(11):1394-

400. Not eligible outcomes 

1272. Erata YE, Kilic B, Guclu S, et al. Risk factors 

for pelvic surgery. Arch Gynecol Obstet 2002 

Nov; 267(1):14-8. Not eligible level of 

evidence 

1273. Erickson DR. Glomerulations in women with 

urethral sphincter deficiency: report of 2 cases 

[corrected]. J Urol 1995 Mar; 153(3 Pt 1):728-

9. Case Reports 

1274. Eriksen BC, Hagen B, Eik-Nes SH, et al. 

Long-term effectiveness of the Burch 

colposuspension in female urinary stress 

incontinence. Acta Obstet Gynecol Scand 

1990; 69(1):45-50. Case-series 

1275. Eriksen BC, Sandvik H, Hunskaar S. 

Management of urinary incontinence in 

gynecological practice in Norway. Acta 

Obstet Gynecol Scand 1990; 69(6):515-9. Not 

eligible target population 

1276. Ertunc D, Tok EC, Pata O, et al. Is stress 

urinary incontinence a familial condition? 

Acta Obstet Gynecol Scand 2004 Oct; 

83(10):912-6. Not eligible level of evidence 

1277. Eterovic D, Strinic T, Dujic Z, et al. Blood 

gases and sex hormones in women with and 

without genital descensus. Respiration 1999; 

66(5):400-6. Not eligible outcomes 

1278. Ethans KD, Nance PW, Bard RJ, et al. 

Efficacy and safety of tolterodine in people 

with neurogenic detrusor overactivity. J Spinal 

Cord Med 2004; 27(3):214-8. Not eligible 

exposure 

1279. Etus V, Akansel G, Ilbay K, et al. Multiple 

sclerosis and coexisting intradural 

extramedullary spinal cord tumour: a case 

report. Neurol Sci 2002 Sep; 23(3):119-22. 

Case Reports 

1280. Evans D. Discreet products for women with 

urinary incontinence. Nurs Times 2005 May 

3-9; 101(18):56-7, 9. Case-reports 
B-58 

1281. Evans D. Lifestyle solutions for men with 

continence problems. Nurs Times 2005 Jan 

11-17; 101(2):61-2, 4. Case-reports 

1282. Evans JW, Christmas TJ. Detrusor instability 

following colchicine therapy. Br J Urol 1991 

May; 67(5):552-4. Case Reports 

1283. Evans RW, Nasir N, Jr. Case report: Dr. 

Lecter's convulsive syncope. MedGenMed 

2001 Oct 1; 3(5):7. Case Reports 

1284. Everaert K, De Ridder D, Baert L, et al. 

Patient satisfaction and complications 

following sacral nerve stimulation for urinary 

retention, urge incontinence and perineal pain: 

a multicenter evaluation. Int Urogynecol J 

Pelvic Floor Dysfunct 2000; 11(4):231-5; 

discussion 6. Not eligible target population 

1285. Everaert K, Derie A, Van Laere M, et al. 

Bilateral S3 nerve stimulation, a minimally 

invasive alternative treatment for 

postoperative stress incontinence after 

implantation of an anterior root stimulator 

with posterior rhizotomy: a preliminary 

observation. Spinal Cord 2000 Apr; 

38(4):262-4. Case Reports 

1286. Eyman RK, Grossman HJ, Chaney RH, et al. 

The life expectancy of profoundly 

handicapped people with mental retardation. 

N Engl J Med 1990 Aug 30; 323(9):584-9. 

Not eligible outcomes 

1287. Ezzat IM. Sling operations in the treatment of 

stress urinary incontinence: how to adjust 

sling tension. J Obstet Gynaecol Res 2003 

Dec; 29(6):374-9. Case-series 

1288. Ezzat MI. Abdomino-perineal approach for 

management of traumatic strictured posterior 

urethra. Int Urol Nephrol 1990; 22(5):447-53. 

Case-series 

1289. Fader M, Clarke-O'Neill S, Cook D, et al. 

Management of night-time urinary 

incontinence in residential settings for older 

people: an investigation into the effects of 

different pad changing regimes on skin health. 

J Clin Nurs 2003 May; 12(3):374-86. Not 

eligible outcomes 

1290. Fader M, Moore KN, Cottenden AM, et al. 

Coated catheters for intermittent 

catheterization: smooth or sticky? BJU Int 

2001 Sep; 88(4):373-7. Not eligible outcomes 

1291. Fader M, Pettersson L, Dean G, et al. Sheaths 

for urinary incontinence: a randomized 

crossover trial. BJU Int 2001 Sep; 88(4):367-

72. Not eligible outcomes 

1292. Faerber GJ. Endoscopic collagen injection 

therapy in elderly women with type I stress 

urinary incontinence. J Urol 1996 Feb; 

155(2):512-4. Not eligible target population 

1293. Faerber GJ. Urethral diverticulectomy and 

pubovaginal sling for simultaneous treatment 

of urethral diverticulum and intrinsic sphincter 

deficiency. Tech Urol 1998 Dec; 4(4):192-7. 

Case-series 

1294. Faerber GJ, Richardson TD. Long-term results 

of transurethral collagen injection in men with 

intrinsic sphincter deficiency. J Endourol 1997 

Aug; 11(4):273-7. Case-series 

1295. Fahn S, Brin MF, Dwork AJ, et al. Case 1, 

1996: rapidly progressive parkinsonism, 

incontinence, impotency, and levodopainduced moaning in a patient with multiple 

myeloma. Mov Disord 1996 May; 11(3):298-

310. Case Reports 

1296. Fainsinger RL, MacEachern T, Hanson J, et 

al. The use of urinary catheters in terminally 

ill cancer patients. J Pain Symptom Manage 

1992 Aug; 7(6):333-8. Case-series 

1297. Falconer C, Blomgren B, Johansson O, et al. 

Different organization of collagen fibrils in 

stress-incontinent women of fertile age. Acta 

Obstet Gynecol Scand 1998 Jan; 77(1):87-94. 

Not eligible outcomes 

1298. Falconer C, Ekman-Ordeberg G, Blomgren B, 

et al. Paraurethral connective tissue in stressincontinent women after menopause. Acta 

Obstet Gynecol Scand 1998 Jan; 77(1):95-

100. Not eligible outcomes 

1299. Falconer C, Soderberg M, Blomgren B, et al. 

Influence of different sling materials on 

connective tissue metabolism in stress urinary 

incontinent women. Int Urogynecol J Pelvic 

Floor Dysfunct 2001; 12 Suppl 2:S19-23. 

Case-series 

1300. Falconio MA, Kokoszka JS, Prasad ML. 

Anorectal manometry. Gastroenterol Nurs 

1992 Dec; 15(3):110-3. Not eligible outcomes 

1301. Falk PM, Blatchford GJ, Cali RL, et al. 

Transanal ultrasound and manometry in the 

evaluation of fecal incontinence. Dis Colon 

Rectum 1994 May; 37(5):468-72. Question 4 

1302. Falkert A, Seelbach-Gobel B. TVT versus 

TOT for surgical treatment of female stress 

urinary incontinence. Int J Gynaecol Obstet 

2007 Jan; 96(1):40-1. Comment 

1303. Fall M, Geirsson G. Positive ice-water test: a 

predictor of neurological disease? World J 

Urol 1996; 14 Suppl 1:S51-4. Case Reports 

1304. Faltin DL, Boulvain M, Irion O, et al. 

Diagnosis of anal sphincter tears by 

postpartum endosonography to predict fecal 

incontinence. Obstet Gynecol 2000 May; 

95(5):643-7. Not eligible outcomes 
B-59 

1305. Fantin AC, Hetzer FH, Christ AD, et al. 

Influence of stapler haemorrhoidectomy on 

anorectal function and on patients' acceptance. 

Swiss Med Wkly 2002 Jan 26; 132(3-4):38-

42. Case-series 

1306. Farag A. Use of the Hagen-Poiseuille law: a 

new mathematical approach for the integration 

and evaluation of anorectal physiological 

testing in patients with faecal incontinence 

and pelvic dyschezia and in normal controls. 

Eur Surg Res 1998; 30(4):279-89. Not eligible 

outcomes 

1307. Faria CA, Sartori MG, Baracat EC, et al. 

Effects of tamoxifen on Doppler velocimetry 

parameters of periurethral vessels in 

postmenopausal women. Int Urogynecol J 

Pelvic Floor Dysfunct 2005 Jan-Feb; 

16(1):56-9; discussion 9. Not eligible 

outcomes 

1308. Farid M, Moneim HA, Mahdy T, et al. 

Augmented unilateral gluteoplasty with fascia 

lata graft in fecal incontinence. Tech 

Coloproctol 2003 Apr; 7(1):23-8; discussion 

8. Case-series 

1309. Faridi A, Willis S, Schelzig P, et al. Anal 

sphincter injury during vaginal delivery--an 

argument for cesarean section on request? J 

Perinat Med 2002; 30(5):379-87. Case-series 

1310. Farouk R, Bartolo DC. The clinical 

contribution of integrated laboratory and 

ambulatory anorectal physiology assessment 

in faecal incontinence. Int J Colorectal Dis 

1993 Jul; 8(2):60-5. Not eligible outcomes 

1311. Farouk R, Bartolo DC. The use of 

endoluminal ultrasound in the assessment of 

patients with faecal incontinence. J R Coll 

Surg Edinb 1994 Oct; 39(5):312-8. Caseseries 

1312. Farouk R, Drew PJ, Duthie GS, et al. 

Disruption of the internal anal sphincter can 

occur after transanal stapling. Br J Surg 1996 

Oct; 83(10):1400. Case-series 

1313. Farouk R, Duthie GS, Bartolo DC. Recovery 

of the internal anal sphincter and continence 

after restorative proctocolectomy. Br J Surg 

1994 Jul; 81(7):1065-8. Case-series 

1314. Farouk R, Duthie GS, Bartolo DC, et al. 

Restoration of continence following rectopexy 

for rectal prolapse and recovery of the internal 

anal sphincter electromyogram. Br J Surg 

1992 May; 79(5):439-40. Case-series 

1315. Farouk R, Duthie GS, MacGregor AB, et al. 

Evidence of electromechanical dissociation of 

the internal anal sphincter in idiopathic fecal 

incontinence. Dis Colon Rectum 1994 Jun; 

37(6):595-601. Not eligible outcomes 

1316. Farouk R, Duthie GS, MacGregor AB, et al. 

Rectoanal inhibition and incontinence in 

patients with rectal prolapse. Br J Surg 1994 

May; 81(5):743-6. Not eligible outcomes 

1317. Farouk R, Duthie GS, Pryde A, et al. Internal 

anal sphincter dysfunction in neurogenic 

faecal incontinence. Br J Surg 1993 Feb; 

80(2):259-61. Not eligible outcomes 

1318. Farouk R, Pemberton JH, Wolff BG, et al. 

Functional outcomes after ileal pouch-anal 

anastomosis for chronic ulcerative colitis. Ann 

Surg 2000 Jun; 231(6):919-26. Not eligible 

level of evidence 

1319. Farrell SA, Baydock S, Amir B, et al. 

Effectiveness of a new self-positioning 

pessary for the management of urinary 

incontinence in women. Am J Obstet Gynecol 

2007 May; 196(5):474 e1-8. Case-series 

1320. Farrell TA, Wallace M, Hicks ME. Long-term 

results of transrenal ureteral occlusion with 

use of Gianturco coils and gelatin sponge 

pledgets. J Vasc Interv Radiol 1997 May-Jun; 

8(3):449-52. Case-series 

1321. Faucheron JL, Bost R, Duffournet V, et al. 

Sacral neuromodulation in the treatment of 

severe anal incontinence. Forty consecutive 

cases treated in one institution. Gastroenterol 

Clin Biol 2006 May; 30(5):669-72. Caseseries 

1322. Faucheron JL, Hannoun L, Thome C, et al. Is 

fecal continence improved by nonstimulated 

gracilis muscle transposition? Dis Colon 

Rectum 1994 Oct; 37(10):979-83. Not eligible 

target population 

1323. Faundes A, Guarisi T, Pinto-Neto AM. The 

risk of urinary incontinence of parous women 

who delivered only by cesarean section. Int J 

Gynaecol Obstet 2001 Jan; 72(1):41-6. Not 

eligible level of evidence 

1324. Fazio VW, O'Riordain MG, Lavery IC, et al. 

Long-term functional outcome and quality of 

life after stapled restorative proctocolectomy. 

Ann Surg 1999 Oct; 230(4):575-84; 

discussion 84-6. Not eligible target population 

1325. Fazio VW, Tjandra JJ. Transanal 

mucosectomy. Ileal pouch advancement for 

anorectal dysplasia or inflammation after 

restorative proctocolectomy. Dis Colon 

Rectum 1994 Oct; 37(10):1008-11. CaseReports 

1326. Fehrmann-Zumpe P, Karbe K, Blessman G. 

Using flavoxate as primary medication for 

patients suffering from urge symptomatology. 

Int Urogynecol J Pelvic Floor Dysfunct 1999; 

10(2):91-5. Case-series 
B-60 

1327. Feigenberg SJ, Lee WR, Desilvio ML, et al. 

Health-related quality of life in men receiving 

prostate brachytherapy on RTOG 98-05. Int J 

Radiat Oncol Biol Phys 2005 Jul 15; 

62(4):956-64. Case-series 

1328. Feldman EL, Jaffe A, Galambos N, et al. 

Clinical practice guidelines on depression: 

awareness, attitudes, and content knowledge 

among family physicians in New York. Arch 

Fam Med 1998 Jan-Feb; 7(1):58-62. 

Guideline 

1329. Feldner PC, Jr., Kati LM, Sartori MG, et al. 

Sulfated glycosaminoglycans of the 

periurethral tissue in women with and without 

stress urinary incontinence, according to 

genital prolapse stage. Eur J Obstet Gynecol 

Reprod Biol 2006 Jun 1; 126(2):250-4. Caseseries 

1330. Felt-Bersma RJ, Cuesta MA, Koorevaar M. 

Anal sphincter repair improves anorectal 

function and endosonographic image. A 

prospective clinical study. Dis Colon Rectum 

1996 Aug; 39(8):878-85. Case-series 

1331. Felt-Bersma RJ, Cuesta MA, Koorevaar M, et 

al. Anal endosonography: relationship with 

anal manometry and neurophysiologic tests. 

Dis Colon Rectum 1992 Oct; 35(10):944-9. 

Not eligible outcomes 

1332. Felt-Bersma RJ, Klinkenberg-Knol EC, 

Meuwissen SG. Anorectal function 

investigations in incontinent and continent 

patients. Differences and discriminatory value. 

Dis Colon Rectum 1990 Jun; 33(6):479-85; 

discussion 85-6. Not eligible outcomes 

1333. Felt-Bersma RJ, Poen AC, Cuesta MA, et al. 

Anal sensitivity test: what does it measure and 

do we need it? Cause or derivative of 

anorectal complaints. Dis Colon Rectum 1997 

Jul; 40(7):811-6. Not eligible outcomes 

1334. Felt-Bersma RJ, Sloots CE, Poen AC, et al. 

Rectal compliance as a routine measurement: 

extreme volumes have direct clinical impact 

and normal volumes exclude rectum as a 

problem. Dis Colon Rectum 2000 Dec; 

43(12):1732-8. Not eligible outcomes 

1335. Felt-Bersma RJ, van Baren R, Koorevaar M, 

et al. Unsuspected sphincter defects shown by 

anal endosonography after anorectal surgery. 

A prospective study. Dis Colon Rectum 1995 

Mar; 38(3):249-53. Not eligible outcomes 

1336. Feneley MR, Walsh PC. Incontinence after 

radical prostatectomy. Lancet 1999 Jun 19; 

353(9170):2091-2. Comment 

1337. Fengler SA, Pearl RK, Prasad ML, et al. 

Management of recurrent rectal prolapse. Dis 

Colon Rectum 1997 Jul; 40(7):832-4. 

1338. Fenig DM, Slova D, Lepor H. Postoperative 

blood loss predicts the development of urinary 

extravasation on cystogram following radical 

retropubic prostatectomy. J Urol 2006 Jan; 

175(1):146-50; discussion 50. Not eligible 

outcomes 

1339. Fenn N, Conn IG, German KA, et al. 

Complications of clam enterocystoplasty with 

particular reference to urinary tract infection. 

Br J Urol 1992 Apr; 69(4):366-8. Case-series 

1340. Feretis C, Benakis P, Dailianas A, et al. 

Implantation of microballoons in the 

management of fecal incontinence. Dis Colon 

Rectum 2001 Nov; 44(11):1605-9. Not 

eligible target population 

1341. Ferland RD, Rosenblatt P. Ureteral 

compromise after laparoscopic Burch 

colpopexy. J Am Assoc Gynecol Laparosc 

1999 May; 6(2):217-9. Case- Reports 

1342. Fernandez-Fraga X, Azpiroz F, Aparici A, et 

al. Predictors of response to biofeedback 

treatment in anal incontinence. Dis Colon 

Rectum 2003 Sep; 46(9):1218-25. Case-series 

1343. Fernandez-Fraga X, Azpiroz F, Malagelada 

JR. Significance of pelvic floor muscles in 

anal incontinence. Gastroenterology 2002 

Nov; 123(5):1441-50. Not eligible outcomes 

1344. Ferrara A, De Jesus S, Gallagher JT, et al. 

Time-related decay of the benefits of 

biofeedback therapy. Tech Coloproctol 2001 

Dec; 5(3):131-5. Case-series 

1345. Ferrara A, Lujan JH, Cebrian J, et al. Clinical, 

manometric, and EMG characteristics of 

patients with fecal incontinence. Tech 

Coloproctol 2001 Apr; 5(1):13-8. Not eligible 

outcomes 

1346. Ferrara A, Pemberton JH, Grotz RL, et al. 

Motor determinants of incontinence after ileal 

pouch-anal anastomosis. Br J Surg 1994 Feb; 

81(2):285-8. Not eligible outcomes 

1347. Ferrari A, Frigerio L. The triangular vaginal 

patch sling for stress urinary incontinence and 

hypermobile urethra. Am J Obstet Gynecol 

1997 Dec; 177(6):1426-31. Case-series 

1348. Fialkow MF, Lentz GM, Miller EA, et al. 

Complications from transvaginal pubovaginal 

slings using bone anchor fixation. Urology 

2004 Dec; 64(6):1127-32. Case-series 

1349. Ficarra V, Novara G, Galfano A, et al. 

Twelve-month self-reported quality of life 

after retropubic radical prostatectomy: a 

prospective study with Rand 36-Item Health 

Survey (Short Form-36). BJU Int 2006 Feb; 

97(2):274-8. Not eligible outcomes 
B-61 

1350. Fichera A, Michelassi F. Long-term 

prospective assessment of functional results 

after proctectomy with coloanal anastomosis. 

J Gastrointest Surg 2001 Mar-Apr; 5(2):153-7. 

Case-series 

1351. Fielding JR. Practical MR imaging of female 

pelvic floor weakness. Radiographics 2002 

Mar-Apr; 22(2):295-304. No associative 

hypothesis tested 

1352. Fielding JR, Dumanli H, Schreyer AG, et al. 

MR-based three-dimensional modeling of the 

normal pelvic floor in women: quantification 

of muscle mass. AJR Am J Roentgenol 2000 

Mar; 174(3):657-60. Not eligible outcomes 

1353. Fielding JR, Griffiths DJ, Versi E, et al. MR 

imaging of pelvic floor continence 

mechanisms in the supine and sitting 

positions. AJR Am J Roentgenol 1998 Dec; 

171(6):1607-10. Not eligible exposure 

1354. Fielding JR, Lee JH, Dubeau CE, et al. 

Voiding cystourethrography findings in 

elderly women with urge incontinence. J Urol 

2000 Apr; 163(4):1216-8. Not eligible 

outcomes 

1355. Fielding JR, Versi E, Mulkern RV, et al. MR 

imaging of the female pelvic floor in the 

supine and upright positions. J Magn Reson 

Imaging 1996 Nov-Dec; 6(6):961-3. Not 

eligible target population 

1356. Figueroa TE, Sabogal L, Helal M, et al. The 

tapered and reimplanted small bowel as a 

variation of the Mitrofanoff procedure: 

preliminary results. J Urol 1994 Jul; 

152(1):73-5. Case-series 

1357. Filiz TM, Uludag C, Cinar N, et al. Risk 

factors for urinary incontinence in Turkish 

women. A cross-sectional study. Saudi Med J 

2006 Nov; 27(11):1688-92. Not eligible level 

of evidence 

1358. Fink D, Perucchini D, Schaer GN, et al. The 

role of the frequency-volume chart in the 

differential diagnostic of female urinary 

incontinence. Acta Obstet Gynecol Scand 

1999 Mar; 78(3):254-7. Not eligible outcomes 

1359. Fink RL, Roberts LJ, Scott M. The role of 

manometry, electromyography and radiology 

in the assessment of faecal incontinence. Aust 

N Z J Surg 1992 Dec; 62(12):951-8. Not 

eligible outcomes 

1360. Finkelstein MM, Skelly J, Kaczorowski J, et 

al. Incontinence Quality of Life Instrument in 

a survey of primary care physicians. J Fam 

Pract 2002 Nov; 51(11):952. Not eligible level 

of evidence 

1361. Fiori M, Gunelli R, Mercuriali M, et al. 

Tension-free vaginal tape and female stress 

incontinence: further evidence of 

effectiveness. Urol Int 2004; 72(4):325-8. 

Case-series 

1362. Fischer JR, Berg PH. Urinary incontinence in 

United States Air Force female aircrew. 

Obstet Gynecol 1999 Oct; 94(4):532-6. Not 

eligible level of evidence 

1363. Fischer MC, Huckabay C, Nitti VW. The male 

perineal sling: assessment and prediction of 

outcome. J Urol 2007 Apr; 177(4):1414-8. 

Case-series 

1364. Fischer W, Baessler K. Postpartum pelvic 

floor conditioning using vaginal cones: not 

only for prophylaxis against urinary 

incontinence and descensus. Int Urogynecol J 

Pelvic Floor Dysfunct 1996; 7(4):208-14. 

Case-series 

1365. Fischer W, Linde A. Pelvic floor findings in 

urinary incontinence--results of conditioning 

using vaginal cones. Acta Obstet Gynecol 

Scand 1997 May; 76(5):455-60. Not eligible 

target population 

1366. Fisher K, Riolo L. What is the evidence 

regarding specific methods of pelvic floor 

exercise for a patient with urinary stress 

incontinence and mild anterior wall prolapse? 

Phys Ther 2004 Aug; 84(8):744-53. Review 

1367. Fishman IJ, Scott FB. Pregnancy in patients 

with the artificial urinary sphincter. J Urol 

1993 Aug; 150(2 Pt 1):340-1. Case-series 

1368. Fishwick JE, Gough DC, O'Flynn KJ. The 

Mitrofanoff procedure: does it last? BJU Int 

2000 Mar; 85(4):496-7. Case-series 

1369. Fitzgerald JF, Smith DM, Martin DK, et al. 

Replication of the multidimensionality of 

activities of daily living. J Gerontol 1993 Jan; 

48(1):S28-31. Not eligible outcomes 

1370. Fitzgerald MP, Ayuste D, Brubaker L. How 

do urinary diaries of women with an 

overactive bladder differ from those of 

asymptomatic controls? BJU Int 2005 Aug; 

96(3):365-7. Not eligible outcomes 

1371. FitzGerald MP, Blazek B, Brubaker L. 

Complex repetitive discharges during urethral 

sphincter EMG: clinical correlates. Neurourol 

Urodyn 2000; 19(5):577-83. Not eligible 

outcomes 

1372. FitzGerald MP, Kenton K, Shott S, et al. 

Responsiveness of quality of life 

measurements to change after reconstructive 

pelvic surgery. Am J Obstet Gynecol 2001 

Jul; 185(1):20-4. Not eligible outcomes 
B-62 

1373. Fitzgerald MP, Mollenhauer J, Brubaker L. 

Failure of allograft suburethral slings. BJU Int 

1999 Nov; 84(7):785-8. Case-series 

1374. FitzGerald MP, Russell B, Hale D, et al. 

Ultrastructure of detrusor and urethral smooth 

muscle in women with urinary incontinence. 

Am J Obstet Gynecol 2000 Apr; 182(4):879-

84. Not eligible outcomes 

1375. Fitzgerald MP, Thom DH, Wassel-Fyr C, et 

al. Childhood urinary symptoms predict adult 

overactive bladder symptoms. J Urol 2006 

Mar; 175(3 Pt 1):989-93. Not eligible 

outcomes 

1376. Fitzgerald MP, Weber AM, Howden N, et al. 

Risk factors for anal sphincter tear during 

vaginal delivery. Obstet Gynecol 2007 Jan; 

109(1):29-34. Not eligible level of evidence 

1377. Fitzgerald ST, Palmer MH, Berry SJ, et al. 

Urinary incontinence. Impact on working 

women. Aaohn J 2000 Mar; 48(3):112-8. Not 

eligible level of evidence 

1378. Fitzgerald ST, Palmer MH, Kirkland VL, et al. 

The impact of urinary incontinence in working 

women: a study in a production facility. 

Women Health 2002; 35(1):1-16. Not eligible 

level of evidence 

1379. Fitzpatrick M, Fynes M, Cassidy M, et al. 

Prospective study of the influence of parity 

and operative technique on the outcome of 

primary anal sphincter repair following 

obstetrical injury. Eur J Obstet Gynecol 

Reprod Biol 2000 Apr; 89(2):159-63. Not 

eligible outcomes 

1380. Fleishman R, Heilbrun G, Mandelson J, et al. 

Improving the quality of institutional care of 

urinary incontinence among the elderly: a 

challenge for governmental regulation. Int J 

Health Care Qual Assur Inc Leadersh Health 

Serv 1999; 12(2-3):105-19. Not eligible level 

of evidence 

1381. Fleshman JW, Dreznik Z, Fry RD, et al. Anal 

sphincter repair for obstetric injury: 

manometric evaluation of functional results. 

Dis Colon Rectum 1991 Dec; 34(12):1061-7. 

Case-series 

1382. Fleshman JW, Peters WR, Shemesh EI, et al. 

Anal sphincter reconstruction: anterior 

overlapping muscle repair. Dis Colon Rectum 

1991 Sep; 34(9):739-43. Case-series 

1383. Fleshner N, Herschorn S. The artificial urinary 

sphincter for post-radical prostatectomy 

incontinence: impact on urinary symptoms 

and quality of life. J Urol 1996 Apr; 

155(4):1260-4. Case-series 

1384. Fletcher JG, Busse RF, Riederer SJ, et al. 

Magnetic resonance imaging of anatomic and 

dynamic defects of the pelvic floor in 

defecatory disorders. Am J Gastroenterol 2003 

Feb; 98(2):399-411. No associative hypothesis 

tested 

1385. Flood HD, Malhotra SJ, O'Connell HE, et al. 

Long-term results and complications using 

augmentation cystoplasty in reconstructive 

urology. Neurourol Urodyn 1995; 14(4):297-

309. Case-series 

1386. Flynn L, Cell P, Luisi E. Effectiveness of 

pelvic muscle exercises in reducing urge 

incontinence among community residing 

elders. J Gerontol Nurs 1994 May; 20(5):23-7. 

Comment 

1387. Flynn MK, Webster GD, Amundsen CL. The 

effect of botulinum-A toxin on patients with 

severe urge urinary incontinence. J Urol 2004 

Dec; 172(6 Pt 1):2316-20. Not eligible target 

population 

1388. Fokdal L, Honore H, Hoyer M, et al. Dosevolume histograms associated to long-term 

colorectal functions in patients receiving 

pelvic radiotherapy. Radiother Oncol 2005 

Feb; 74(2):203-10. Case-series 

1389. Foldspang A, Mommsen S. Adult female 

urinary incontinence and childhood 

bedwetting. J Urol 1994 Jul; 152(1):85-8. Not 

eligible exposure 

1390. Foldspang A, Mommsen S. The International 

Continence Society (ICS) incontinence 

definition: is the social and hygienic aspect 

appropriate for etiologic research? J Clin 

Epidemiol 1997 Sep; 50(9):1055-60. Not 

eligible level of evidence 

1391. Foley CL, Bott SR, Thomas K, et al. A large 

prostate at radical retropubic prostatectomy 

does not adversely affect cancer control, 

continence or potency rates. BJU Int 2003 

Sep; 92(4):370-4. Case Series 

1392. Fonda D. Improving management of urinary 

incontinence in geriatric centres and nursing 

homes. Victorian Geriatricians Peer Review 

Group. Aust Clin Rev 1990; 10(2):66-71. Not 

eligible level of evidence 

1393. Fonda D, Woodward M, D'Astoli M, et al. 

Sustained improvement of subjective quality 

of life in older community-dwelling people 

after treatment of urinary incontinence. Age 

Ageing 1995 Jul; 24(4):283-6. No associative 

hypothesis tested 
B-63 

1394. Fontaine E, Ben Mouelli S, Thomas L, et al. 

Urinary continence after salvage radiation 

therapy following radical prostatectomy, 

assessed by a self-administered questionnaire: 

a prospective study. BJU Int 2004 Sep; 

94(4):521-3. Case-Series 

1395. Fontaine E, Bendaya S, Desert JF, et al. 

Combined modified rectus fascial sling and 

augmentation ileocystoplasty for neurogenic 

incontinence in women. J Urol 1997 Jan; 

157(1):109-12. Case-series 

1396. Fontaine E, Hajri M, Rhein F, et al. 

Reappraisal of endoscopic sphincterotomy for 

post-traumatic neurogenic bladder: a 

prospective study. J Urol 1996 Jan; 

155(1):277-80. Case-series 

1397. Fontaine E, Izadifar V, Barthelemy Y, et al. 

Urinary continence following radical 

prostatectomy assessed by a self-administered 

questionnaire. Eur Urol 2000 Feb; 37(2):223-

7. Case-series 

1398. Forbat L. Listening to carers talking about the 

subjects of continence and toileting. Nurs 

Times 2004 Jan 13-19; 100(2):46-9. Not 

eligible target population 

1399. Foreman MD, Theis SL, Anderson MA. 

Adverse events in the hospitalized elderly. 

Clin Nurs Res 1993 Aug; 2(3):360-70. Caseseries 

1400. Formenti SC, Lieskovsky G, Simoneau AR, et 

al. Impact of moderate dose of postoperative 

radiation on urinary continence and potency in 

patients with prostate cancer treated with 

nerve sparing prostatectomy. J Urol 1996 Feb; 

155(2):616-9. Case-series 

1401. Formenti SC, Lieskovsky G, Skinner D, et al. 

Update on impact of moderate dose of 

adjuvant radiation on urinary continence and 

sexual potency in prostate cancer patients 

treated with nerve-sparing prostatectomy. 

Urology 2000 Sep 1; 56(3):453-8. Case-series 

1402. Fornell EK, Berg G, Hallbook O, et al. 

Clinical consequences of anal sphincter 

rupture during vaginal delivery. J Am Coll 

Surg 1996 Dec; 183(6):553-8. Case-series 

1403. Fornell EU, Matthiesen L, Sjodahl R, et al. 

Obstetric anal sphincter injury ten years after: 

subjective and objective long term effects. 

Bjog 2005 Mar; 112(3):312-6. Case-series 

1404. Forster JA, Thomas WM. Patient preferences 

and side effects experienced with oral bowel 

preparations versus self-administered 

phosphate enema. Ann R Coll Surg Engl 2003 

May; 85(3):185-6. Not eligible outcomes 

1405. Forte F, Maturo G, Catania A, et al. 

Retroperitoneal lipoma. Unusual presentation 

with detrusor instability. Minerva Urol Nefrol 

2002 Jun; 54(2):131-3. Case Reports 

1406. Fossaluzza V, Di Benedetto P, Zampa A, et al. 

Misoprostol-induced urinary incontinence. J 

Intern Med 1991 Nov; 230(5):463-4. Case 

Reports 

1407. Fourie T, Cohen PL. Delayed bowel erosion 

by tension-free vaginal tape (TVT). Int 

Urogynecol J Pelvic Floor Dysfunct 2003 

Nov; 14(5):362-4. Case Reports 

1408. Fourie T, Ramphal S. Aerosol caps and 

vesicovaginal fistulas. Int J Gynaecol Obstet 

2001 Jun; 73(3):275-6. Case Reports 

1409. Fournier C, Corcos J. Collagen injections in 

difficult cases of stress urinary incontinence: 

study results. Urol Nurs 1996 Dec; 16(4):123-

6. Not eligible target population 

1410. Fowler AL, Mills A, Durdey P, et al. Singlefiber electromyography correlates more 

closely with incontinence scores than 

pudendal nerve terminal motor latency. Dis 

Colon Rectum 2005 Dec; 48(12):2309-12. Not 

eligible level of evidence 

1411. Fowler EM, Ouslander J, Papen J. Managing 

incontinence in the nursing home population. J 

Enterostomal Ther 1990 Mar-Apr; 17(2):77-

86. 

1412. Fox M, Schwizer W, Menne D, et al. The 

physical properties of rectal contents have 

effects on anorectal continence: insights from 

a study into the cause of fecal spotting on 

orlistat. Dis Colon Rectum 2004 Dec; 

47(12):2147-56. Not eligible target population 

1413. Fox M, Stutz B, Menne D, et al. The effects of 

loperamide on continence problems and 

anorectal function in obese subjects taking 

orlistat. Dig Dis Sci 2005 Sep; 50(9):1576-83. 

Not eligible outcomes 

1414. Fox M, Thumshirn M, Menne D, et al. The 

pathophysiology of faecal spotting in obese 

subjects during treatment with orlistat. 

Aliment Pharmacol Ther 2004 Feb 1; 

19(3):311-21. Not eligible outcomes 

1415. Fox PD, Coleman E. Managing common 

geriatric conditions. Healthplan 2002 MarApr; 43(2):47-53. Comment 

1416. Foxman B, Somsel P, Tallman P, et al. 

Urinary tract infection among women aged 40 

to 65: behavioral and sexual risk factors. J 

Clin Epidemiol 2001 Jul; 54(7):710-8. Not 

eligible outcomes 
B-64 

1417. Franco I, Kolligian M, Reda EF, et al. The 

importance of catheter size in the achievement 

of urinary continence in patients undergoing a 

Young-Dees-Leadbetter procedure. J Urol 

1994 Aug; 152(2 Pt 2):710-2. Not eligible 

target population 

1418. Francois Y, Descos L, Vignal J. Conservative 

treatment of low rectovaginal fistula in 

Crohn's disease. Int J Colorectal Dis 1990 

Feb; 5(1):12-4. Case-series 

1419. Frang D, Pajor L. Radical prostatectomy and 

complications. Int Urol Nephrol 1990; 

22(4):349-57. Case-series 

1420. Frankenburg FR, Zanarini MC. The 

association between borderline personality 

disorder and chronic medical illnesses, poor 

health-related lifestyle choices, and costly 

forms of health care utilization. J Clin 

Psychiatry 2004 Dec; 65(12):1660-5. Not 

eligible level of evidence 

1421. Frankenburg FR, Zanarini MC. Obesity and 

obesity-related illnesses in borderline patients. 

J Personal Disord 2006 Feb; 20(1):71-80. Not 

eligible level of evidence 

1422. Franks ME, Lavelle JP, Yokoyama T, et al. 

Metastatic osteomyelitis after pubovaginal 

sling using bone anchors. Urology 2000 Aug 

1; 56(2):330-1. Case Reports 

1423. Franssen EH, Souren LE, Torossian CL, et al. 

Utility of developmental reflexes in the 

differential diagnosis and prognosis of 

incontinence in Alzheimer's disease. J Geriatr 

Psychiatry Neurol 1997 Jan; 10(1):22-8. Not 

eligible outcomes 

1424. Fransson P, Bergstrom P, Lofroth PO, et al. 

Prospective evaluation of urinary and 

intestinal side effects after BeamCath 

stereotactic dose-escalated radiotherapy of 

prostate cancer. Radiother Oncol 2002 Jun; 

63(3):239-48. Not eligible level of evidence 

1425. Fransson P, Bergstrom P, Lofroth PO, et al. 

Five-year prospective patient evaluation of 

bladder and bowel symptoms after doseescalated radiotherapy for prostate cancer with 

the BeamCath technique. Int J Radiat Oncol 

Biol Phys 2006 Oct 1; 66(2):430-8. Case 

series 

1426. Frantz RA, Xakellis GC, Jr., Harvey PC, et al. 

Implementing an incontinence management 

protocol in long-term care. Clinical outcomes 

and costs. J Gerontol Nurs 2003 Aug; 

29(8):46-53. Case-series 

1427. Frauscher F, Helweg G, Strasser H, et al. 

Intraurethral ultrasound: diagnostic evaluation 

of the striated urethral sphincter in incontinent 

females. Eur Radiol 1998; 8(1):50-3. Not 

eligible outcomes 

1428. Freeman EW, Grisso JA, Berlin J, et al. 

Symptom reports from a cohort of African 

American and white women in the late 

reproductive years. Menopause 2001 Jan-Feb; 

8(1):33-42. Not eligible level of evidence 

1429. Freeman R, Hill S, Millard R, et al. Reduced 

perception of urgency in treatment of 

overactive bladder with extended-release 

tolterodine. Obstet Gynecol 2003 Sep; 

102(3):605-11. Not eligible exposure 

1430. Freeman RM, Adekanmi O, Waterfield MR, et 

al. The effect of cannabis on urge 

incontinence in patients with multiple 

sclerosis: a multicentre, randomised placebocontrolled trial (CAMS-LUTS). Int 

Urogynecol J Pelvic Floor Dysfunct 2006 

Nov; 17(6):636-41. Not eligible exposure 

1431. Freeman SB. Management of perimenopausal 

symptoms. NAACOGS Clin Issu Perinat 

Womens Health Nurs 1991; 2(4):429-39. 

Review 

1432. Fried GW, Goetz G, Potts-Nulty S, et al. A 

behavioral approach to the treatment of 

urinary incontinence in a disabled population. 

Arch Phys Med Rehabil 1995 Dec; 

76(12):1120-4. Case-series 

1433. Friedman WH, Gallup DG, Burke JJ, 2nd, et 

al. Outcomes of octogenarians and 

nonagenarians in elective major gynecologic 

surgery. Am J Obstet Gynecol 2006 Aug; 

195(2):547-52; discussion 52-3. Not eligible 

outcomes 

1434. Frieri G, Ligas E, Perugini B, et al. Ulcerative 

colitis: rectal dilations in a patient with 

refractory diarrhea. Report of a case. Dis 

Colon Rectum 1995 May; 38(5):545-9. CaseReports 

1435. Frigell A, Ottander M, Stenbeck H, et al. 

Quality of life of patients treated with 

abdominoperineal resection or anterior 

resection for rectal carcinoma. Ann Chir 

Gynaecol 1990; 79(1):26-30. case-series 

1436. Frisbie JH. Improved bowel care with a 

polyethylene glycol based bisacadyl 

suppository. J Spinal Cord Med 1997 Apr; 

20(2):227-9. Case-series 

1437. Fritel X, Pigne A. Anterior repair using 

Bologna procedure: long-term results on stress 

urinary continence. Int Urogynecol J Pelvic 

Floor Dysfunct 2002; 13(3):176-81; 

discussion 81. Not eligible level of evidence 
B-65 

1438. Fritel X, Zabak K, Pigne A, et al. Predictive 

value of urethral mobility before suburethral 

tape procedure for urinary stress incontinence 

in women. J Urol 2002 Dec; 168(6):2472-5. 

Case-series 

1439. Frizelle FA, Gearry RB, Johnston M, et al. 

Penile and clitoral stimulation for faecal 

incontinence: external application of a bipolar 

electrode for patients with faecal incontinence. 

Colorectal Dis 2004 Jan; 6(1):54-7. Caseseries 

1440. Froeling FM, Deprest JA, Ankum WM, et al. 

Controlled balloon dilatation for laparoscopic 

extraperitoneal bladder neck suspension in 

patients with previous abdominal surgery. J 

Laparoendosc Adv Surg Tech A 2000 Feb; 

10(1):27-30. Case-series 

1441. Frudinger A, Bartram CI, Halligan S, et al. 

Examination techniques for endosonography 

of the anal canal. Abdom Imaging 1998 MayJun; 23(3):301-3. Not eligible outcomes 

1442. Frudinger A, Bartram CI, Spencer JA, et al. 

Perineal examination as a predictor of 

underlying external anal sphincter damage. Br 

J Obstet Gynaecol 1997 Sep; 104(9):1009-13. 

Case-series 

1443. Frudinger A, Halligan S, Bartram CI, et al. 

Assessment of the predictive value of a bowel 

symptom questionnaire in identifying perianal 

and anal sphincter trauma after vaginal 

delivery. Dis Colon Rectum 2003 Jun; 

46(6):742-7. Not eligible outcomes 

1444. Fu X, Rezapour M, Wu X, et al. Expression of 

estrogen receptor-alpha and -beta in anterior 

vaginal walls of genuine stress incontinent 

women. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Oct; 14(4):276-81; discussion 

81. Not eligible outcomes 

1445. Fujisawa M, Higuchi A, Gotoh A, et al. 

Outcome of precise vesicourethral 

anastomosis following retropubic radical 

prostatectomy using a Foley catheter. Int J 

Urol 1999 Feb; 6(2):75-7. Not eligible target 

population 

1446. Fujita M, Ohno S, Danno K, et al. Two cases 

of diaper area granuloma of the adult. J 

Dermatol 1991 Nov; 18(11):671-5. Caseseries 

1447. Fukunaga K, Kimura K, Lawrence JP, et al. 

Button device for antegrade enema in the 

treatment of incontinence and constipation. J 

Pediatr Surg 1996 Aug; 31(8):1038-9. Casereports 

1448. Fulcher RA, Maisey SP. Evaluation of 

dipstick tests and reflectance meter for 

screening for bacteriuria in elderly patients. Br 

J Clin Pract 1991 Winter; 45(4):245-6. Not 

eligible outcomes 

1449. Fuller MA, Borovicka MC, Jaskiw GE, et al. 

Clozapine-induced urinary incontinence: 

incidence and treatment with ephedrine. J Clin 

Psychiatry 1996 Nov; 57(11):514-8. Not 

eligible target population 

1450. Fulmer BR, Bissonette EA, Petroni GR, et al. 

Prospective assessment of voiding and sexual 

function after treatment for localized prostate 

carcinoma: comparison of radical 

prostatectomy to hormonobrachytherapy with 

and without external beam radiotherapy. 

Cancer 2001 Jun 1; 91(11):2046-55. Not 

eligible level of evidence 

1451. Fulmer BR, Sakamoto K, Turk TM, et al. 

Acute and long-term outcomes of radio 

frequency bladder neck suspension. J Urol 

2002 Jan; 167(1):141-5. Not eligible target 

population 

1452. Fultz N, Girts T, Kinchen K, et al. Prevalence, 

management and impact of urinary 

incontinence in the workplace. Occup Med 

(Lond) 2005 Oct; 55(7):552-7. Not eligible 

level of evidence 

1453. Fultz NH, Herzog AR. Measuring urinary 

incontinence in surveys. Gerontologist 1993 

Dec; 33(6):708-13. Comment 

1454. Fultz NH, Herzog AR. Prevalence of urinary 

incontinence in middle-aged and older 

women: a survey-based methodological 

experiment. J Aging Health 2000 Nov; 

12(4):459-69. Not eligible level of evidence 

1455. Fultz NH, Herzog AR. Self-reported social 

and emotional impact of urinary incontinence. 

J Am Geriatr Soc 2001 Jul; 49(7):892-9. Not 

eligible outcomes 

1456. Fultz NH, Rahrig Jenkins K, Ostbye T, et al. 

The impact of own and spouse's urinary 

incontinence on depressive symptoms. Soc Sci 

Med 2005 Jun; 60(11):2537-48. Not eligible 

outcomes 

1457. Fynes M, Donnelly V, Behan M, et al. Effect 

of second vaginal delivery on anorectal 

physiology and faecal continence: a 

prospective study. Lancet 1999 Sep 18; 

354(9183):983-6. Case-series 

1458. Gadonneix P, Ercoli A, Salet-Lizee D, et al. 

Laparoscopic sacrocolpopexy with two 

separate meshes along the anterior and 

posterior vaginal walls for multicompartment 

pelvic organ prolapse. J Am Assoc Gynecol 

Laparosc 2004 Feb; 11(1):29-35. Case-series 
B-66 

1459. Gahimer J, Wernicke J, Yalcin I, et al. A 

retrospective pooled analysis of duloxetine 

safety in 23,983 subjects. Curr Med Res Opin 

2007 Jan; 23(1):175-84. Not eligible target 

population 

1460. Gaker DL, Gaker LB, Stewart JF, et al. 

Radical prostatectomy with preservation of 

urinary continence. J Urol 1996 Aug; 156(2 Pt 

1):445-9. Case-series 

1461. Gaker DL, Steel BL. Radical prostatectomy 

with preservation of urinary continence: 

pathology and long-term results. J Urol 2004 

Dec; 172(6 Pt 2):2549-52. Case-series 

1462. Galandiuk S, Scott NA, Dozois RR, et al. Ileal 

pouch-anal anastomosis. Reoperation for 

pouch-related complications. Ann Surg 1990 

Oct; 212(4):446-52; discussion 52-4. Not 

eligible outcomes 

1463. Galarneau L. Bedside cystometry--a useful 

diagnostic tool for nurse continence advisors. 

Perspectives 2003 Spring; 27(1):3-5. 

Comment 

1464. Gallagher PV, Mellon JK, Ramsden PD, et al. 

Tanagho bladder neck reconstruction in the 

treatment of adult incontinence. J Urol 1995 

May; 153(5):1451-4. Case-series 

1465. Gallentine ML, Cespedes RD. Occult stress 

urinary incontinence and the effect of vaginal 

vault prolapse on abdominal leak point 

pressures. Urology 2001 Jan; 57(1):40-4. 

Case-series 

1466. Galli S, Simonato A, Bozzola A, et al. 

Oncologic outcome and continence recovery 

after laparoscopic radical prostatectomy: 3 

years' follow-up in a "second generation 

center". Eur Urol 2006 May; 49(5):859-65. 

Case-series 

1467. Gallien P, Robineau S, Nicolas B, et al. 

Vesicourethral dysfunction and urodynamic 

findings in multiple sclerosis: a study of 149 

cases. Arch Phys Med Rehabil 1998 Mar; 

79(3):255-7. Not eligible outcomes 

1468. Gallo M, Staskin DR. Patient satisfaction with 

a reusable undergarment for urinary 

incontinence. J Wound Ostomy Continence 

Nurs 1997 Jul; 24(4):226-36. Not eligible 

outcomes 

1469. Gallo ML, Fallon PJ. Evaluation of a pelvic 

floor treatment plan for patients undergoing 

radical prostatectomy. Urol Nurs 1996 Mar; 

16(1):9-13. Case-series 

1470. Gallo ML, Hancock R, Davila GW. Clinical 

experience with a balloon-tipped urethral 

insert for stress urinary incontinence. J Wound 

Ostomy Continence Nurs 1997 Jan; 24(1):51-

7. no associative hypothesis tested 

1471. Gallo ML, Staskin DR. Cues to action: pelvic 

floor muscle exercise compliance in women 

with stress urinary incontinence. Neurourol 

Urodyn 1997; 16(3):167-77. Not eligible 

outcomes 

1472. Galloway NT, El-Galley RE, Sand PK, et al. 

Extracorporeal magnetic innervation therapy 

for stress urinary incontinence. Urology 1999 

Jun; 53(6):1108-11. Not eligible target 

population 

1473. Galloway NT, El-Galley RE, Sand PK, et al. 

Update on extracorporeal magnetic 

innervation (EXMI) therapy for stress urinary 

incontinence. Urology 2000 Dec 4; 56(6 Suppl 

1):82-6. Not eligible target population 

1474. Gambassi G, Landi F, Lapane KL, et al. 

Predictors of mortality in patients with 

Alzheimer's disease living in nursing homes. J 

Neurol Neurosurg Psychiatry 1999 Jul; 

67(1):59-65. Not eligible outcomes 

1475. Gambino J, Cohen AJ, Friedenberg RM. The 

direction of bladder displacement by adnexal 

masses. Clin Imaging 1993 Jan-Mar; 17(1):8-

11. Case-series 

1476. Game X, Villers A, Malavaud B, et al. 

Bladder cancer arising in a spina bifida 

patient. Urology 1999 Nov; 54(5):923. Case 

Reports 

1477. Ganabathi K, Leach GE, Zimmern PE, et al. 

Experience with the management of urethral 

diverticulum in 63 women. J Urol 1994 Nov; 

152(5 Pt 1):1445-52. Case-series 

1478. Gandhi S, Abramov Y, Kwon C, et al. TVT 

versus SPARC: comparison of outcomes for 

two midurethral tape procedures. Int 

Urogynecol J Pelvic Floor Dysfunct 2006 Feb; 

17(2):125-30. Not eligible target population 

1479. Ganio E, Luc AR, Clerico G, et al. Sacral 

nerve stimulation for treatment of fecal 

incontinence: a novel approach for intractable 

fecal incontinence. Dis Colon Rectum 2001 

May; 44(5):619-29; discussion 29-31. Not 

eligible target population 

1480. Ganio E, Masin A, Ratto C, et al. Short-term 

sacral nerve stimulation for functional 

anorectal and urinary disturbances: results in 

40 patients: evaluation of a new option for 

anorectal functional disorders. Dis Colon 

Rectum 2001 Sep; 44(9):1261-7. Not eligible 

target population 
B-67 

1481. Ganio E, Ratto C, Masin A, et al. 

Neuromodulation for fecal incontinence: 

outcome in 16 patients with definitive implant. 

The initial Italian Sacral Neurostimulation 

Group (GINS) experience. Dis Colon Rectum 

2001 Jul; 44(7):965-70. Not eligible target 

population 

1482. Ganta SB, Chakravarti A, Somani B, et al. 

Removal of catheter at midnight versus early 

morning: the patients' perspective. Urol Int 

2005; 75(1):26-9. Not eligible exposure 

1483. Ganz DA, Wenger NS, Roth CP, et al. The 

effect of a quality improvement initiative on 

the quality of other aspects of health care: the 

law of unintended consequences? Med Care 

2007 Jan; 45(1):8-18. Not eligible outcomes 

1484. Ganz PA, Greendale GA, Petersen L, et al. 

Managing menopausal symptoms in breast 

cancer survivors: results of a randomized 

controlled trial. J Natl Cancer Inst 2000 Jul 5; 

92(13):1054-64. Not eligible outcomes 

1485. Garber SJ, Christmas TJ, Rickards D. Voiding 

dysfunction due to neurosyphilis. Br J Urol 

1990 Jul; 66(1):19-21. Case- Reports 

1486. Garcea G, Sutton C, Mansoori S, et al. Results 

following conservative lateral sphincteromy 

for the treatment of chronic anal fissures. 

Colorectal Dis 2003 Jul; 5(4):311-4. Caseseries 

1487. Garcia A, Smith M, Freedman M. Vitamin 

B12 deficiency and incontinence in older 

people. Can J Urol 2000 Aug; 7(4):1077-80. 

Not eligible level of evidence 

1488. Garcia Armengol J, Hinojosa J, Lledo S, et al. 

Evolutive study of the functional results after 

restorative proctocolectomy for ulcerative 

colitis. Rev Esp Enferm Dig 1997 Sep; 

89(9):685-98. Case-series 

1489. Garcia JG, Lam C. Treating urinary 

incontinence in a head-injured adult. Brain Inj 

1990 Apr-Jun; 4(2):203-7. Case- Reports 

1490. Garcia Montes JM, Caunedo Alvarez A, 

Herrerias Gutierrez JM. Utility of the endorectal ultrasonography with sectorial 

transducer in the study of rectoanal pathology. 

Rev Esp Enferm Dig 2001 Aug; 93(8):509-18. 

Not eligible target population 

1491. Garcia-Aguilar J, Belmonte C, Wong DW, et 

al. Cutting seton versus two-stage seton 

fistulotomy in the surgical management of 

high anal fistula. Br J Surg 1998 Feb; 

85(2):243-5. Case-series 

1492. Garcia-Aguilar J, Belmonte Montes C, Perez 

JJ, et al. Incontinence after lateral internal 

sphincterotomy: anatomic and functional 

evaluation. Dis Colon Rectum 1998 Apr; 

41(4):423-7. Not eligible outcomes 

1493. Garcia-Aguilar J, Davey CS, Le CT, et al. 

Patient satisfaction after surgical treatment for 

fistula-in-ano. Dis Colon Rectum 2000 Sep; 

43(9):1206-12. Not eligible outcomes 

1494. Garcia-Granero E, Sanahuja A, GarciaArmengol J, et al. Anal endosonographic 

evaluation after closed lateral subcutaneous 

sphincterotomy. Dis Colon Rectum 1998 

May; 41(5):598-601. Question 4 

1495. Garcia-Olmo D, Garcia-Arranz M, Garcia LG, 

et al. Autologous stem cell transplantation for 

treatment of rectovaginal fistula in perianal 

Crohn's disease: a new cell-based therapy. Int 

J Colorectal Dis 2003 Sep; 18(5):451-4. CaseReports 

1496. Gardner BG, Zietman AL, Shipley WU, et al. 

Late normal tissue sequelae in the second 

decade after high dose radiation therapy with 

combined photons and conformal protons for 

locally advanced prostate cancer. J Urol 2002 

Jan; 167(1):123-6. Case-series 

1497. Gardy M, Kozminski M, DeLancey J, et al. 

Stress incontinence and cystoceles. J Urol 

1991 Jun; 145(6):1211-3. Case-series 

1498. Garely AD, Lucente V, Vapnek J, et al. 

Solifenacin for overactive bladder with 

incontinence: symptom bother and healthrelated quality of life outcomes. Ann 

Pharmacother 2007 Mar; 41(3):391-8. Not 

eligible target population 

1499. Gariballa SE. Potentially treatable causes of 

poor outcome in acute stroke patients with 

urinary incontinence. Acta Neurol Scand 2003 

May; 107(5):336-40. Not eligible outcomes 

1500. Garrido R, Lagos N, Lattes K, et al. 

Gonyautoxin: new treatment for healing acute 

and chronic anal fissures. Dis Colon Rectum 

2005 Feb; 48(2):335-40; discussion 40-3. Not 

eligible outcomes 

1501. Gasparini ME, Hinman F, Jr., Presti JC, Jr., et 

al. Continence after radical 

cystoprostatectomy and total bladder 

replacement: a urodynamic analysis. J Urol 

1992 Dec; 148(6):1861-4. Case-series 

1502. Gateau T, Faramarzi-Roques R, Le Normand 

L, et al. Clinical and urodynamic 

repercussions after TVT procedure and how to 

diminish patient complaints. Eur Urol 2003 

Sep; 44(3):372-6; discussion 6. Not eligible 

target population 
B-68 

1503. Gaur C, Mathur A, Agarwal A, et al. Diabetic 

autonomic neuropathy causing gall bladder 

dysfunction. J Assoc Physicians India 2000 

Jun; 48(6):603-5. Not eligible target 

population 

1504. Gauruder-Burmester A, Tunn R. Pregnancy 

and labor after TVT-plasty. Acta Obstet 

Gynecol Scand 2001 Mar; 80(3):283-4. Casereports 

1505. Gauthier AR, Jr., Winters JC. Incontinent 

ileovesicostomy in the management of 

neurogenic bladder dysfunction. Neurourol 

Urodyn 2003; 22(2):142-6. Case-series 

1506. Gavagan JA, Whiteford MH, Swanstrom LL. 

Full-thickness intraperitoneal excision by 

transanal endoscopic microsurgery does not 

increase short-term complications. Am J Surg 

2004 May; 187(5):630-4. Case-series 

1507. Gavira Iglesias FJ, Caridady Ocerin JM, Perez 

del Molino Martin PJ, et al. Prevalence and 

psychosocial impact of urinary incontinence in 

older people of a Spanish rural population. 

Journals of Gerontology.Series A: Biological 

Sciences and Medical Sciences 2000 Apr; 

55A(4):M207-14. Not eligible level of 

evidence 

1508. Gearhart JP, Peppas DS, Jeffs RD. Complete 

genitourinary reconstruction in female 

epispadias. J Urol 1993 May; 149(5):1110-3. 

Case-series 

1509. Gearhart S, Hull T, Floruta C, et al. Anal 

manometric parameters: predictors of outcome 

following anal sphincter repair? J Gastrointest 

Surg 2005 Jan; 9(1):115-20. Case-series 

1510. Gearhart SL, Hull TL, Schroeder T, et al. 

Sphincter defects are not associated with longterm incontinence following ileal pouch-anal 

anastomosis. Dis Colon Rectum 2005 Jul; 

48(7):1410-5. Case-series 

1511. Gearhart SL, Pannu HK, Cundiff GW, et al. 

Perineal descent and levator ani hernia: a 

dynamic magnetic resonance imaging study. 

Dis Colon Rectum 2004 Aug; 47(8):1298-304. 

Not eligible outcomes 

1512. Geary ES, Dendinger TE, Freiha FS, et al. 

Nerve sparing radical prostatectomy: a 

different view. J Urol 1995 Jul; 154(1):145-9. 

Case-series 

1513. Gee AS, Durdey P. Urge incontinence of 

faeces is a marker of severe external anal 

sphincter dysfunction. Br J Surg 1995 Sep; 

82(9):1179-82. Not eligible outcomes 

1514. Gee AS, Durdey P. Preoperative increase in 

neuromuscular jitter and outcome following 

surgery for faecal incontinence. Br J Surg 

1997 Sep; 84(9):1265-8. Not eligible exposure 

1515. Gee AS, Mills A, Durdey P. What is the 

relationship between perineal descent and anal 

mucosal electrosensitivity? Dis Colon Rectum 

1995 Apr; 38(4):419-23. Not eligible 

outcomes 

1516. Geerdes BP, Heineman E, Konsten J, et al. 

Dynamic graciloplasty. Complications and 

management. Dis Colon Rectum 1996 Aug; 

39(8):912-7. Not eligible target population 

1517. Geerdes BP, Kurvers HA, Konsten J, et al. 

Assessment of ischaemia of the distal part of 

the gracilis muscle during transposition for 

anal dynamic graciloplasty. Br J Surg 1997 

Aug; 84(8):1127-9. Not eligible target 

population 

1518. Geirsson G, Fall M. Maximal functional 

electrical stimulation in routine practice. 

Neurourol Urodyn 1997; 16(6):559-65. Caseseries 

1519. Geirsson G, Fall M, Lindstrom S. The icewater test--a simple and valuable supplement 

to routine cystometry. Br J Urol 1993 Jun; 

71(6):681-5. Not eligible outcomes 

1520. Gelber DA, Good DC, Laven LJ, et al. Causes 

of urinary incontinence after acute 

hemispheric stroke. Stroke 1993 Mar; 

24(3):378-82. Case-series 

1521. Gelet A, Meunier P, Platet RL, et al. 

Treatment of dual urinary and fecal 

incontinence by implantation of two AMS 800 

artificial sphincters. Case report. Eur Urol 

1997; 31(1):115-7; discussion 7-8. Casereports 

1522. Gelet A, Sanseverino R, Salas M, et al. The 

AS 800 urinary sphincter in renal 

transplantation. Br J Urol 1990 Nov; 

66(5):549-50. Case-reports 

1523. Gelister JS, Woodhouse CR. Role of continent 

suprapubic diversion in pelvic cancer. Br J 

Urol 1991 Oct; 68(4):376-9. Case-series 

1524. Gemlo BT, Belmonte C, Wiltz O, et al. 

Functional assessment of ileal pouch-anal 

anastomotic techniques. Am J Surg 1995 Jan; 

169(1):137-41; discussion 41-2. Case-series 

1525. George BD, Williams NS, Patel J, et al. 

Physiological and histochemical adaptation of 

the electrically stimulated gracilis muscle to 

neoanal sphincter function. Br J Surg 1993 

Oct; 80(10):1342-6. Case-series 

1526. George VK, Russell GL, Shutt A, et al. Clam 

ileocystoplasty. Br J Urol 1991 Nov; 

68(5):487-9. Case-series 

1527. Georgiou M, Shehata HA, Chaliha C, et al. 

Fasciitis: a rare complication of Burch 

colposuspension. Bjog 2001 Feb; 108(2):227-

9. Case Reports 
B-69 

1528. Gerber SD. They don't all live happily ever 

after. Nursing 1991 Mar; 21(3):136. Case 

Reports 

1529. Gerharz EW, Kohl UN, Weingartner K, et al. 

Experience with the Mainz modification of 

ureterosigmoidostomy. Br J Surg 1998 Nov; 

85(11):1512-6. Case-series 

1530. Gerharz EW, Vik V, Webb G, et al. The value 

of the MACE (Malone antegrade colonic 

enema) procedure in adult patients. J Am Coll 

Surg 1997 Dec; 185(6):544-7. Case-series 

1531. Gerharz EW, Vik V, Webb G, et al. The in 

situ appendix in the Malone antegrade 

continence enema procedure for faecal 

incontinence. Br J Urol 1997 Jun; 79(6):985-

6. Case-reports 

1532. Gerrard ER, Jr., Lloyd LK, Kubricht WS, et 

al. Transvaginal ultrasound for the diagnosis 

of urethral diverticulum. J Urol 2003 Apr; 

169(4):1395-7. Not eligible outcomes 

1533. Gerstenbluth RE, Goldman HB. Simultaneous 

urethral erosion of tension-free vaginal tape 

and woven polyester pubovaginal sling. J Urol 

2003 Aug; 170(2 Pt 1):525-6. Case Reports 

1534. Gervaz P, Rotholtz N, Wexner SD, et al. 

Colonic J-pouch function in rectal cancer 

patients: impact of adjuvant 

chemoradiotherapy. Dis Colon Rectum 2001 

Nov; 44(11):1667-75. Case-series 

1535. Ghali WA, Freund KM, Boss RD, et al. 

Menopausal hormone therapy: physician 

awareness of patient attitudes. Am J Med 

1997 Jul; 103(1):3-10. Not eligible outcomes 

1536. Ghei M, Malone-Lee J. Using the 

circumstances of symptom experience to 

assess the severity of urgency in the 

overactive bladder. J Urol 2005 Sep; 

174(3):972-6. Not eligible outcomes 

1537. Ghei M, Maraj BH, Miller R, et al. Effects of 

botulinum toxin B on refractory detrusor 

overactivity: a randomized, double-blind, 

placebo controlled, crossover trial. J Urol 

2005 Nov; 174(5):1873-7; discussion 7. Not 

eligible exposure 

1538. Ghei M, Miller R, Malone-Lee J. Case series 

data to encourage randomized trials of bladder 

retraining compared to antimuscarinic agents. 

J Urol 2006 Apr; 175(4):1411-5; discussion 5-

6. Not eligible target population 

1539. Ghezzi F, Cromi A, Raio L, et al. Influence of 

the type of anesthesia and hydrodissection on 

the complication rate after tension-free vaginal 

tape procedure. Eur J Obstet Gynecol Reprod 

Biol 2005 Jan 10; 118(1):96-100. Not eligible 

exposure 

1540. Ghezzi F, Franchi M, Buttarelli M, et al. The 

use of suction drains at burch colposuspension 

and postoperative infectious morbidity. Arch 

Gynecol Obstet 2003 Apr; 268(1):41-4. Not 

eligible outcomes 

1541. Ghezzi F, Serati M, Cromi A, et al. Tensionfree vaginal tape for the treatment of 

urodynamic stress incontinence with intrinsic 

sphincteric deficiency. Int Urogynecol J 

Pelvic Floor Dysfunct 2006 Jun; 17(4):335-9. 

Case-series 

1542. Ghoniem GM. The recalcitrant overactive 

bladder patient. Geriatrics 2002 May; 57 

Suppl 1:23-9. Case-reports 

1543. Ghoniem GM, Van Leeuwen JS, Elser DM, et 

al. A randomized controlled trial of duloxetine 

alone, pelvic floor muscle training alone, 

combined treatment and no active treatment in 

women with stress urinary incontinence. J 

Urol 2005 May; 173(5):1647-53. Not eligible 

exposure 

1544. Ghoniem GM, Walters F, Lewis V. The value 

of the vaginal pack test in large cystoceles. J 

Urol 1994 Sep; 152(3):931-4. Not eligible 

outcomes 

1545. Ghosh T, Banfield PJ, Klazinga DA. An 

unusual complication of tension-free vaginal 

tape procedure: recurrent anterior vaginal wall 

abscess and sinus formation. J Obstet 

Gynaecol 2004 Aug; 24(5):590-1. Case 

Reports 

1546. Ghosh TS, Kwawukume EY. A new method 

of achieving total continence in vesicourethro-vaginal fistula (circumferential fistula) 

with total urethral destruction--surgical 

technique. West Afr J Med 1993 Jul-Sep; 

12(3):141-3. Case-series 

1547. Giacalone PL, Laffargue F, Daures JP, et al. 

The Bologna bladder neck suspension 

procedure for treatment of stress urinary 

incontinence associated with cystocele. Int 

Urogynecol J Pelvic Floor Dysfunct 1998; 

9(6):370-8. Case-series 

1548. Giamundo P, Welber A, Weiss EG, et al. The 

procon incontinence device: a new 

nonsurgical approach to preventing episodes 

of fecal incontinence. Am J Gastroenterol 

2002 Sep; 97(9):2328-32. Case-series 

1549. Giannantoni A, Mearini E, Di Stasi SM, et al. 

Assessment of bladder and urethral sphincter 

function before and after radical retropubic 

prostatectomy. J Urol 2004 Apr; 171(4):1563-

6. Case-series 
B-70 

1550. Giannitsas K, Perimenis P, Athanasopoulos A, 

et al. Comparison of the efficacy of 

tolterodine and oxybutynin in different 

urodynamic severity grades of idiopathic 

detrusor overactivity. Eur Urol 2004 Dec; 

46(6):776-82; discussion 82-3. Not eligible 

exposure 

1551. Gibbons G. Assessing and managing 

incontinence in women. Community Nurse 

1996 Jun; 2(5):34-6. Case Reports 

1552. Gibbs DH, Hooks VH, 3rd. Overlapping 

sphincteroplasty for acquired anal 

incontinence. South Med J 1993 Dec; 

86(12):1376-80. Case-series 

1553. Giberti C, Rovida S. Transvaginal boneanchored synthetic sling for the treatment of 

stress urinary incontinence: an outcomes 

analysis. Urology 2000 Dec 20; 56(6):956-61. 

Case-series 

1554. Gilbert R, Glen M. Implementing an NHS 

continence service for nursing home residents. 

Prof Nurse 2004 Nov; 20(3):35-7. Not eligible 

exposure 

1555. Giles DL, Davila GW. Suprapubicvaginocutaneous fistula 18 years after a 

bladder-neck suspension. Obstet Gynecol 

2005 May; 105(5 Pt 2):1193-5. Case Reports 

1556. Giles LG, Yamada S. An unusual cause of 

incontinence. Aust Fam Physician 2001 Aug; 

30(8):767-9. Case report 

1557. Gilja I. Tansvaginal needle suspension 

operation: the way we do it. Clinical and 

urodynamic study: long-term results. Eur Urol 

2000 Mar; 37(3):325-30. Case-series 

1558. Gilja I, Kovacic M, Radej M, et al. The 

sigmoidorectal pouch (Mainz pouch II). Eur 

Urol 1996; 29(2):210-5. No associative 

hypothesis tested 

1559. Gilja I, Sarac S, Radej M. A modified Raz 

bladder neck suspension operation 

(transvaginal Burch). J Urol 1995 May; 

153(5):1455-7. Case-series 

1560. Gill EJ, Elser DM, Bonidie MJ, et al. The 

routine use of cystoscopy with the Burch 

procedure. Am J Obstet Gynecol 2001 Aug; 

185(2):345-8. Not eligible outcomes 

1561. Gill EJ, Nichols CM. Cystoscopic 

confirmation of inadvertent ureteral 

catheterization during cystometry. Int 

Urogynecol J Pelvic Floor Dysfunct 2002; 

13(4):266-7. Case Reports 

1562. Gill SS, Mamdani M, Naglie G, et al. A 

prescribing cascade involving cholinesterase 

inhibitors and anticholinergic drugs. Arch 

Intern Med 2005 Apr 11; 165(7):808-13. Not 

eligible exposure 

1563. Gillatt DA, Feneley RC. Magnetic resonance 

imaging in the identification of an otherwise 

undetectable upper pole moiety. Br J Urol 

1993 Jul; 72(1):122-3. Case report 

1564. Gilleran JP, Lemack GE, Zimmern PE. 

Reduction of moderate-to-large cystocele 

during urodynamic evaluation using a vaginal 

gauze pack: 8-year experience. BJU Int 2006 

Feb; 97(2):292-5. Not eligible exposure 

1565. Gillon G, Engelstein D, Servadio C. Risk 

factors and their effect on the results of Burch 

colposuspension for urinary stress 

incontinence. Isr J Med Sci 1992 Jun; 

28(6):354-6. Case-series 

1566. Gil-Nagel A, Gapany S, Blesi K, et al. 

Incontinence during treatment with 

gabapentin. Neurology 1997 May; 

48(5):1467-8. Case- Reports 

1567. Gimbel H, Zobbe V, Andersen BM, et al. 

Total versus subtotal hysterectomy: an 

observational study with one-year follow-up. 

Aust N Z J Obstet Gynaecol 2005 Feb; 

45(1):64-7. Not eligible level of evidence 

1568. Ginsberg D, Rovner E, Raz S. Continence 

mechanism based on a modified ileocecal 

valve. Tech Urol 2000 Sep; 6(3):167-71. 

Case-series 

1569. Ginsberg DA, Rovner ES, Raz S. 

Posthysterectomy vaginal cuff fistula: 

diagnosis and management of an unusual 

cause of "incontinence". Urology 1998 Jul; 

52(1):61-4; discussion 4-5. Case-reports 

1570. Girao MJ, Jarmy-Di Bella ZI, Sartori MG, et 

al. Doppler velocimetry parameters of 

periurethral vessels in postmenopausal 

incontinent women receiving estrogen 

replacement. Int Urogynecol J Pelvic Floor 

Dysfunct 2001; 12(4):241-6. Case-series 

1571. Girgin C, Oder M, Sahin MO, et al. Erectionand ejaculation-preserving cystectomy with 

orthotopic urinary diversion: is it feasible? J 

Androl 2006 Mar-Apr; 27(2):263-7. Caseseries 

1572. Giri SK, Hickey JP, Sil D, et al. The long-term 

results of pubovaginal sling surgery using 

acellular cross-linked porcine dermis in the 

treatment of urodynamic stress incontinence. J 

Urol 2006 May; 175(5):1788-92; discussion 

93. Case-series 

1573. Girman CJ, Chandler JM, Zimmerman SI, et 

al. Prediction of fracture in nursing home 

residents. J Am Geriatr Soc 2002 Aug; 

50(8):1341-7. Not eligible outcomes 
B-71 

1574. Gjessing H, Backe B, Sahlin Y. Third degree 

obstetric tears; outcome after primary repair. 

Acta Obstet Gynecol Scand 1998 Aug; 

77(7):736-40. Case-series 

1575. Gladman JR, Harwood DM, Barer DH. 

Predicting the outcome of acute stroke: 

prospective evaluation of five multivariate 

models and comparison with simple methods. 

J Neurol Neurosurg Psychiatry 1992 May; 

55(5):347-51. Not eligible outcomes 

1576. Gladman MA, Dvorkin LS, Lunniss PJ, et al. 

Rectal hyposensitivity: a disorder of the rectal 

wall or the afferent pathway? An assessment 

using the barostat. Am J Gastroenterol 2005 

Jan; 100(1):106-14. Not eligible outcomes 

1577. Gladman MA, Scott SM, Chan CL, et al. 

Rectal hyposensitivity: prevalence and clinical 

impact in patients with intractable constipation 

and fecal incontinence. Dis Colon Rectum 

2003 Feb; 46(2):238-46. Not eligible 

outcomes 

1578. Gladman MA, Scott SM, Williams NS, et al. 

Clinical and physiological findings, and 

possible aetiological factors of rectal 

hyposensitivity. Br J Surg 2003 Jul; 

90(7):860-6. Not eligible exposure 

1579. Glasgow SC, Birnbaum EH, Kodner IJ, et al. 

Preoperative anal manometry predicts 

continence after perineal proctectomy for 

rectal prolapse. Dis Colon Rectum 2006 Jul; 

49(7):1052-8. Not eligible outcomes 

1580. Glavind K. Use of a vaginal sponge during 

aerobic exercises in patients with stress 

urinary incontinence. Int Urogynecol J Pelvic 

Floor Dysfunct 1997; 8(6):351-3. No 

associative hypothesis tested 

1581. Glavind K. Conservative treatment of stress 

incontinence with Geisha balls. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 

12(4):223-4; discussion 4-5. Case-series 

1582. Glavind K, Bjork J, Nohr M, et al. A 

prospective study on whether a tension-free 

urethropexy procedure affects the residual 

urine and flow up to 4 years after the 

operation. Acta Obstet Gynecol Scand 2006; 

85(8):982-5. Case-series 

1583. Glavind K, Glavind E. Treatment of 

prolonged voiding dysfunction after tensionfree vaginal tape procedure. Acta Obstet 

Gynecol Scand 2007; 86(3):357-60. Caseseries 

1584. Glavind K, Kempf L. Colpectomy or Le Fort 

colpocleisis--a good option in selected elderly 

patients. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Jan-Feb; 16(1):48-51; 

discussion Not eligible target population 

1585. Glavind K, Laursen B, Jaquet A. Efficacy of 

biofeedback in the treatment of urinary stress 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 1998; 9(3):151-3. Case-series 

1586. Glavind K, Sander P. Erosion, defective 

healing and extrusion after tension-free 

urethropexy for the treatment of stress urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2004 May-Jun; 15(3):179-82. Not 

eligible outcomes 

1587. Glavind K, Tetsche MS. Sexual function in 

women before and after suburethral sling 

operation for stress urinary incontinence: a 

retrospective questionnaire study. Acta Obstet 

Gynecol Scand 2004 Oct; 83(10):965-8. Not 

eligible outcomes 

1588. Gleason DM, Susset J, White C, et al. 

Evaluation of a new once-daily formulation of 

oxbutynin for the treatment of urinary urge 

incontinence. Ditropan XL Study Group. 

Urology 1999 Sep; 54(3):420-3. Not eligible 

target population 

1589. Glenn J. Restorative Nursing Bladder Training 

program: recommending a strategy. Rehabil 

Nurs 2003 Jan-Feb; 28(1):15-22. Case-series 

1590. Glia A, Gylin M, Akerlund JE, et al. 

Biofeedback training in patients with fecal 

incontinence. Dis Colon Rectum 1998 Mar; 

41(3):359-64. Case-series 

1591. Glickman S, Kamm MA. Bowel dysfunction 

in spinal-cord-injury patients. Lancet 1996 Jun 

15; 347(9016):1651-3. Case-series 

1592. Gnanadesigan N, Saliba D, Roth CP, et al. 

The quality of care provided to vulnerable 

older community-based patients with urinary 

incontinence. Journal of the American 

Medical Directors Association 2004 May-Jun; 

5(3):141-6. Not eligible level of evidence 

1593. Gnanapragasam VJ, Kumar V, Langton D, et 

al. Outcome of transurethral prostatectomy for 

the palliative management of lower urinary 

tract symptoms in men with prostate cancer. 

Int J Urol 2006 Jun; 13(6):711-5. Case-series 

1594. Gnessin E, Livne PM, Baniel J, et al. 

Continence and quality of life assessment after 

artificial urinary sphincter implantation. Isr 

Med Assoc J 2004 Oct; 6(10):592-4. Caseseries 

1595. Godfrey K. Incontinence in ethnic groups. 

Community Nurse 1997 Jun; 3(5):42. 

Comment 

1596. Goei R. Anorectal function in patients with 

defecation disorders and asymptomatic 

subjects: evaluation with defecography. 

Radiology 1990 Jan; 174(1):121-3. Not 

eligible outcomes 
B-72 

1597. Goel A, Seth A, Kumar R. Autocystectomy 

following extensive genitourinary 

tuberculosis: presentation and management. 

Int Urol Nephrol 2002; 34(3):325-7. Casereports 

1598. Goel MC, Roberts JG. Dynamic rectus 

abdominis tendon colposuspension for female 

stress urinary incontinence: a new procedure 

and its follow-up. Urol Int 2003; 71(1):45-50. 

Case-series 

1599. Goepel C, Hefler L, Methfessel HD, et al. 

Periurethral connective tissue status of 

postmenopausal women with genital prolapse 

with and without stress incontinence. Acta 

Obstet Gynecol Scand 2003 Jul; 82(7):659-64. 

Not eligible outcomes 

1600. Goepel M, Hoffmann JA, Piro M, et al. 

Prevalence and physician awareness of 

symptoms of urinary bladder dysfunction. Eur 

Urol 2002 Mar; 41(3):234-9. Not eligible 

outcomes 

1601. Goepel M, Sperling H, Stohrer M, et al. 

Management of neurogenic fecal incontinence 

in myelodysplastic children by a modified 

continent appendiceal stoma and antegrade 

colonic enema. Urology 1997 May; 

49(5):758-61. Not eligible target population 

1602. Goere D, Benoist S, Penna C, et al. H-pouch: 

new isoperistaltic colonic pouch for coloanal 

anastomosis after rectal resection for cancer: a 

pilot study. Dis Colon Rectum 2004 Oct; 

47(10):1740-4. Case-series 

1603. Goes RN, Simons AJ, Beart RW, Jr. Level of 

highest mean resting pressure segment in the 

anal canal. A quantitative assessment of anal 

sphincter function. Dis Colon Rectum 1996 

Mar; 39(3):289-93. Not eligible outcomes 

1604. Goes RN, Simons AJ, Masri L, et al. Gradient 

of pressure and time between proximal anal 

canal and high-pressure zone during internal 

anal sphincter relaxation. Its role in the fecal 

continence mechanism. Dis Colon Rectum 

1995 Oct; 38(10):1043-6. Not eligible 

outcomes 

1605. Goffeng AR, Andersch B, Andersson M, et al. 

Objective methods cannot predict anal 

incontinence after primary repair of extensive 

anal tears. Acta Obstet Gynecol Scand 1998 

Apr; 77(4):439-43. Case-series 

1606. Gofrit ON, Landau EH, Shapiro A, et al. The 

Stamey procedure for stress incontinence: 

long-term results. Eur Urol 1998 Oct; 

34(4):339-43. Case-series 

1607. Goke M, Donner K, Ewe K, et al. 

Intraindividual variability of anorectal 

manometry parameters. Z Gastroenterol 1992 

Apr; 30(4):243-6. Not eligible outcomes 

1608. Gold DM, Bartram CI, Halligan S, et al. 

Three-dimensional endoanal sonography in 

assessing anal canal injury. Br J Surg 1999 

Mar; 86(3):365-70. Not eligible outcomes 

1609. Gold MF. Restoring dignity. Provider 1992 

Apr; 18(4):16-8, 20, 2-4. Comment 

1610. Gold MF. Breaking through incontinence. 

Provider 1995 Jul; 21(7):70-2, 4, 6. Comment 

1611. Goldberg KB, Ellis DW. Anoxic 

encephalopathy: a neurobehavioural study in 

rehabilitation. Brain Inj 1997 Oct; 11(10):743-

50. Case Reports 

1612. Goldberg RP, Koduri S, Lobel RW, et al. 

Protective effect of suburethral slings on 

postoperative cystocele recurrence after 

reconstructive pelvic operation. Am J Obstet 

Gynecol 2001 Dec; 185(6):1307-12; 

discussion 12-3. Not eligible outcomes 

1613. Goldberg RP, Sand PK, Beck H. Early-stage 

ovarian carcinoma presenting with irritative 

voiding symptoms and urge incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 

12(5):342-4. Not eligible outcomes 

1614. Goldenberg I, Shupak A, Shoshani O. Oxyhelium treatment for refractory neurological 

decompression sickness: a case report. Aviat 

Space Environ Med 1996 Jan; 67(1):57-60. 

Case- Reports 

1615. Goldstein M, Hawthorne ME, Engeberg S, et 

al. Urinary incontinence. Why people do not 

seek help. J Gerontol Nurs 1992 Apr; 

18(4):15-20. Not eligible outcomes 

1616. Goldstein SR, Neven P, Zhou L, et al. 

Raloxifene effect on frequency of surgery for 

pelvic floor relaxation. Obstet Gynecol 2001 

Jul; 98(1):91-6. Not eligible outcomes 

1617. Goldwasser B, Ben-Chaim J, Golomb J, et al. 

Bladder neck closure with an Indiana stoma 

outlet as a technique for continent 

vesicostomy. Surg Gynecol Obstet 1993 Nov; 

177(5):448-50. Case Reports 

1618. Golimbu M, al-Askari S, Morales P. 

Transpubic approach for lower urinary tract 

surgery: a 15-year experience. J Urol 1990 

Jan; 143(1):72-6. Not eligible level of evidence 

1619. Golomb J, Ben-Chaim J, Goldwasser B, et al. 

Conservative treatment of a vesicocervical 

fistula resulting from Shirodkar cervical 

cerclage. J Urol 1993 Apr; 149(4):833-4. 

Case-reports 
B-73 

1620. Golomb J, Groutz A, Mor Y, et al. 

Management of urethral erosion caused by a 

pubovaginal fascial sling. Urology 2001 Jan; 

57(1):159-60. Case- Reports 

1621. Golub RW, Wise WE, Jr., Kerner BA, et al. 

Endorectal mucosal advancement flap: the 

preferred method for complex cryptoglandular 

fistula-in-ano. J Gastrointest Surg 1997 SepOct; 1(5):487-91. Not eligible level of 

evidence 

1622. Goluboff ET, Chang DT, Olsson CA, et al. 

Urodynamics and the etiology of postprostatectomy urinary incontinence: the initial 

Columbia experience. J Urol 1995 Mar; 153(3 

Pt 2):1034-7. Case-series 

1623. Gomes CM, Broderick GA, Sanchez-Ortiz 

RF, et al. Artificial urinary sphincter for postprostatectomy incontinence: impact of prior 

collagen injection on cost and clinical 

outcome. J Urol 2000 Jan; 163(1):87-90. 

Case-series 

1624. Gomes CM, Trigo-Rocha F, Arap MA, et al. 

Schistosomal myelopathy: urologic 

manifestations and urodynamic findings. 

Urology 2002 Feb; 59(2):195-200. Caseseries 

1625. Gomez-Lobo V, Burgansky A, Kim-Schluger 

L, et al. Gynecologic symptoms and sexual 

function before and after liver transplantation. 

J Reprod Med 2006 Jun; 51(6):457-62. Not 

eligible level of evidence 

1626. Gomha MA, Boone TB. Artificial urinary 

sphincter for post-prostatectomy incontinence 

in men who had prior radiotherapy: a risk and 

outcome analysis. J Urol 2002 Feb; 167(2 Pt 

1):591-6. Case-series 

1627. Gomha MA, Boone TB. Voiding patterns in 

patients with post-prostatectomy incontinence: 

urodynamic and demographic analysis. J Urol 

2003 May; 169(5):1766-9. Case-series 

1628. Gonzalez R, Buson H, Reid C, et al. 

Seromuscular colocystoplasty lined with 

urothelium: experience with 16 patients. 

Urology 1995 Jan; 45(1):124-9. Case-series 

1629. Goode PS. Behavioral and drug therapy for 

urinary incontinence. Urology 2004 Mar; 63(3 

Suppl 1):58-64. Not eligible exposure 

1630. Goode PS, Locher JL, Bryant RL, et al. 

Measurement of postvoid residual urine with 

portable transabdominal bladder ultrasound 

scanner and urethral catheterization. Int 

Urogynecol J Pelvic Floor Dysfunct 2000; 

11(5):296-300. Not eligible outcomes 

1631. Goodwin TM, Banks E, Millar LK, et al. 

Catastrophic shoulder dystocia and emergency 

symphysiotomy. Am J Obstet Gynecol 1997 

Aug; 177(2):463-4. Case Reports 

1632. Gordon D, Gold R, Pauzner D, et al. Tensionfree vaginal tape in the elderly: is it a safe 

procedure? Urology 2005 Mar; 65(3):479-82. 

Not eligible target population 

1633. Gordon D, Gold RS, Pauzner D, et al. 

Combined genitourinary prolapse repair and 

prophylactic tension-free vaginal tape in 

women with severe prolapse and occult stress 

urinary incontinence: preliminary results. 

Urology 2001 Oct; 58(4):547-50. Not eligible 

target population 

1634. Gordon D, Groutz A, Ascher-Landsberg J, et 

al. Double-blind, placebo-controlled study of 

magnesium hydroxide for treatment of sensory 

urgency and detrusor instability: preliminary 

results. Br J Obstet Gynaecol 1998 Jun; 

105(6):667-9. Not eligible exposure 

1635. Gordon D, Groutz A, Sinai T, et al. Sexual 

function in women attending a urogynecology 

clinic. Int Urogynecol J Pelvic Floor Dysfunct 

1999; 10(5):325-8. Not eligible outcomes 

1636. Gordon D, Groutz A, Wolman I, et al. 

Development of postoperative urinary stress 

incontinence in clinically continent patients 

undergoing prophylactic Kelly plication 

during genitourinary prolapse repair. 

Neurourol Urodyn 1999; 18(3):193-7; 

discussion 7-8. Not eligible target population 

1637. Gorman R. Expert system for management of 

urinary incontinence in women. Proc Annu 

Symp Comput Appl Med Care 1995:527-31. 

Not eligible outcomes 

1638. Gormley EA, Griffiths DJ, McCracken PN, et 

al. Polypharmacy and its effect on urinary 

incontinence in a geriatric population. Br J 

Urol 1993 Mar; 71(3):265-9. Not eligible level 

of evidence 

1639. Gormley EA, Griffiths DJ, McCracken PN, et 

al. Effect of transurethral resection of the 

prostate on detrusor instability and urge 

incontinence in elderly males. Neurourol 

Urodyn 1993; 12(5):445-53. Case-series 

1640. Gorton E, Stanton S, Monga A, et al. 

Periurethral collagen injection: a long-term 

follow-up study. BJU Int 1999 Dec; 

84(9):966-71. Not eligible target population 

1641. Gosselink MP, Darby M, Zimmerman DD, et 

al. Long-term follow-up of retrograde colonic 

irrigation for defaecation disturbances. 

Colorectal Dis 2005 Jan; 7(1):65-9. Not 

eligible target population 
B-74 

1642. Gosselink MP, West RL, Kuipers EJ, et al. 

Integrity of the anal sphincters after pouchanal anastomosis: evaluation with threedimensional endoanal ultrasonography. Dis 

Colon Rectum 2005 Sep; 48(9):1728-35. 

Case-series 

1643. Gotoh M, Mizutani K, Furukawa T, et al. 

Quality of micturition in male patients with 

orthotopic neobladder replacement. World J 

Urol 2000 Dec; 18(6):411-6. Case-series 

1644. Goudet P, Roy P, Arveux I, et al. Populationbased study of the treatment and prognosis of 

carcinoma of the rectum. Br J Surg 1997 Nov; 

84(11):1546-50. Not eligible outcomes 

1645. Gough M, McDermott EW, Lyons B, et al. 

Perforation of bladder carcinoma presenting as 

acute abdomen. Br J Urol 1992 May; 

69(5):541-2. Case Reports 

1646. Gousse AE, Madjar S, Lambert MM, et al. 

Artificial urinary sphincter for post-radical 

prostatectomy urinary incontinence: long-term 

subjective results. J Urol 2001 Nov; 

166(5):1755-8. Case-series 

1647. Gousse AE, Safir MH, Cortina G, et al. 

Tubulovillous adenoma in the cecal segment 

after cecocystoplasty. J Urol 1998 Aug; 

160(2):490-1. Case Reports 

1648. Govier FE, Gibbons RP, Correa RJ, et al. 

Pubovaginal slings using fascia lata for the 

treatment of intrinsic sphincter deficiency. J 

Urol 1997 Jan; 157(1):117-21. Not eligible 

target population 

1649. Govier FE, Kobashi KC, Kuznetsov DD, et al. 

Complications of transvaginal silicone-coated 

polyester synthetic mesh sling. Urology 2005 

Oct; 66(4):741-5. Not eligible target 

population 

1650. Govier FE, Litwiller S, Nitti V, et al. 

Percutaneous afferent neuromodulation for the 

refractory overactive bladder: results of a 

multicenter study. J Urol 2001 Apr; 

165(4):1193-8. Not eligible target population 

1651. Govier FE, Pritchett TR, Kornman JD. 

Correlation of the cystoscopic appearance and 

functional integrity of the female urethral 

sphincteric mechanism. Urology 1994 Aug; 

44(2):250-3. Not eligible outcomes 

1652. Graefen M, Hammerer P, Michl U, et al. 

Incidence of positive surgical margins after 

biopsy-selected nerve-sparing radical 

prostatectomy. Urology 1998 Mar; 51(3):437-

42. Not eligible outcomes 

1653. Graf W, Ekstrom K, Glimelius B, et al. A pilot 

study of factors influencing bowel function 

after colorectal anastomosis. Dis Colon 

Rectum 1996 Jul; 39(7):744-9. Case-series 

1654. Graf W, Pahlman L, Ejerblad S. Functional 

results after seton treatment of high 

transsphincteric anal fistulas. Eur J Surg 1995 

Apr; 161(4):289-91. Case-series 

1655. Graham CA, Mallett VT. Race as a predictor 

of urinary incontinence and pelvic organ 

prolapse. Am J Obstet Gynecol 2001 Jul; 

185(1):116-20. Not eligible target population 

1656. Graham JM, Stresing HA. A modified 

cystourethropexy in the management of 

incontinence and dyspareunia. J S C Med 

Assoc 1990 Nov; 86(11):578-82. 

1657. Graham RA, Atkins MB, Karp DD, et al. 

Local excision of rectal carcinoma. Early 

results with combined chemoradiation therapy 

using 5-fluorouracil and leucovorin. Dis 

Colon Rectum 1994 Apr; 37(4):308-12. Caseseries 

1658. Gray M, McClain R, Peruggia M, et al. A 

model for predicting motor urge urinary 

incontinence. Nurs Res 2001 Mar-Apr; 

50(2):116-22. Not eligible outcomes 

1659. Gray M, Rayome R, Anson C. Incontinence 

and clean intermittent catheterization 

following spinal cord injury. Clin Nurs Res 

1995 Feb; 4(1):6-18; discussion 9-21. Caseseries 

1660. Gray R, Stern G, Malone-Lee J. Lower 

urinary tract dysfunction in Parkinson's 

disease: changes relate to age and not disease. 

Age Ageing 1995 Nov; 24(6):499-504. Not 

eligible level of evidence 

1661. Graziotti P, Giusti G, Seveso M, et al. 

Retropubic nerve and seminal sparing radical 

prostatectomy for recurrent bladder neckprostatic urethra strictures. Arch Ital Urol 

Androl 2005 Dec; 77(4):181-4. Case-series 

1662. Grdal M, Tekin A, Erdoan K, et al. 

Endoscopic silicone injection for female stress 

urinary incontinence due to intrinsic sphincter 

deficiency: impact of coexisting urethral 

mobility on treatment outcome. Urology 2002 

Dec; 60(6):1016-9. Case-series 

1663. Green JP, Smoker I, Ho MT, et al. Urinary 

incontinence in subacute care--a retrospective 

analysis of clinical outcomes and costs. Med J 

Aust 2003 Jun 2; 178(11):550-3. Not eligible 

outcomes 

1664. Green N, Treible D, Wallack H. Prostate 

cancer: post-irradiation incontinence. J Urol 

1990 Aug; 144(2 Pt 1):307-9. Case series 
B-75 

1665. Greenberger M, Steiner MS. The University 

of Tennessee experience with the Indigo 830e 

laser device for the minimally invasive 

treatment of benign prostatic hyperplasia: 

interim analysis. World J Urol 1998; 

16(6):386-91. Case-series 

1666. Greendale GA, Petersen L, Zibecchi L, et al. 

Factors related to sexual function in 

postmenopausal women with a history of 

breast cancer. Menopause 2001 Summer; 

8(2):111-9. Not eligible outcomes 

1667. Greer DS. Incontinence in the elderly. R I 

Med 1994 Aug; 77(8):281-3. Comment 

1668. Gregory WT, Lou JS, Stuyvesant A, et al. 

Quantitative electromyography of the anal 

sphincter after uncomplicated vaginal 

delivery. Obstet Gynecol 2004 Aug; 

104(2):327-35. Case-Series 

1669. Grein U, Meyer WW. Local recurrent cancer 

after radical prostatectomy and incontinence. 

Is the artificial urinary sphincter a useful 

therapeutic option? Urol Int 2001; 66(1):9-12. 

Case-series 

1670. Grey BR, Sheldon RR, Telford KJ, et al. 

Anterior anal sphincter repair can be of long 

term benefit: a 12-year case cohort from a 

single surgeon. BMC Surg 2007; 7:1. Caseseries 

1671. Griebling TL, Kreder KJ, Jr., Williams RD. 

Transurethral collagen injection for treatment 

of postprostatectomy urinary incontinence in 

men. Urology 1997 Jun; 49(6):907-12. Not 

eligible target population 

1672. Grieve T. Continence promotion among 

children with severe disabilities. Nurs Times 

1998 Oct 14-20; 94(41):58-9. Comment 

1673. Griffith-Jones MD, Abrams PH. The Stamey 

endoscopic bladder neck suspension in the 

elderly. Br J Urol 1990 Feb; 65(2):170-2. 

Case-series 

1674. Griffith-Jones MD, Jarvis GJ, McNamara 

HM. Adverse urinary symptoms after total 

abdominal hysterectomy--fact or fiction? Br J 

Urol 1991 Mar; 67(3):295-7. Case-series 

1675. Griffiths AN, Makam A, Edwards GJ. Should 

we actively screen for urinary and anal 

incontinence in the general gynaecology 

outpatients setting?--A prospective 

observational study. J Obstet Gynaecol 2006 

Jul; 26(5):442-4. Not eligible outcomes 

1676. Griffiths D. Clinical studies of cerebral and 

urinary tract function in elderly people with 

urinary incontinence. Behav Brain Res 1998 

May; 92(2):151-5. Not eligible outcomes 

1677. Griffiths D, Derbyshire S, Stenger A, et al. 

Brain control of normal and overactive 

bladder. J Urol 2005 Nov; 174(5):1862-7. Not 

eligible outcomes 

1678. Griffiths DJ, Harrison G, Moore K, et al. 

Variability of post-void residual urine volume 

in the elderly. Urol Res 1996; 24(1):23-6. Not 

eligible outcomes 

1679. Griffiths DJ, McCracken PN, Harrison GM, et 

al. Cerebral aetiology of urinary urge 

incontinence in elderly people. Age Ageing 

1994 May; 23(3):246-50. Question 2 

1680. Griffiths DJ, McCracken PN, Harrison GM, et 

al. Urge incontinence and impaired detrusor 

contractility in the elderly. Neurourol Urodyn 

2002; 21(2):126-31. Case-series 

1681. Griffiths DJ, McCracken PN, Harrison GM, et 

al. Urinary incontinence in the elderly: the 

brain factor. Scand J Urol Nephrol Suppl 

1994; 157:83-8. Not eligible outcomes 

1682. Griffiths DJ, McCracken PN, Harrison GM, et 

al. Urge incontinence in elderly people: 

factors predicting the severity of urine loss 

before and after pharmacological treatment. 

Neurourol Urodyn 1996; 15(1):53-7. Caseseries 

1683. Griffiths JM, Black NA, Pope C, et al. What 

determines the choice of procedure in stress 

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modeling. Int J Technol Assess Health Care 

1998 Summer; 14(3):431-45. Not eligible 

outcomes 

1684. Grignaffini A, Bazzani F, Bertoli P, et al. 

Intravesicular prostaglandin E2 for the 

prophylaxis of urinary retention after 

colpohysterectomy. J Int Med Res 1998 MarApr; 26(2):87-92. Not eligible exposure 

1685. Grills IS, Martinez AA, Hollander M, et al. 

High dose rate brachytherapy as prostate 

cancer monotherapy reduces toxicity 

compared to low dose rate palladium seeds. J 

Urol 2004 Mar; 171(3):1098-104. Not eligible 

level of evidence 

1686. Grimby A, Milsom I, Molander U, et al. The 

influence of urinary incontinence on the 

quality of life of elderly women. Age Ageing 

1993 Mar; 22(2):82-9. Not eligible outcomes 

1687. Grimby A, Rosenhall U. Health-related 

quality of life and dizziness in old age. 

Gerontology 1995; 41(5):286-98. Not eligible 

level of evidence 

1688. Grimby A, Svanborg A. Morbidity and healthrelated quality of life among ambulant elderly 

citizens. Aging (Milano) 1997 Oct; 9(5):356-

64. Not eligible outcomes 
B-76 

1689. Grinspun D. Bladder management for adults 

following head injury. Rehabil Nurs 1993 

Sep-Oct; 18(5):300-5. Case- Reports 

1690. Grise P, Droupy S, Saussine C, et al. 

Transobturator tape sling for female stress 

incontinence with polypropylene tape and 

outside-in procedure: prospective study with 1 

year of minimal follow-up and review of 

transobturator tape sling. Urology 2006 Oct; 

68(4):759-63. Not eligible target population 

1691. Groen J, Amiel C, Bosch JL. Chronic 

pudendal nerve neuromodulation in women 

with idiopathic refractory detrusor 

overactivity incontinence: results of a pilot 

study with a novel minimally invasive 

implantable mini-stimulator. Neurourol 

Urodyn 2005; 24(3):226-30. Case-series 

1692. Groen J, Bosch JL. Bladder contraction 

strength parameters poorly predict the 

necessity of long-term catheterization after a 

pubovaginal rectus fascial sling procedure. J 

Urol 2004 Sep; 172(3):1006-9. Case-series 

1693. Gross JC. A comparison of the characteristics 

of incontinent and continent stroke patients in 

a rehabilitation program. Rehabil Nurs 1998 

May-Jun; 23(3):132-40. Not eligible outcomes 

1694. Gross JC. Urinary incontinence and stroke 

outcomes. Arch Phys Med Rehabil 2000 Jan; 

81(1):22-7. Not eligible outcomes 

1695. Grossklaus DJ, Franke JJ. Treatment of 

elderly women with urge incontinence in 

middle tennessee: a single institution practicebased study. Tenn Med 2000 Dec; 93(12):457-

60. Case-series 

1696. Grotz RL, Pemberton JH, Ferrara A, et al. 

Ileal pouch pressures after defecation in 

continent and incontinent patients. Dis Colon 

Rectum 1994 Nov; 37(11):1073-7. Not 

eligible exposure 

1697. Groutz A, Blaivas JG, Chaikin DC, et al. 

Noninvasive outcome measures of urinary 

incontinence and lower urinary tract 

symptoms: a multicenter study of micturition 

diary and pad tests. J Urol 2000 Sep; 164(3 Pt 

1):698-701. Not eligible outcomes 

1698. Groutz A, Blaivas JG, Chaikin DC, et al. The 

pathophysiology of post-radical prostatectomy 

incontinence: a clinical and video urodynamic 

study. J Urol 2000 Jun; 163(6):1767-70. Caseseries 

1699. Groutz A, Blaivas JG, Hyman MJ, et al. 

Pubovaginal sling surgery for simple stress 

urinary incontinence: analysis by an outcome 

score. J Urol 2001 May; 165(5):1597-600. 

Case-series 

1700. Groutz A, Blaivas JG, Rosenthal JE. A 

simplified urinary incontinence score for the 

evaluation of treatment outcomes. Neurourol 

Urodyn 2000; 19(2):127-35. Not eligible 

outcomes 

1701. Groutz A, Chaikin DC, Theusen E, et al. Use 

of cadaveric solvent-dehydrated fascia lata for 

cystocele repair--preliminary results. Urology 

2001 Aug; 58(2):179-83. Case-series 

1702. Groutz A, Gold R, Pauzner D, et al. Tensionfree vaginal tape (TVT) for the treatment of 

occult stress urinary incontinence in women 

undergoing prolapse repair: a prospective 

study of 100 consecutive cases. Neurourol 

Urodyn 2004; 23(7):632-5. Case-series 

1703. Groutz A, Gordon D, Keidar R, et al. Stress 

urinary incontinence: prevalence among 

nulliparous compared with primiparous and 

grand multiparous premenopausal women. 

Neurourol Urodyn 1999; 18(5):419-25. Not 

eligible level of evidence 

1704. Groutz A, Gordon D, Wolman I, et al. The use 

of prophylactic Stamey bladder neck 

suspension to prevent post-operative stress 

urinary incontinence in clinically continent 

women undergoing genitourinary prolapse 

repair. Neurourol Urodyn 2000; 19(6):671-6. 

Not eligible target population 

1705. Grunberger W, Grunberger V, Wierrani F. 

Pelvic promontory fixation of the vaginal 

vault in sixty-two patients with prolapse after 

hysterectomy. J Am Coll Surg 1994 Jan; 

178(1):69-72. Case-series 

1706. Guarino AH. Treatment of intractable 

constipation with orlistat: a report of three 

cases. Pain Med 2005 Jul-Aug; 6(4):327-8. 

Case- Reports 

1707. Guarisi T, Pinto-Neto AM, Herrmann V, et al. 

Urodynamics in climacteric women with 

urinary incontinence: correlation with route of 

delivery. Int Urogynecol J Pelvic Floor 

Dysfunct 2002 Nov; 13(6):366-71; discussion 

71. Case-series 

1708. Guatelli S, Dall'Oglio B, Schiavon L, et al. 

Pubo-vaginal sling. Arch Ital Urol Androl 

2004 Mar; 76(1):46-8. Case-series 

1709. Gudziak MR, McGuire EJ, Gormley EA. 

Urodynamic assessment of urethral sphincter 

function in post-prostatectomy incontinence. J 

Urol 1996 Sep; 156(3):1131-4; discussion 4-5. 

Not eligible outcomes 
B-77 

1710. Guelinckx PJ, Sinsel NK, Gruwez JA. Anal 

sphincter reconstruction with the gluteus 

maximus muscle: anatomic and physiologic 

considerations concerning conventional and 

dynamic gluteoplasty. Plast Reconstr Surg 

1996 Aug; 98(2):293-302; discussion 3-4. 

Case-series 

1711. Guerette N, Neimark M, Kopka SL, et al. 

Initial experience with a new method for the 

dynamic assessment of pelvic floor function in 

women: the Kolpexin Pull Test. Int 

Urogynecol J Pelvic Floor Dysfunct 2004 JanFeb; 15(1):39-43; discussion Not eligible level 

of evidence 

1712. Gufler H, DeGregorio G, Allmann KH, et al. 

Comparison of cystourethrography and 

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Comput Assist Tomogr 2000 May-Jun; 

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1713. Gufler H, Laubenberger J, DeGregorio G, et 

al. Pelvic floor descent: dynamic MR imaging 

using a half-Fourier RARE sequence. J Magn 

Reson Imaging 1999 Mar; 9(3):378-83. Not 

eligible outcomes 

1714. Gufler H, Ohde A, Grau G, et al. 

Colpocystoproctography in the upright and 

supine positions correlated with dynamic MRI 

of the pelvic floor. Eur J Radiol 2004 Jul; 

51(1):41-7. Case-series 

1715. Gui D, Cassetta E, Anastasio G, et al. 

Botulinum toxin for chronic anal fissure. 

Lancet 1994 Oct 22; 344(8930):1127-8. Caseseries 

1716. Guihan M, Simmons B, Nelson A, et al. 

Spinal cord injury providers' perceptions of 

barriers to implementing selected clinical 

practice guideline recommendations. J Spinal 

Cord Med 2003 Spring; 26(1):48-58. Not 

eligible outcomes 

1717. Guillemot F, Bouche B, Gower-Rousseau C, 

et al. Biofeedback for the treatment of fecal 

incontinence. Long-term clinical results. Dis 

Colon Rectum 1995 Apr; 38(4):393-7. Not 

eligible target population 

1718. Guillemot F, Leroy J, Boniface M, et al. 

Functional assessment of coloanal 

anastomosis with reservoir and excision of the 

anal transition zone. Dis Colon Rectum 1991 

Nov; 34(11):967-72. Case-series 

1719. Guillonneau B, Cathelineau X, Doublet JD, et 

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15(4):441-5; discussion 7-8. Case series 

1720. Gundian JC, Barrett DM, Parulkar BG. Mayo 

Clinic experience with the AS800 artificial 

urinary sphincter for urinary incontinence 

after transurethral resection of prostate or 

open prostatectomy. Urology 1993 Apr; 

41(4):318-21. Case-series 

1721. Gungor T, Ekin M, Dogan M, et al. Influence 

of anterior colporrhaphy with 

colpoperineoplasty operations for stress 

incontinence and/or genital descent on sexual 

life. J Pak Med Assoc 1997 Oct; 47(10):248-

50. Not eligible outcomes 

1722. Gunnarsson M, Mattiasson A. Female stress, 

urge, and mixed urinary incontinence are 

associated with a chronic and progressive 

pelvic floor/vaginal neuromuscular disorder: 

An investigation of 317 healthy and 

incontinent women using vaginal surface 

electromyography. Neurourol Urodyn 1999; 

18(6):613-21. Not eligible outcomes 

1723. Gunningberg L. Risk, prevalence and 

prevention of pressure ulcers in three Swedish 

healthcare settings. J Wound Care 2004 Jul; 

13(7):286-90. Not eligible outcomes 

1724. Guo Y, Palmer JL, Shen L, et al. Bowel and 

bladder continence, wound healing, and 

functional outcomes in patients who 

underwent sacrectomy. J Neurosurg Spine 

2005 Aug; 3(2):106-10. Case-series 

1725. Gupta G, Aronow WS. Hormone replacement 

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1726. Gupta PJ. Sphincterolysis: a novel approach 

towards chronic anal fissure. Eur Surg Res 

2006; 38(2):122-6. Case-series 

1727. Gupta SK, Sathyan G. Pharmacokinetics of an 

oral once-a-day controlled-release oxybutynin 

formulation compared with immediate-release 

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39(3):289-96. Not eligible outcomes 

1728. Gupta SK, Sathyan G, Lindemulder EA, et al. 

Quantitative characterization of therapeutic 

index: application of mixed-effects modeling 

to evaluate oxybutynin dose-efficacy and 

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Ther 1999 Jun; 65(6):672-84. Not eligible 

exposure 

1729. Gurel H, Gurel SA. Pelvic relaxation and 

associated risk factors: the results of logistic 

regression analysis. Acta Obstet Gynecol 

Scand 1999 Apr; 78(4):290-3. Not eligible 

outcomes 
B-78 

1730. Gustafsson C, Ekstrom A, Brismar S, et al. 

Urinary incontinence after hysterectomy--

three-year observational study. Urology 2006 

Oct; 68(4):769-74. Not eligible level of 

evidence 

1731. Gustafsson UM, Graf W. Excision of anal 

fistula with closure of the internal opening: 

functional and manometric results. Dis Colon 

Rectum 2002 Dec; 45(12):1672-8. Case-series 

1732. Gutierrez-Molina M, Caminero Rodriguez A, 

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syndrome. Acta Neuropathol (Berl) 1994; 

87(1):98-105. Case Reports 

1733. Haab F, Cardozo L, Chapple C, et al. Longterm open-label solifenacin treatment 

associated with persistence with therapy in 

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Eur Urol 2005 Mar; 47(3):376-84. Not eligible 

exposure 

1734. Haab F, Leach GE. Feasibility of outpatient 

percutaneous bladder neck suspension under 

local anesthesia. Urology 1997 Oct; 

50(4):585-7. Not eligible target population 

1735. Haab F, Stewart L, Dwyer P. Darifenacin, an 

M3 selective receptor antagonist, is an 

effective and well-tolerated once-daily 

treatment for overactive bladder. Eur Urol 

2004 Apr; 45(4):420-9; discussion 9. Not 

eligible exposure 

1736. Haab F, Trockman BA, Zimmern PE, et al. 

Quality of life and continence assessment of 

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minimum 3.5 years of followup. J Urol 1997 

Aug; 158(2):435-9. Case-series 

1737. Haab F, Zimmern PE, Leach GE. Urinary 

stress incontinence due to intrinsic sphincteric 

deficiency: experience with fat and collagen 

periurethral injections. J Urol 1997 Apr; 

157(4):1283-6. Not eligible target population 

1738. Haadem K, Dahlstrom JA, Ling L. Maximum 

anal sphincter strength measured by the solid 

sphere test and anal pressure profiles. Eur J 

Surg 1992 Sep; 158(9):499-502. Not eligible 

outcomes 

1739. Haadem K, Dahlstrom JA, Lingman G. Anal 

sphincter function after delivery: a prospective 

study in women with sphincter rupture and 

controls. Eur J Obstet Gynecol Reprod Biol 

1990 Apr; 35(1):7-13. Not eligible outcomes 

1740. Haadem K, Ling L, Ferno M, et al. Estrogen 

receptors in the external anal sphincter. Am J 

Obstet Gynecol 1991 Feb; 164(2):609-10. Not 

eligible outcomes 

1741. Haberl H, Tallen G, Michael T, et al. Surgical 

aspects and outcome of delayed tethered cord 

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65(4):161-7. Not eligible target population 

1742. Hadley HR, Pineda EB. The urethral sling and 

stress urinary incontinence. West J Med 1998 

Sep; 169(3):167-8. Comment 

1743. Hadzi-Djokic J, Stoiljkovic J, Basic D, et al. 

Clinical and urodynamic outcomes of tensionfree vaginal tape procedure. Acta Chir Iugosl 

2004; 51(3):57-60. Case-series 

1744. Haenggi W, Ammann M, Katz M, et al. 

Urethral isolation of Chlamydia trachomatis in 

women with urinary incontinence. Eur J 

Obstet Gynecol Reprod Biol 1991 Nov 3; 

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1745. Hafeez M, Asif S, Hanif H. Profile and repair 

success of vesico-vaginal fistula in Lahore. J 

Coll Physicians Surg Pak 2005 Mar; 

15(3):142-4. Case-series 

1746. Haferkamp A, Freund T, Wagener N, et al. 

Distribution of neuropeptide Y-containing 

nerves in the neurogenic and non-neurogenic 

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eligible outcomes 

1747. Haferkamp A, Staehler G, Gerner HJ, et al. 

Dosage escalation of intravesical oxybutynin 

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Case-series 

1748. Hagan T. Nurses take the lead in continence 

work. Nurs Stand 1990 Jun 27-Jul 3; 4(40):24-

8. Comment 

1749. Hagen S, Hanley J, Capewell A. Test-retest 

reliability, validity, and sensitivity to change 

of the urogenital distress inventory and the 

incontinence impact questionnaire. Neurourol 

Urodyn 2002; 21(6):534-9. Not eligible 

outcomes 

1750. Hagiwara N, Toyoda K, Uwatoko T, et al. 

Successful high dose glucocorticoid treatment 

for subacute neuromyelitis optica with 

systemic lupus erythematosus. Intern Med 

2005 Sep; 44(9):998-1001. Case- Reports 

1751. Hahn I, Milsom I. Treatment of female stress 

urinary incontinence with a new anatomically 

shaped vaginal device (Conveen Continence 

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eligible target population 

1752. Hahnfeld LE, Nakada SY, Moon TD. 

Identification of microtacks in the bladder 

after laparoscopic pelvic surgery. Urology 

1999 Jul; 54(1):162. Case Reports 
B-79 

1753. Hahnloser D, Pemberton JH, Wolff BG, et al. 

Pregnancy and delivery before and after ileal 

pouch-anal anastomosis for inflammatory 

bowel disease: immediate and long-term 

consequences and outcomes. Dis Colon 

Rectum 2004 Jul; 47(7):1127-35. Not eligible 

target population 

1754. Haimanot RT. Neurological complications of 

endemic skeletal fluorosis, with special 

emphasis on radiculo-myelopathy. Paraplegia 

1990 May; 28(4):244-51. Case-series 

1755. Hajebrahimi S, Corcos J, Lemieux MC. 

International consultation on incontinence 

questionnaire short form: comparison of 

physician versus patient completion and 

immediate and delayed self-administration. 

Urology 2004 Jun; 63(6):1076-8. Not eligible 

outcomes 

1756. Hakenberg OW, Ebermayer J, Manseck A, et 

al. Application of the Mitrofanoff principle for 

intermittent self-catheterization in 

quadriplegic patients. Urology 2001 Jul; 

58(1):38-42. Case Reports 

1757. Halaska M, Ralph G, Wiedemann A, et al. 

Controlled, double-blind, multicentre clinical 

trial to investigate long-term tolerability and 

efficacy of trospium chloride in patients with 

detrusor instability. World J Urol 2003 May; 

20(6):392-9. Not eligible exposure 

1758. Hale DS, Benson JT, Brubaker L, et al. 

Histologic analysis of needle biopsy of 

urethral sphincter from women with normal 

and stress incontinence with comparison of 

electromyographic findings. Am J Obstet 

Gynecol 1999 Feb; 180(2 Pt 1):342-8. Not 

eligible level of evidence 

1759. Hall AF, Theofrastous JP, Cundiff GW, et al. 

Interobserver and intraobserver reliability of 

the proposed International Continence 

Society, Society of Gynecologic Surgeons, 

and American Urogynecologic Society pelvic 

organ prolapse classification system. Am J 

Obstet Gynecol 1996 Dec; 175(6):1467-70; 

discussion 70-1. Not eligible outcomes 

1760. Hall J, Thomas DG. Surgical closure of the 

bulbar urethra for the treatment of intractable 

urinary incontinence in the paralysed patient. 

Br J Urol 1998 Dec; 82(6):912. Case-reports 

1761. Hall JD, Boyd JC, Lippert MC, et al. Why 

patients choose prostatectomy or 

brachytherapy for localized prostate cancer: 

results of a descriptive survey. Urology 2003 

Feb; 61(2):402-7. Not eligible outcomes 

1762. Hall W, McCracken K, Osterweil P, et al. 

Frequency and predictors for postpartum fecal 

incontinence. Am J Obstet Gynecol 2003 

May; 188(5):1205-7. Case-series 

1763. Hallbook O, Sjodahl R. Comparison between 

the colonic J pouch-anal anastomosis and 

healthy rectum: clinical and physiological 

function. Br J Surg 1997 Oct; 84(10):1437-41. 

Not eligible outcomes 

1764. Halligan S, Spence-Jones C, Kamm MA, et al. 

Dynamic cystoproctography and physiological 

testing in women with urinary stress 

incontinence and urogenital prolapse. Clin 

Radiol 1996 Nov; 51(11):785-90. Not eligible 

outcomes 

1765. Haltbakk J, Hanestad BR, Hunskaar S. 

Relevance and variability of the severity of 

incontinence, and increased daytime and 

night-time voiding frequency, associated with 

quality of life in men with lower urinary tract 

symptoms. BJU Int 2005 Jul; 96(1):83-7. Case 

series 

1766. Haltbakk J, Hanestad BR, Hunskaar S. How 

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symptoms (LUTS) and their impact on the 

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Sep; 14(7):1733-41. Case series 

1767. Halverson AL, Hull TL. Long-term outcome 

of overlapping anal sphincter repair. Dis 

Colon Rectum 2002 Mar; 45(3):345-8. 

Comment 

1768. Halverson AL, Hull TL, Paraiso MF, et al. 

Outcome of sphincteroplasty combined with 

surgery for urinary incontinence and pelvic 

organ prolapse. Dis Colon Rectum 2001 Oct; 

44(10):1421-6. Case-series 

1769. Hamalainen KJ, Raivio P, Antila S, et al. 

Biofeedback therapy in rectal prolapse 

patients. Dis Colon Rectum 1996 Mar; 

39(3):262-5. Not eligible target population 

1770. Hamalainen KP, Sainio AP. Cutting seton for 

anal fistulas: high risk of minor control 

defects. Dis Colon Rectum 1997 Dec; 

40(12):1443-6; discussion 7. Case-series 

1771. Hamdy H, Abdul Wahab AM, Fakhroo A, et 

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Br J Surg 1994 Apr; 81(4):601-2. Comment 

1772. Hamid R, Arya M, Khastgir J, et al. The 

treatment of male stress urinary incontinence 

with polydimethylsiloxane in compliant 

bladders following spinal cord injury. Spinal 

Cord 2003 May; 41(5):286-9. Case-series 
B-80 

1773. Hamid R, Khastgir J, Arya M, et al. 

Experience of tension-free vaginal tape for the 

treatment of stress incontinence in females 

with neuropathic bladders. Spinal Cord 2003 

Feb; 41(2):118-21. Case-series 

1774. Hamilton AS, Stanford JL, Gilliland FD, et al. 

Health outcomes after external-beam radiation 

therapy for clinically localized prostate 

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19(9):2517-26. Case Series 

1775. Hammer BJ. An interdisciplinary approach to 

urinary incontinence. Geriatr Nurs 1998 NovDec; 19(6):338-41. Comment 

1776. Hammerer P, Huland H. Urodynamic 

evaluation of changes in urinary control after 

radical retropubic prostatectomy. J Urol 1997 

Jan; 157(1):233-6. Case-series 

1777. Hampel C, Wienhold D, Benken N, et al. 

Prevalence and natural history of female 

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Review and meta-analysis 

1778. Hamzeh R, Oligbo N. Tension-free tape 

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Reports 

1779. Han MO, Lee NY, Park HS. Abdominal 

obesity is associated with stress urinary 

incontinence in Korean women. Int 

Urogynecol J Pelvic Floor Dysfunct 2006 Jan; 

17(1):35-9. Not eligible level of evidence 

1780. Han PY, Ezquerro R, Pan KM, et al. 

Comorbidities associated with diabetic foot 

complications among Asian Americans in 

southern California. J Am Podiatr Med Assoc 

2003 Jan-Feb; 93(1):37-41. Not eligible level 

of evidence 

1781. Han SJ, Park HJ, Kim CB, et al. Long-term 

follow-up of gracilis muscle transposition in 

children. Yonsei Med J 1995 Sep; 36(4):372-

7. Not eligible target population 

1782. Han TR, Kim JH, Kwon BS. Chronic 

gastrointestinal problems and bowel 

dysfunction in patients with spinal cord injury. 

Spinal Cord 1998 Jul; 36(7):485-90. Caseseries 

1783. Hancock R, Bender P, Dayhoff N, et al. 

Factors associated with nursing interventions 

to reduce incontinence in hospitalized older 

adults. Urol Nurs 1996 Sep; 16(3):79-85. Not 

eligible target population 

1784. Handa VL, Harvey L, Cundiff GW, et al. 

Perioperative complications of surgery for 

genital prolapse: does concomitant antiincontinence surgery increase complications? 

Urology 2005 Mar; 65(3):483-7. Not eligible 

outcomes 

1785. Handa VL, Harvey L, Cundiff GW, et al. 

Sexual function among women with urinary 

incontinence and pelvic organ prolapse. Am J 

Obstet Gynecol 2004 Sep; 191(3):751-6. 

Case-series 

1786. Handa VL, Jensen JK, Germain MM, et al. 

Banked human fascia lata for the suburethral 

sling procedure: a preliminary report. Obstet 

Gynecol 1996 Dec; 88(6):1045-9. Case-series 

1787. Handa VL, Jensen JK, Ostergard DR. The 

effect of patient position on proximal urethral 

mobility. Obstet Gynecol 1995 Aug; 

86(2):273-6. Not eligible outcomes 

1788. Hanif MS, Saeed K, Sheikh MA. Surgical 

management of genitourinary fistula. J Pak 

Med Assoc 2005 Jul; 55(7):280-4. Case-series 

1789. Hankey GJ, Jamrozik K, Broadhurst RJ, et al. 

Five-year survival after first-ever stroke and 

related prognostic factors in the Perth 

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31(9):2080-6. Not eligible level of evidence 

1790. Hankins GD. Lower thoracic spinal cord 

injury--a severe complication of shoulder 

dystocia. Am J Perinatol 1998 Jul; 15(7):443-

4. Case-reports 

1791. Hanlon M, Cofone E. Patient with frequent 

liquid stools resulting in a chemical dermatitis 

and a perianal ulcer. J Wound Ostomy 

Continence Nurs 1996 May; 23(3):174-7. 

Case Reports 

1792. Hannappel J, Krieger S. Subjective and 

clinical results after transurethral resection and 

suprapubic prostatectomy in benign prostatic 

hypertrophy. Eur Urol 1991; 20(4):272-6. 

Case-series 

1793. Hannestad YS, Lie RT, Rortveit G, et al. 

Familial risk of urinary incontinence in 

women: population based cross sectional 

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Not eligible level of evidence 

1794. Hannestad YS, Rortveit G, Hunskaar S. Helpseeking and associated factors in female 

urinary incontinence. The Norwegian 

EPINCONT Study. Epidemiology of 

Incontinence in the County of NordTrondelag. Scand J Prim Health Care 2002 

Jun; 20(2):102-7. Not eligible outcomes 
B-81 

1795. Hanzal E, Berger E, Koelbl H. Levator ani 

muscle morphology and recurrent genuine 

stress incontinence. Obstet Gynecol 1993 

Mar; 81(3):426-9. Case-series 

1796. Hanzal E, Joura EM, Haeusler G, et al. 

Influence of catheterisation on the results of 

sonographic urethrocystography in patients 

with genuine stress incontinence. Arch 

Gynecol Obstet 1994; 255(4):189-93. Not 

eligible outcomes 

1797. Hara I, Kawabata G, Miyake H, et al. 

Comparison of quality of life following 

laparoscopic and open prostatectomy for 

prostate cancer. J Urol 2003 Jun; 169(6):2045-

8. Not eligible outcomes 

1798. Hara N, Koike H, Bilim V, et al. Placement of 

a urethral catheter into the ureter: An 

unexpected complication after retropubic 

suspension. Int J Urol 2005 Feb; 12(2):217-9. 

Case Reports 

1799. Harano M, Eto M, Nakamura M, et al. A pilot 

study of the assessment of the quality of life, 

functional results, and complications in 

patients with an ileal neobladder for invasive 

bladder cancer. Int J Urol 2007 Feb; 

14(2):112-7. Case-series 

1800. Harari D, Malone-Lee JG. Oxybutynin and 

incontinence during grand mal seizures. Br J 

Urol 1991 Dec; 68(6):658. Case- Reports 

1801. Harari D, Sarkarati M, Gurwitz JH, et al. 

Constipation-related symptoms and bowel 

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401. Case-series 

1802. Hardiman PJ, Drutz HP. Sacrospinous vault 

suspension and abdominal colposacropexy: 

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Gynecol 1996 Sep; 175(3 Pt 1):612-6. Not 

eligible outcomes 

1803. Harewood GC, Coulie B, Camilleri M, et al. 

Descending perineum syndrome: audit of 

clinical and laboratory features and outcome 

of pelvic floor retraining. Am J Gastroenterol 

1999 Jan; 94(1):126-30. Case-series 

1804. Harewood LM. Laparoscopic needle 

colposuspension for genuine stress 

incontinence. J Endourol 1993 Aug; 7(4):319-

22. Case-reports 

1805. Harmanli OH, Dandolu V, Chatwani AJ, et al. 

Total colpocleisis for severe pelvic organ 

prolapse. J Reprod Med 2003 Sep; 48(9):703-

6. Case-series 

1806. Harms BA, Andersen AB, Starling JR. The W 

ileal reservoir: long-term assessment after 

proctocolectomy for ulcerative colitis and 

familial polyposis. Surgery 1992 Oct; 

112(4):638-46; discussion 46-8. Case-series 

1807. Harrington KL, Haskvitz EM. Managing a 

patient's constipation with physical therapy. 

Phys Ther 2006 Nov; 86(11):1511-9. Casereports 

1808. Harris CF, Cooper CS, Hutcheson JC, et al. 

Appendicovesicostomy: the mitrofanoff 

procedure-a 15-year perspective. J Urol 2000 

Jun; 163(6):1922-6. Case-series 

1809. Harris RL, Cundiff GW, Coates KW, et al. 

Urinary incontinence and pelvic organ 

prolapse in nulliparous women. Obstet 

Gynecol 1998 Dec; 92(6):951-4. Not eligible 

level of evidence 

1810. Harris RL, Cundiff GW, Theofrastous JP, et 

al. The value of intraoperative cystoscopy in 

urogynecologic and reconstructive pelvic 

surgery. Am J Obstet Gynecol 1997 Dec; 

177(6):1367-9; discussion 9-71. Not eligible 

target population 

1811. Harrison GL, Memel DS. Urinary 

incontinence in women: its prevalence and its 

management in a health promotion clinic. Br J 

Gen Pract 1994 Apr; 44(381):149-52. Not 

eligible level of evidence 

1812. Hart AL, Kamm MA, Palmer JG, et al. An 

extra-ordinary cause of megacolon. Lancet 

1997 Jul 12; 350(9071):110. Case-reports 

1813. Hart KJ, Palmer MH, Fitzgerald S. Perceived 

causes of urinary incontinence and reporting: 

a study with working women. Clin Nurs Res 

1999 Feb; 8(1):84-92. Not eligible outcomes 

1814. Hartanto VH, Lightner DJ, Nitti VW. 

Endoscopic evacuation of Durasphere. 

Urology 2003 Jul; 62(1):135-7. Case- Reports 

1815. Hartmaier SL, Sloane PD, Guess HA, et al. 

The MDS Cognition Scale: a valid instrument 

for identifying and staging nursing home 

residents with dementia using the minimum 

data set. J Am Geriatr Soc 1994 Nov; 

42(11):1173-9. Not eligible outcomes 

1816. Hartman EE, Oort FJ, Aronson DC, et al. 

Critical factors affecting quality of life of 

adult patients with anorectal malformations or 

Hirschsprung's disease. Am J Gastroenterol 

2004 May; 99(5):907-13. Not eligible 

outcomes 
B-82 

1817. Harvey MA, Kristjansson B, Griffith D, et al. 

The Incontinence Impact Questionnaire and 

the Urogenital Distress Inventory: a revisit of 

their validity in women without a urodynamic 

diagnosis. Am J Obstet Gynecol 2001 Jul; 

185(1):25-31. Not eligible outcomes 

1818. Hasegawa H, Radley S, Keighley MR. Longterm results of cutting seton fistulotomy. Acta 

Chir Iugosl 2000; 47(4 Suppl 1):19-21. Caseseries 

1819. Hashim H, Abrams P. Is the bladder a reliable 

witness for predicting detrusor overactivity? J 

Urol 2006 Jan; 175(1):191-4; discussion 4-5. 

Not eligible outcomes 

1820. Hashimoto BE, Botoman VA. New challenge 

for endorectal sonography: diagnosis of fecal 

incontinence. J Ultrasound Med 1993 Jul; 

12(7):375-8. Not eligible outcomes 

1821. Hashimoto K, Ohnishi N, Esa A, et al. 

Clinical efficacy of oxybutynin on sensory 

urgency as compared with that on motor 

urgency. Urol Int 1999; 62(1):12-6. Caseseries 

1822. Haslam J. The prevalence of stress urinary 

incontinence in women. Nurs Times 2004 

May 18; 100(20):71-3. No associative 

hypothesis tested 

1823. Hassan I, Horgan AF, Nivatvongs S. V-Y 

island flaps for repair of large perianal defects. 

Am J Surg 2001 Apr; 181(4):363-5. Caseseries 

1824. Hassink EA, Rieu PN, Severijnen RS, et al. 

Adults born with high anorectal atresia--how 

do they manage? Dis Colon Rectum 1996 Jun; 

39(6):695-9. Case-series 

1825. Hassink EA, Rieu PN, Severijnen RS, et al. 

Are adults content or continent after repair for 

high anal atresia? A long-term follow-up 

study in patients 18 years of age and older. 

Ann Surg 1993 Aug; 218(2):196-200. Caseseries 

1826. Hassouna MM, Heaton JP. Prostate cancer: 8. 

Urinary incontinence and erectile dysfunction. 

Cmaj 1999 Jan 12; 160(1):78-86. Case 

Reports 

1827. Hatada Y. Two-step surgical approach to 

labial adhesions in a postmenopausal woman. 

Acta Obstet Gynecol Scand 2003 Nov; 

82(11):1054-5. Case Reports 

1828. Hatch ML. Conceptualization and treatment of 

bowel obsessions: two case reports. Behav 

Res Ther 1997 Mar; 35(3):253-7. CaseReports 

1829. Hatem M, Fraser W, Lepire E. Postpartum 

urinary and anal incontinence: a populationbased study of quality of life of primiparous 

women in Quebec. J Obstet Gynaecol Can 

2005 Jul; 27(7):682-8. Not eligible level of 

evidence 

1830. Haugen V. Perineal skin care for patients with 

frequent diarrhea or fecal incontinence. 

Gastroenterol Nurs 1997 May-Jun; 20(3):87-

90. Case Reports 

1831. Haugen V, Loehner D. Surgical and 

nonsurgical options for a patient with a 

retracted stoma and peristomal skin crease. J 

Wound Ostomy Continence Nurs 2001 Jul; 

28(4):219-22. Case Reports 

1832. Hautmann RE. The ileal neobladder. Acta 

Urol Belg 1991; 59(2):227-40. Case-series 

1833. Hautmann RE, de Petriconi R, Gottfried HW, 

et al. The ileal neobladder: complications and 

functional results in 363 patients after 11 years 

of followup. J Urol 1999 Feb; 161(2):422-7; 

discussion 7-8. Not eligible level of evidence 

1834. Hautmann RE, Miller K, Steiner U, et al. The 

ileal neobladder: 6 years of experience with 

more than 200 patients. J Urol 1993 Jul; 

150(1):40-5. Case series 

1835. Hautmann RE, Sauter TW, Wenderoth UK. 

Radical retropubic prostatectomy: morbidity 

and urinary continence in 418 consecutive 

cases. Urology 1994 Feb; 43(2 Suppl):47-51. 

Not eligible level of evidence 

1836. Hawkyard S, Poon P, Morgan DR. Sertoli 

tumour presenting with stress incontinence in 

a patient with testicular feminization. BJU Int 

1999 Aug; 84(3):382-3. Case Reports 

1837. Haylen BT, Cerqui AJ, Meagher AP. Fivelayer repair of rectovaginal fistula using a 

vaginal approach. A case report. Aust N Z J 

Obstet Gynaecol 1999 Feb; 39(1):131-3. Case 

Reports 

1838. Haylen BT, Chetty N, Logan V, et al. Is 

sensory urgency part of the same spectrum of 

bladder dysfunction as detrusor overactivity? 

Int Urogynecol J Pelvic Floor Dysfunct 2007 

Feb; 18(2):123-8. Not eligible level of 

evidence 

1839. Hayn MA, Greco SJ, Capuano K, et al. 

Compliance with pelvic floor exercise 

program: maintaining bladder symptom relief. 

Urol Nurs 2000 Apr; 20(2):129-31. Not 

eligible outcomes 

1840. He S, Hussain N, Li S, et al. Clinical and 

prognostic analysis of ossified ligamentum 

flavum in a Chinese population. J Neurosurg 

Spine 2005 Nov; 3(5):348-54. Case-series 
B-83 

1841. Healy JC, Halligan S, Bartram CI, et al. 

Dynamic magnetic resonance imaging 

evaluation of the structural and functional 

results of postanal repair for neuropathic fecal 

incontinence. Dis Colon Rectum 2002 Dec; 

45(12):1629-34. Not eligible target population 

1842. Healy JC, Halligan S, Reznek RH, et al. 

Patterns of prolapse in women with symptoms 

of pelvic floor weakness: assessment with MR 

imaging. Radiology 1997 Apr; 203(1):77-81. 

Not eligible outcomes 

1843. Heath T, Watson R. The causes of urinary 

incontinence in men. Nurs Older People 2002 

Sep; 14(6):15-9. No associative hypothesis 

tested 

1844. Hebbard GS, Jenney AW, Gibson PR, et al. 

Chronic hepatic encephalopathy following 

portacaval shunt: management by loop 

ileostomy. Aust N Z J Surg 1993 Mar; 

63(3):231-4. Case Reports 

1845. Hedin K, Petersson C, Wideback K, et al. 

Asymptomatic bacteriuria in a population of 

elderly in municipal institutional care. Scand J 

Prim Health Care 2002 Sep; 20(3):166-8. Not 

eligible outcomes 

1846. Heemsbergen WD, Peeters ST, Koper PC, et 

al. Acute and late gastrointestinal toxicity after 

radiotherapy in prostate cancer patients: 

consequential late damage. Int J Radiat Oncol 

Biol Phys 2006 Sep 1; 66(1):3-10. Not eligible 

outcomes 

1847. Hefti M, Landolt H. Presacral mass consisting 

of a meningocele and a Tarlov cyst: successful 

surgical treatment based on pathogenic 

hypothesis. Acta Neurochir (Wien) 2006 Apr; 

148(4):479-83. Case Reports 

1848. Hegarty PK, Power PC, O'Brien MF, et al. 

Longevity of the Marshall-Marchetti-Krantz 

procedure. Ann Chir Gynaecol 2001; 

90(4):286-9. Case-series 

1849. Hegland A. A fresh start. Federal guidelines 

bring new perspective on incontinence. 

Contemp Longterm Care 1992 Jun; 15(6):78, 

80, 100. Comment 

1850. Hegland A. Incontinence: targeting treatment 

approaches. Provider 1994 Jul; 20(7):26-30, 2, 

4-6. Comment 

1851. Heikkinen M, Rintala R, Luukkonen P. Longterm anal sphincter performance after surgery 

for Hirschsprung's disease. J Pediatr Surg 

1997 Oct; 32(10):1443-6. Not eligible target 

population 

1852. Heinzlef O, Paternotte C, Mahieux F, et al. 

Mapping of a complicated familial spastic 

paraplegia to locus SPG4 on chromosome 2p. 

J Med Genet 1998 Feb; 35(2):89-93. Case 

Reports 

1853. Heit M. Infectious peritonitis complicating 

suprapubic catheter removal. Int Urogynecol J 

Pelvic Floor Dysfunct 1997; 8(1):47-9. Case 

Reports 

1854. Heit M. Intraurethral ultrasonography: 

correlation of urethral anatomy with 

functional urodynamic parameters in stress 

incontinent women. Int Urogynecol J Pelvic 

Floor Dysfunct 2000; 11(4):204-11. Not 

eligible outcomes 

1855. Heit M, Blackwell L, Ouseph R. 

Comorbidities affect the impact of urinary 

incontinence as measured by disease-specific 

quality of life instruments. Int Urogynecol J 

Pelvic Floor Dysfunct 2005 Jan-Feb; 16(1):6-

11; discussion Not eligible level of evidence 

1856. Heit M, Blackwell L, Thomas S, et al. 

Prevalence and severity of urinary 

incontinence in kidney transplant recipients. 

Obstet Gynecol 2004 Feb; 103(2):352-8. 

Case-series 

1857. Heit M, Vogt V, Brubaker L. An alternative 

statistical approach for predicting prolonged 

catheterization after Burch colposuspension 

during reconstructive pelvic surgery. Int 

Urogynecol J Pelvic Floor Dysfunct 1997; 

8(4):203-8. Not eligible outcomes 

1858. Helayel PE, Ceccon MS, Knaesel JA, et al. 

Urinary incontinence after bilateral parasacral 

sciatic-nerve block: report of two cases. Reg 

Anesth Pain Med 2006 Jul-Aug; 31(4):368-71. 

Case Reports 

1859. Helgason AR, Adolfsson J, Dickman P, et al. 

Waning sexual function--the most important 

disease-specific distress for patients with 

prostate cancer. Br J Cancer 1996 Jun; 

73(11):1417-21. Not eligible target population 

1860. Helstrom L, Nilsson B. Impact of vaginal 

surgery on sexuality and quality of life in 

women with urinary incontinence or genital 

descensus. Acta Obstet Gynecol Scand 2005 

Jan; 84(1):79-84. Not eligible outcomes 

1861. Helt M, Benson JT, Russell B, et al. Levator 

ani muscle in women with genitourinary 

prolapse: indirect assessment by muscle 

histopathology. Neurourol Urodyn 1996; 

15(1):17-29. Not eligible outcomes 
B-84 

1862. Helweg-Larsen S. Clinical outcome in 

metastatic spinal cord compression. A 

prospective study of 153 patients. Acta Neurol 

Scand 1996 Oct; 94(4):269-75. Not eligible 

exposure 

1863. Hely MA, Morris JG, Reid WG, et al. Sydney 

Multicenter Study of Parkinson's disease: nonL-dopa-responsive problems dominate at 15 

years. Mov Disord 2005 Feb; 20(2):190-9. 

Case-series 

1864. Hemal AK, Kumar R, Nabi G. Post-cesarean 

cervicovesical fistula: technique of 

laparoscopic repair. J Urol 2001 Apr; 

165(4):1167-8. Case-reports 

1865. Henderson JS, Kashka MS. Development and 

testing of the Urinary Incontinence Scales. 

Urol Nurs 1999 Jun; 19(2):109-19. Not 

eligible outcomes 

1866. Hendren WH. Construction of a female 

urethra using the vaginal wall and a buttock 

flap: experience with 40 cases. J Pediatr Surg 

1998 Feb; 33(2):180-7. Case-series 

1867. Hendry WF. Bladder replacement by 

ileocystoplasty after cystectomy for cancer: 

comparison of two techniques. Br J Urol 1996 

Jul; 78(1):74-9. Case-series 

1868. Henry LG, Cattey RP. Rectal prolapse. Surg 

Laparosc Endosc 1994 Oct; 4(5):357-60. 

Case-series 

1869. Henry T. Continence. Survey shows hidden 

problem. Nurs Times 1996 Feb 14-20; 

92(7):62-6. Comment 

1870. Hensle TW, Reiley EA, Chang DT. The 

Malone antegrade continence enema 

procedure in the management of patients with 

spina bifida. J Am Coll Surg 1998 Jun; 

186(6):669-74. Case-series 

1871. Henwood AM. A case of fecal incontinence. 

Home Healthc Nurse 1997 Aug; 15(8):558-9. 

Case Reports 

1872. Herbert JH. Postnatal pelvic floor screening 

clinics: a pilot study. Br J Community Nurs 

2000 Aug; 5(8):370, 2, 4-6. Case-series 

1873. Herbertsson G, Iosif CS. Surgical results and 

urodynamic studies 10 years after retropubic 

colpourethrocystopexy. Acta Obstet Gynecol 

Scand 1993 May; 72(4):298-301. Case-series 

1874. Herbst F, Kamm MA, Morris GP, et al. 

Gastrointestinal transit and prolonged 

ambulatory colonic motility in health and 

faecal incontinence. Gut 1997 Sep; 41(3):381-

9. Not eligible outcomes 

1875. Herbst F, Teleky B. Alteration of maximum 

anal resting pressure by digital rectal 

examination prior to manometry: analysis of 

agreement between repeat measurements. Int J 

Colorectal Dis 1994; 9(4):207-10. Not eligible 

outcomes 

1876. Herman RM, Richter P, Walega P, et al. 

Anorectal sphincter function and rectal 

barostat study in patients following transanal 

endoscopic microsurgery. Int J Colorectal Dis 

2001 Nov; 16(6):370-6. Case-series 

1877. Herman RM, Thor PJ, Sobocki J, et al. 

Anorectal and urinary dysfunction after 

surgery for rectal cancer. Folia Med Cracov 

2004; 45(3-4):63-71. Case-series 

1878. Hernandez-Magro PM, Villanueva Saenz E, 

Alvarez-Tostado Fernandez F, et al. Endoanal 

sonography in the assessment of perianal 

endometriosis with external anal sphincter 

involvement. J Clin Ultrasound 2002 May; 

30(4):245-8. Case-reports 

1879. Herr HW. Quality of life of incontinent men 

after radical prostatectomy. J Urol 1994 Mar; 

151(3):652-4. Case-series 

1880. Herrmann V, Arya LA, Myers DL, et al. 

Urethral resistance measurement: a new 

method for evaluation of stress urinary 

incontinence in women. Int Urogynecol J 

Pelvic Floor Dysfunct 2004 May-Jun; 

15(3):208-11. Not eligible exposure 

1881. Herschorn S, Becker D, Miller E, et al. Impact 

of a health education intervention in 

overactive bladder patients. Can J Urol 2004 

Dec; 11(6):2430-7. Not eligible exposure 

1882. Herschorn S, Radomski SB. Fascial slings and 

bladder neck tapering in the treatment of male 

neurogenic incontinence. J Urol 1992 Apr; 

147(4):1073-5. Case-series 

1883. Herschorn S, Steele DJ, Radomski SB. 

Followup of intraurethral collagen for female 

stress urinary incontinence. J Urol 1996 Oct; 

156(4):1305-9. Case-series 

1884. Herschorn S, Thijssen AJ, Radomski SB. 

Experience with the hemi-Kock 

ileocystoplasty with a continent abdominal 

stoma. J Urol 1993 May; 149(5):998-1001. 

Case-series 

1885. Herwig R, Bruns F, Strasser H, et al. Late 

urologic effects after adjuvant irradiation in 

stage I endometrial carcinoma. Urology 2004 

Feb; 63(2):354-8. Case-series 

1886. Hettiarachchi M, Garcea G, deSouza NM, et 

al. Evaluation of dysfunction following 

reconstruction of an anorectal anomaly. 

Pediatr Surg Int 2002 Sep; 18(5-6):405-9. Not 

eligible target population 
B-85 

1887. Hetzer FH, Hahnloser D, Clavien PA, et al. 

Video-assisted sacral nerve stimulation. Tech 

Coloproctol 2006 Jul; 10(2):121-3; discussion 

3-4. Case-series 

1888. Hetzer FH, Hahnloser D, Clavien PA, et al. 

Quality of life and morbidity after permanent 

sacral nerve stimulation for fecal 

incontinence. Arch Surg 2007 Jan; 142(1):8-

13. Case-series 

1889. Hewitt WR, Sokol TP, Fleshner PR. Should 

HIV status alter indications for 

hemorrhoidectomy? Dis Colon Rectum 1996 

Jun; 39(6):615-8. Not eligible exposure 

1890. Hextall A, Bidmead J, Cardozo L, et al. The 

impact of the menstrual cycle on urinary 

symptoms and the results of urodynamic 

investigation. Bjog 2001 Nov; 108(11):1193-

6. Not eligible target population 

1891. Hextall A, Boos K, Cardozo L, et al. 

Videocystourethrography with a ring pessary 

in situ. A clinically useful preoperative 

investigation for continent women with 

urogenital prolapse? Int Urogynecol J Pelvic 

Floor Dysfunct 1998; 9(4):205-9. Question 4 

1892. Heymen S, Wexner SD, Gulledge AD. MMPI 

assessment of patients with functional bowel 

disorders. Dis Colon Rectum 1993 Jun; 

36(6):593-6. Not eligible outcomes 

1893. Heyt GJ, Oh MK, Alemzadeh N, et al. 

Impaired rectoanal inhibitory response in 

scleroderma (systemic sclerosis): an 

association with fecal incontinence. Dig Dis 

Sci 2004 Jun; 49(6):1040-5. Not eligible 

outcomes 

1894. Hicken BL, Putzke JD, Richards JS. Bladder 

management and quality of life after spinal 

cord injury. Am J Phys Med Rehabil 2001 

Dec; 80(12):916-22. Not eligible outcomes 

1895. Hida J, Yoshifuji T, Tokoro T, et al. 

Comparison of long-term functional results of 

colonic J-pouch and straight anastomosis after 

low anterior resection for rectal cancer: a fiveyear follow-up. Dis Colon Rectum 2004 Oct; 

47(10):1578-85. Case-series 

1896. Hida J, Yoshifuji T, Tokoro T, et al. Longterm functional outcome of low anterior 

resection with colonic J-pouch reconstruction 

for rectal cancer in the elderly. Dis Colon 

Rectum 2004 Sep; 47(9):1448-54. Case-series 

1897. Higley P. With nature's help. Nurs Times 1998 

Aug 12-18; 94(32):79-80. Case- Reports 

1898. Hill DE, Chantigian PM, Kramer SA. 

Pregnancy after augmentation cystoplasty. 

Surg Gynecol Obstet 1990 Jun; 170(6):485-7. 

Case-reports 

1899. Hill E, Haydel M. Conversion disorder 

presenting as hemiplegia and hemianesthesia 

with loss of neurologic reflexes: a case report. 

South Med J 2006 Apr; 99(4):380-2. Case 

Reports 

1900. Hill J, Corson RJ, Brandon H, et al. History 

and examination in the assessment of patients 

with idiopathic fecal incontinence. Dis Colon 

Rectum 1994 May; 37(5):473-7. Not eligible 

outcomes 

1901. Hill J, Hosker G, Kiff ES. Pudendal nerve 

terminal motor latency measurements: what 

they do and do not tell us. Br J Surg 2002 Oct; 

89(10):1268-9. Not eligible outcomes 

1902. Hill J, Mumtaz A, Kiff ES. Pudendal 

neuropathy in patients with idiopathic faecal 

incontinence progresses with time. Br J Surg 

1994 Oct; 81(10):1494-5. Not eligible 

outcomes 

1903. Hill K, Fanning S, Fennerty MB, et al. 

Endoanal ultrasound compared to anorectal 

manometry for the evaluation of fecal 

incontinence: a study of the effect these tests 

have on clinical outcome. Dig Dis Sci 2006 

Feb; 51(2):235-40. case-series 

1904. Hill S, Khullar V, Wyndaele JJ, et al. Dose 

response with darifenacin, a novel once-daily 

M3 selective receptor antagonist for the 

treatment of overactive bladder: results of a 

fixed dose study. Int Urogynecol J Pelvic 

Floor Dysfunct 2006 May; 17(3):239-47. Not 

eligible exposure 

1905. Hilton P. Urodynamic findings in patients 

with urogenital fistulae. Br J Urol 1998 Apr; 

81(4):539-42. Case-series 

1906. Hiltunen KM, Matikainen M. Clinical results 

of abdominal rectopexy for rectal prolapse. 

Ann Chir Gynaecol 1991; 80(3):263-6. Caseseries 

1907. Hiltunen KM, Matikainen M. Improvement of 

continence after abdominal rectopexy for 

rectal prolapse. Int J Colorectal Dis 1992 Feb; 

7(1):8-10. Case-series 

1908. Himpens J, Cadiere GB, Bruyns J, et al. 

Laparoscopic rectopexy according to Wells. 

Surg Endosc 1999 Feb; 13(2):139-41. Caseseries 

1909. Hinata N, Shirakawa T, Okada H, et al. 

Quantitative analysis of the levels of 

expression of muscarinic receptor subtype 

RNA in the detrusor muscle of patients with 

overactive bladder. Mol Diagn 2004; 8(1):17-

22. Not eligible outcomes 
B-86 

1910. Hines SH, Seng JS, Messer KL, et al. 

Adherence to a behavioral program to prevent 

incontinence. West J Nurs Res 2007 Feb; 

29(1):36-56; discussion 7-64. Not eligible 

outcomes 

1911. Hinze J, Junkin J. The latest in treatments for 

incontinence in women. Nebr Nurse 2006 JunAug; 39(2):22-6; quiz 7-8. No associative 

hypothesis tested 

1912. Hirai K, Ishiko O, Sumi T, et al. Indifference 

and resignation of Japanese women toward 

urinary incontinence. Int J Gynaecol Obstet 

2001 Oct; 75(1):89-91. Not eligible level of 

evidence 

1913. Hirato J. Left frontal tumor in a 46-year-old 

man with urinary incontinence and gait 

disturbance. Neuropathology 2002 Dec; 

22(4):362-4. Case Reports 

1914. Hirono N, Kitagaki H, Kazui H, et al. Impact 

of white matter changes on clinical 

manifestation of Alzheimer's disease: A 

quantitative study. Stroke 2000 Sep; 

31(9):2182-8. Case-series 

1915. Hirsch A, Weirauch G, Steimer B, et al. 

Treatment of female urinary incontinence with 

EMG-controlled biofeedback home training. 

Int Urogynecol J Pelvic Floor Dysfunct 1999; 

10(1):7-10. Case-series 

1916. Hirsh T, Lembo T. Diagnosis and 

management of fecal incontinence in elderly 

patients. Am Fam Physician 1996 Oct; 

54(5):1559-64, 69-70. Review 

1917. Hirst GR, Arumugam PJ, Watkins AJ, et al. 

Antegrade continence enema in the treatment 

of obstructed defaecation with or without 

faecal incontinence. Tech Coloproctol 2005 

Dec; 9(3):217-21. Not eligible exposure 

1918. Ho AM, Roth P, Cowan WD. Gaseous 

distention of the urinary bag indicating 

bladder perforation during laparoscopic pelvic 

procedures. Int J Gynaecol Obstet 1996 Dec; 

55(3):297-8. Case Reports 

1919. Ho NC, Hadley DW, Jain PK, et al. Case 47: 

dural ectasia associated with Marfan 

syndrome. Radiology 2002 Jun; 223(3):767-

71. Case Reports 

1920. Ho P, Law WL, Chan SC, et al. Functional 

outcome following low anterior resection with 

total mesorectal excision in the elderly. Int J 

Colorectal Dis 2003 May; 18(3):230-3. Caseseries 

1921. Ho YH. Postanal sphincter repair for anterior 

resection anal sphincter injuries: report of 

three cases. Dis Colon Rectum 2001 Aug; 

44(8):1218-20. Case-reports 

1922. Ho YH, Chiang JM, Tan M, et al. 

Biofeedback therapy for excessive stool 

frequency and incontinence following anterior 

resection or total colectomy. Dis Colon 

Rectum 1996 Nov; 39(11):1289-92. Caseseries 

1923. Ho YH, Goh HS. Computerised 3-dimensional 

vector volume analysis--the role of a new 

method for assessing anal sphincter 

competence. Ann Acad Med Singapore 1992 

Mar; 21(2):263-6. Not eligible outcomes 

1924. Ho YH, Goh HS. Unilateral anal 

electrosensation. Modified technique to 

improve quantification of anal sensory loss. 

Dis Colon Rectum 1995 Mar; 38(3):239-44. 

Not eligible outcomes 

1925. Ho YH, Goh HS. The neurophysiological 

significance of perineal descent. Int J 

Colorectal Dis 1995; 10(2):107-11. Not 

eligible outcomes 

1926. Ho YH, Low D, Goh HS. Bowel function 

survey after segmental colorectal resections. 

Dis Colon Rectum 1996 Mar; 39(3):307-10. 

Not eligible level of evidence 

1927. Ho YH, Tan M. Biofeedback therapy for 

bowel dysfunction following low anterior 

resection. Ann Acad Med Singapore 1997 

May; 26(3):299-302. Case-series 

1928. Ho YH, Tan M, Chui CH, et al. Randomized 

controlled trial of primary fistulotomy with 

drainage alone for perianal abscesses. Dis 

Colon Rectum 1997 Dec; 40(12):1435-8. Not 

eligible outcomes 

1929. Hodder J. Shy Drager syndrome. Axone 1997 

Jun; 18(4):75-9. Comment 

1930. Hodges AM. The Mitrofanoff urinary 

diversion for complex vesicovaginal fistulae: 

experience from Uganda. BJU Int 1999 Sep; 

84(4):436-9. Case Reports 

1931. Hoffman MS, Arango H. Transvestibular 

retropubic bladder neck suspension. A pilot 

study. J Reprod Med 1995 Mar; 40(3):181-4. 

Case-series 

1932. Hoffman MS, Harris MS, Bouis PJ. 

Sacrospinous colpopexy in the management of 

uterovaginal prolapse. J Reprod Med 1996 

May; 41(5):299-303. Case-series 

1933. Hoffman MS, LaPolla JP, Roberts WS, et al. 

Use of local flaps for primary anal 

reconstruction following perianal resection for 

neoplasia. Gynecol Oncol 1990 Mar; 

36(3):348-52. Case-series 
B-87 

1934. Hoffman MS, Roberts WS, Finan MA, et al. A 

comparative study of radical vulvectomy and 

modified radical vulvectomy for the treatment 

of invasive squamous cell carcinoma of the 

vulva. Gynecol Oncol 1992 May; 45(2):192-7. 

Case-series 

1935. Hoffmann BA, Timmcke AE, Gathright JB, 

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of rectal sensation. Dis Colon Rectum 1995 

Jul; 38(7):746-8. Not eligible outcomes 

1936. Hofmann T, Gaensheimer S, Buchner A, et al. 

An unrandomized prospective comparison of 

urinary continence, bowel symptoms and the 

need for further procedures in patients with 

and with no adjuvant radiation after radical 

prostatectomy. BJU Int 2003 Sep; 92(4):360-

4. Case-series 

1937. Hoggarth A, Waring M, Alexander J, et al. A 

controlled, three-part trial to investigate the 

barrier function and skin hydration properties 

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exposure 

1938. Hogstel MO, Nelson M. Anticipation and 

early detection can reduce bowel elimination 

complications. Geriatr Nurs 1992 Jan-Feb; 

13(1):28-33. Case report 

1939. Hohenfellner M, Pannek J, Botel U, et al. 

Sacral bladder denervation for treatment of 

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Case-series 

1940. Hol M, van Bolhuis C, Vierhout ME. Vaginal 

ultrasound studies of bladder neck mobility. 

Br J Obstet Gynaecol 1995 Jan; 102(1):47-53. 

Not eligible level of evidence 

1941. Hollabaugh RS, Jr., Dmochowski RR, Kneib 

TG, et al. Preservation of putative continence 

nerves during radical retropubic prostatectomy 

leads to more rapid return of urinary 

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Case-series 

1942. Hollabaugh RS, Jr., Steiner MS, Sellers KD, 

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implications for colonic and rectal resection. 

Dis Colon Rectum 2000 Oct; 43(10):1390-7. 

Not eligible target population 

1943. Hollenbeck BK, Lipp ER, Hayward RA, et al. 

Concurrent assessment of obstructive/irritative 

urinary symptoms and incontinence after 

radical prostatectomy. Urology 2002 Mar; 

59(3):389-93. Not eligible level of evidence 

1944. Hollins S, Attard MT, von Fraunhofer N, et al. 

Mortality in people with learning disability: 

risks, causes, and death certification findings 

in London. Dev Med Child Neurol 1998 Jan; 

40(1):50-6. Not eligible outcomes 

1945. Holmberg A, Graf W, Osterberg A, et al. 

Anorectal manovolumetry in the diagnosis of 

fecal incontinence. Dis Colon Rectum 1995 

May; 38(5):502-8. Not eligible level of 

evidence 

1946. Holmdahl G, Sillen U. Boys with posterior 

urethral valves: outcome concerning renal 

function, bladder function and paternity at 

ages 31 to 44 years. J Urol 2005 Sep; 

174(3):1031-4; discussion 4. Not eligible 

exposure 

1947. Holmes P. Mind over bladder. Nurs Times 

1990 Jan 24-30; 86(4):16-7. Case Reports 

1948. Holmes SA, Christmas TJ, Kirby RS, et al. 

Cystectomy and substitution 

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treatment for T2/3 bladder cancer. Br J Urol 

1992 Mar; 69(3):260-4. Comment 

1949. Holmgren C, Hellberg D, Lanner L, et al. 

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surgery for female stress incontinence. Scand 

J Urol Nephrol 2006; 40(2):131-7. Case-series 

1950. Holmgren C, Nilsson S, Lanner L, et al. Longterm results with tension-free vaginal tape on 

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Gynecol 2005 Jul; 106(1):38-43. Case-series 

1951. Holroyd-Leduc JM, Straus SE. Management 

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Case-reports 

1952. Holschneider AM, Pfrommer W, Gerresheim 

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histology of the rectal pouch. Eur J Pediatr 

Surg 1994 Oct; 4(5):303-9. Not eligible target 

population 

1953. Holubar S, Hyman N. Continence alterations 

after ileal pouch-anal anastomosis do not 

diminish quality of life. Dis Colon Rectum 

2003 Nov; 46(11):1489-91. Not eligible target 

population 

1954. Holzer B, Matzel K, Schiedeck T, et al. Do 

geographic and educational factors influence 

the quality of life in rectal cancer patients with 

a permanent colostomy? Dis Colon Rectum 

2005 Dec; 48(12):2209-16. Not eligible 

outcomes 

1955. Hom D, Desautel MG, Lumerman JH, et al. 

Pubovaginal sling using polypropylene mesh 

and Vesica bone anchors. Urology 1998 May; 

51(5):708-13. Case-series 
B-88 

1956. Hombersley S. Guiding continence care. Elder 

Care 2000 Feb; 11(10):33. Comment 

1957. Homma Y, Ando T, Yoshida M, et al. Voiding 

and incontinence frequencies: variability of 

diary data and required diary length. 

Neurourol Urodyn 2002; 21(3):204-9. Not 

eligible outcomes 

1958. Homma Y, Kawabe K. Health-related quality 

of life of Japanese patients with overactive 

bladder treated with extended-release 

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J Urol 2004 Oct; 22(4):251-6. Not eligible 

exposure 

1959. Homma Y, Kawabe K, Hayashi K. Urologic 

morbidity and its influence on global 

satisfaction with treatment outcome after 

radical prostatectomy for prostate cancer. Int J 

Urol 1998 Nov; 5(6):556-61. Case-series 

1960. Homma Y, Kawabe K, Kageyama S, et al. 

Injection of glutaraldehyde cross-linked 

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Mar; 3(2):124-7. Not eligible target 

population 

1961. Homma Y, Koyama N. Minimal clinically 

important change in urinary incontinence 

detected by a quality of life assessment tool in 

overactive bladder syndrome with urge 

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25(3):228-35. Not eligible target population 

1962. Homma Y, Paick JS, Lee JG, et al. Clinical 

efficacy and tolerability of extended-release 

tolterodine and immediate-release oxybutynin 

in Japanese and Korean patients with an 

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7. Not eligible exposure 

1963. Homma Y, Uemura S. Use of the short form 

of King's Health Questionnaire to measure 

quality of life in patients with an overactive 

bladder. BJU Int 2004 May; 93(7):1009-13. 

Not eligible outcomes 

1964. Homma Y, Yoshida M, Seki N, et al. 

Symptom assessment tool for overactive 

bladder syndrome--overactive bladder 

symptom score. Urology 2006 Aug; 

68(2):318-23. Not eligible outcomes 

1965. Honein K, Boujaoude J, Chemaly M, et al. 

How can a migraine cause faecal 

incontinence? Gut 2005 Dec; 54(12):1817, 24. 

Case Reports 

1966. Hong B, Park S, Kim HS, et al. Factors 

predictive of urinary retention after a tensionfree vaginal tape procedure for female stress 

urinary incontinence. J Urol 2003 Sep; 

170(3):852-6. Not eligible target population 

1967. Honjo H, Naya Y, Ukimura O, et al. 

Acupuncture on clinical symptoms and 

urodynamic measurements in spinal-cordinjured patients with detrusor hyperreflexia. 

Urol Int 2000; 65(4):190-5. Not eligible target 

population 

1968. Hool GR, Hull TL, Fazio VW. Surgical 

treatment of recurrent complete rectal 

prolapse: a thirty-year experience. Dis Colon 

Rectum 1997 Mar; 40(3):270-2. Case-series 

1969. Hool GR, Lieber ML, Church JM. 

Postoperative anal canal length predicts 

outcome in patients having sphincter repair for 

fecal incontinence. Dis Colon Rectum 1999 

Mar; 42(3):313-8. Not eligible outcomes 

1970. Hope T, Keene J, Gedling K, et al. Behaviour 

changes in dementia. 1: Point of entry data of 

a prospective study. Int J Geriatr Psychiatry 

1997 Nov; 12(11):1062-73. Case-series 

1971. Horbach NS, Ostergard DR. Predicting 

intrinsic urethral sphincter dysfunction in 

women with stress urinary incontinence. 

Obstet Gynecol 1994 Aug; 84(2):188-92. Not 

eligible outcomes 

1972. Horimoto Y, Matsumoto M, Akatsu H, et al. 

Autonomic dysfunctions in dementia with 

Lewy bodies. J Neurol 2003 May; 250(5):530-

3. Case-series 

1973. Horstmann M, Schaefer T, Aguilar Y, et al. 

Neurogenic bladder treatment by doubling the 

recommended antimuscarinic dosage. 

Neurourol Urodyn 2006; 25(5):441-5. Not 

eligible target population 

1974. Hossack T, Solomon MJ, Young JM. Anocutaneous flap repair for complex and 

recurrent supra-sphincteric anal fistula. 

Colorectal Dis 2005 Mar; 7(2):187-92. Caseseries 

1975. Houser EE, Bartholomew TH, Cookson MS, 

et al. A prospective evaluation of leak point 

pressure, bladder compliance and clinical 

status in myelodysplasia patients with tethered 

spinal cords. J Urol 1994 Jan; 151(1):177-80; 

discussion 80-1. Not eligible target population 

1976. Houston S, Thornton C, Emmanuel J, et al. 

Human T cell lymphotropic virus type 1 in 

Zimbabwe. Trans R Soc Trop Med Hyg 1994 

Mar-Apr; 88(2):170-2. Case-reports 
B-89 

1977. Hovdenak N, Karlsdottir A, Sorbye H, et al. 

Profiles and time course of acute radiation 

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Oncol 2003; 42(7):741-8. Case-series 

1978. Howard D, Delancey JO, Tunn R, et al. Racial 

differences in the structure and function of the 

stress urinary continence mechanism. Obstet 

Gynecol 2000 May; 95(5):713-7. Case-series 

1979. Howden NS, Zyczynski HM, Moalli PA, et al. 

Comparison of autologous rectus fascia and 

cadaveric fascia in pubovaginal sling 

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2006 May; 194(5):1444-9. Case-series 

1980. Hoyte L, Jakab M, Warfield SK, et al. Levator 

ani thickness variations in symptomatic and 

asymptomatic women using magnetic 

resonance-based 3-dimensional color 

mapping. Am J Obstet Gynecol 2004 Sep; 

191(3):856-61. Not eligible outcomes 

1981. Hoyte L, Schierlitz L, Zou K, et al. Two- and 

3-dimensional MRI comparison of levator ani 

structure, volume, and integrity in women 

with stress incontinence and prolapse. Am J 

Obstet Gynecol 2001 Jul; 185(1):11-9. Not 

eligible exposure 

1982. Hruby G, Choo R, Lehman M, et al. Female 

clear cell adenocarcinoma arising within a 

urethral diverticulum. Can J Urol 2000 Dec; 

7(6):1160-3. Case Reports 

1983. Hsieh CH, Su TH, Chang ST. Prevalence of 

and attitude toward urinary incontinence in 

Taiwanese women. Int J Gynaecol Obstet 

2005 Feb; 88(2):152-3. Not eligible level of 

evidence 

1984. Hsieh CL, Sheu CF, Hsueh IP, et al. Trunk 

control as an early predictor of comprehensive 

activities of daily living function in stroke 

patients. Stroke 2002 Nov; 33(11):2626-30. 

Not eligible outcomes 

1985. Hsieh GC, Klutke JJ, Kobak WH. Low 

valsalva leak-point pressure and success of 

retropubic urethropexy. Int Urogynecol J 

Pelvic Floor Dysfunct 2001; 12(1):46-50. 

Case-series 

1986. Hsu EI, Hong EK, Lepor H. Influence of body 

weight and prostate volume on intraoperative, 

perioperative, and postoperative outcomes 

after radical retropubic prostatectomy. 

Urology 2003 Mar; 61(3):601-6. Case series 

1987. Hsu JW, Wang YC, Lin CC, et al. No 

evidence for association of alpha 1a 

adrenoceptor gene polymorphism and 

clozapine-induced urinary incontinence. 

Neuropsychobiology 2000; 42(2):62-5. Not 

eligible exposure 

1988. Hsu TH, Rackley RR, Abdelmalak JB, et al. 

Novel technique for combined repair of 

postirradiation vesicovaginal fistula and 

augmentation ileocystoplasty. Urology 2002 

Apr; 59(4):597-9. Case- Reports 

1989. Hsu WM, Chen CC. Clinical and manometric 

evaluation of postoperative fecal soiling in 

patients with Hirschsprung's disease. J Formos 

Med Assoc 1999 Jun; 98(6):410-4. Caseseries 

1990. Hu TW. Impact of urinary incontinence on 

health-care costs. J Am Geriatr Soc 1990 Mar; 

38(3):292-5. Not eligible outcomes 

1991. Hu TW, Wagner TH. Health-related 

consequences of overactive bladder: an 

economic perspective. BJU Int 2005 Sep; 96 

Suppl 1:43-5. Not eligible outcomes 

1992. Hu TW, Wagner TH, Bentkover JD, et al. 

Estimated economic costs of overactive 

bladder in the United States. Urology 2003 

Jun; 61(6):1123-8. Not eligible outcomes 

1993. Hu TW, Wagner TH, Bentkover JD, et al. 

Costs of urinary incontinence and overactive 

bladder in the United States: a comparative 

study. Urology 2004 Mar; 63(3):461-5. Not 

eligible outcomes 

1994. Huang AJ, Brown JS, Kanaya AM, et al. 

Quality-of-life impact and treatment of urinary 

incontinence in ethnically diverse older 

women. Arch Intern Med 2006 Oct 9; 

166(18):2000-6. Not eligible level of evidence 

1995. Huang AJ, Thom DH, Kanaya AM, et al. 

Urinary incontinence and pelvic floor 

dysfunction in Asian-American women. 

American Journal of Obstetrics and 

Gynecology 2006 Nov; 195(5):1331-7. Not 

eligible level of evidence 

1996. Huang KH, Kung FT, Liang HM, et al. 

Management of polypropylene mesh erosion 

after intravaginal midurethral sling operation 

for female stress urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2005 

Nov-Dec; 16(6):437-40. Case-reports 

1997. Huang KH, Kung FT, Liang HM, et al. 

Concomitant pelvic organ prolapse surgery 

with TVT procedure. Int Urogynecol J Pelvic 

Floor Dysfunct 2006 Jan; 17(1):60-5. Caseseries 

1998. Huang KH, Kung FT, Liang HM, et al. 

Concomitant surgery with tension-free vaginal 

tape. Acta Obstet Gynecol Scand 2003 Oct; 

82(10):948-53. Not eligible outcomes 
B-90 

1999. Huang WC, Yang JM. Sonographic 

appearance of a bladder calculus secondary to 

a suture from a bladder neck suspension. J 

Ultrasound Med 2002 Nov; 21(11):1303-5. 

Case Reports 

2000. Huang WC, Yang JM. Anatomic comparison 

between laparoscopic and open Burch 

colposuspension for primary stress urinary 

incontinence. Urology 2004 Apr; 63(4):676-

81; discussion 81. Case-series 

2001. Huang WC, Yang JM, Yang SH. Cystoscopy 

to investigate suprapubic catheter blockage: 

plugging of the side holes by bladder mucosa. 

Bjog 2005 May; 112(5):670-1. Case Reports 

2002. Huang WC, Yang SH, Yang JM. Anatomical 

and functional significance of urogenital 

hiatus in primary urodynamic stress 

incontinence. Ultrasound Obstet Gynecol 

2006 Jan; 27(1):71-7. Not eligible outcomes 

2003. Huang YH, Lin AT, Chen KK, et al. High 

failure rate using allograft fascia lata in 

pubovaginal sling surgery for female stress 

urinary incontinence. Urology 2001 Dec; 

58(6):943-6. Case-series 

2004. Huber FT, Stein H, Siewert JR. Functional 

results after treatment of rectal prolapse with 

rectopexy and sigmoid resection. World J 

Surg 1995 Jan-Feb; 19(1):138-43; discussion 

43. Case-series 

2005. Hubner WA, Schlarp OM. Treatment of 

incontinence after prostatectomy using a new 

minimally invasive device: adjustable 

continence therapy. BJU Int 2005 Sep; 

96(4):587-94. Case-series 

2006. Huckabay C, Twiss C, Berger A, et al. A 

urodynamics protocol to optimally assess men 

with post-prostatectomy incontinence. 

Neurourol Urodyn 2005; 24(7):622-6. Caseseries 

2007. Huebner ES, Surawicz CM. Diagnosis of 

celiac disease in a patient with fecal 

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Hepatol 2006 Mar; 3(3):172-5; quiz 6. Case 

Reports 

2008. Hueting WE, Gooszen HG, van Laarhoven CJ. 

Sexual function and continence after ileo 

pouch anal anastomosis: a comparison 

between a meta-analysis and a questionnaire 

survey. Int J Colorectal Dis 2004 May; 

19(3):215-8. Not eligible target population 

2009. Hughes SF, Williams NS. Continent colonic 

conduit for the treatment of faecal 

incontinence associated with disordered 

evacuation. Br J Surg 1995 Oct; 82(10):1318-

20. Case-series 

2010. Hugonnet CL, Danuser H, Springer JP, et al. 

Urethral sensitivity and the impact on urinary 

continence in patients with an ileal bladder 

substitute after cystectomy. J Urol 2001 May; 

165(5):1502-5. Not eligible exposure 

2011. Hui-Chi H. A checklist for assessing the risk 

of falls among the elderly. J Nurs Res 2004 

Jun; 12(2):131-42. Not eligible outcomes 

2012. Hull TL, Floruta C, Piedmonte M. Preliminary 

results of an outcome tool used for evaluation 

of surgical treatment for fecal incontinence. 

Dis Colon Rectum 2001 Jun; 44(6):799-805. 

Not eligible outcomes 

2013. Hullfish KL, Bovbjerg VE, Gibson J, et al. 

Patient-centered goals for pelvic floor 

dysfunction surgery: what is success, and is it 

achieved? Am J Obstet Gynecol 2002 Jul; 

187(1):88-92. Case-series 

2014. Hultman CS, Zenn MR, Agarwal T, et al. 

Restoration of fecal continence after 

functional gluteoplasty: long-term results, 

technical refinements, and donor-site 

morbidity. Ann Plast Surg 2006 Jan; 56(1):65-

70; discussion -1. Case-series 

2015. Hung MJ, Ho ES, Shen PS, et al. Urgency is 

the core symptom of female overactive 

bladder syndrome, as demonstrated by a 

statistical analysis. J Urol 2006 Aug; 

176(2):636-40. Not eligible target population 

2016. Hung MJ, Liu FS, Shen PS, et al. Analysis of 

two sling procedures using polypropylene 

mesh for treatment of stress urinary 

incontinence. Int J Gynaecol Obstet 2004 Feb; 

84(2):133-41. Case-series 

2017. Hunskaar S. One hundred and fifty men with 

urinary incontinence. I. Demography and 

medical history. Scand J Prim Health Care 

1992 Mar; 10(1):21-5. Not eligible target 

population 

2018. Hunskaar S, Sandvik H. One hundred and fifty 

men with urinary incontinence. III. 

Psychosocial consequences. Scand J Prim 

Health Care 1993 Sep; 11(3):193-6. Not 

eligible outcomes 

2019. Hunskaar S, Seim A, Freeman T. The journey 

of incontinent women from community to 

university clinic; implications for selection 

bias, gatekeeper function, and primary care. 

Fam Pract 1996 Aug; 13(4):363-8. Not 

eligible level of evidence 

2020. Hunt GM. Open spina bifida: outcome for a 

complete cohort treated unselectively and 

followed into adulthood. Dev Med Child 

Neurol 1990 Feb; 32(2):108-18. Not eligible 

target population 
B-91 

2021. Hunter S, Anderson J, Hanson D, et al. 

Clinical trial of a prevention and treatment 

protocol for skin breakdown in two nursing 

homes. J Wound Ostomy Continence Nurs 

2003 Sep; 30(5):250-8. Not eligible outcomes 

2022. Hurley DJ, Turner CL, Yalcin I, et al. 

Duloxetine for the treatment of stress urinary 

incontinence in women: an integrated analysis 

of safety. Eur J Obstet Gynecol Reprod Biol 

2006 Mar 1; 125(1):120-8. Not eligible 

exposure 

2023. Hurst C. Self-care secrets. Talking about 

urinary incontinence. You're not alone. Loss 

of bladder control is more common than you 

think. Diabetes Forecast 2003 Feb; 56(2):94-5. 

Patient handouts 

2024. Hussain MS, Shuaib A, Siddiqi ZA. Spinal 

cord transient ischemic attacks: a possible role 

for abciximab. Neurology 2005 Feb 22; 

64(4):761-2. Case- Reports 

2025. Hussain RM, Hartigan-Go K, Thomas SH, et 

al. Effect of oxybutynin on the QTc interval in 

elderly patients with urinary incontinence. Br 

J Clin Pharmacol 1996 Jan; 41(1):73-5. Not 

eligible outcomes 

2026. Hussar DA. New drugs: acamprosate calcium 

and solifenacin succinate. J Am Pharm Assoc 

(Wash DC) 2005 Jan-Feb; 45(1):109-11. No 

associative hypothesis tested 

2027. Hutchings A, Black NA. Surgery for stress 

incontinence: a non-randomised trial of 

colposuspension, needle suspension and 

anterior colporrhaphy. Eur Urol 2001 Apr; 

39(4):375-82. Not eligible outcomes 

2028. Hutchings A, Griffiths J, Black NA. Surgery 

for stress incontinence: factors associated with 

a successful outcome. Br J Urol 1998 Nov; 

82(5):634-41. Not eligible target population 

2029. Hutchinson R, Mostafa AB, Grant EA, et al. 

Scintigraphic defecography: quantitative and 

dynamic assessment of anorectal function. Dis 

Colon Rectum 1993 Dec; 36(12):1132-8. Not 

eligible outcomes 

2030. Hvidman L, Hvidman L, Foldspang A, et al. 

Correlates of urinary incontinence in 

pregnancy. Int Urogynecol J Pelvic Floor 

Dysfunct 2002; 13(5):278-83. Not eligible 

level of evidence 

2031. Hwang YH, Person B, Choi JS, et al. 

Biofeedback therapy for rectal 

intussusception. Tech Coloproctol 2006 Mar; 

10(1):11-5; discussion 5-6. Case-series 

2032. Hwang YM, Lee MC, Suh DC, et al. Coxiella 

(Q fever)-associated myelopathy. Neurology 

1993 Feb; 43(2):338-42. Case Reports 

2033. Hyman MJ, Groutz A, Blaivas JG. Detrusor 

instability in men: correlation of lower urinary 

tract symptoms with urodynamic findings. J 

Urol 2001 Aug; 166(2):550-2; discussion 3. 

Not eligible outcomes 

2034. Hyman N. Endoanal advancement flap repair 

for complex anorectal fistulas. Am J Surg 

1999 Oct; 178(4):337-40. Case-series 

2035. Hyman N. Incontinence after lateral internal 

sphincterotomy: a prospective study and 

quality of life assessment. Dis Colon Rectum 

2004 Jan; 47(1):35-8. Case-series 

2036. Hyman NH, Fazio VW, Tuckson WB, et al. 

Consequences of ileal pouch-anal anastomosis 

for Crohn's colitis. Dis Colon Rectum 1991 

Aug; 34(8):653-7. Case-series 

2037. Iglesias X, Espuna M. Surgical treatment of 

urinary stress incontinence using a method for 

postoperative adjustment of sling tension 

(Remeex System). Int Urogynecol J Pelvic 

Floor Dysfunct 2003 Nov; 14(5):326-30; 

discussion 30. Case-series 

2038. Iglesias X, Espuna M, Puig M, et al. Pubic 

bone anchoring devices for the surgical 

treatment of urinary stress incontinence in 

patients with severe genital prolapse. Int 

Urogynecol J Pelvic Floor Dysfunct 2002; 

13(5):314-8. Case-series 

2039. Iglicki F, Coffin B, Ille O, et al. Fecal 

incontinence after pelvic radiotherapy: 

evidences for a lumbosacral plexopathy. 

Report of a case. Dis Colon Rectum 1996 Apr; 

39(4):465-7. Case- Reports 

2040. Ijland MM, Fischer DC, Kieback DG, et al. 

Midline intravaginal slingplasty for treatment 

of urinary stress incontinence: results of an 

independent audit up to 2 years after surgery. 

Int Urogynecol J Pelvic Floor Dysfunct 2005 

Nov-Dec; 16(6):447-54. Case-series 

2041. Ikeda T, Tomita R, Koshinaga T. Anal 

mucosal electric sensation in postoperative 

patients with anorectal malformations. J 

Pediatr Surg 2005 Jul; 40(7):1146-50. Not 

eligible target population 

2042. Ikeuchi H, Kusunoki M, Shoji Y, et al. 

Clinico-physiological results after sphinctersaving resection for rectal carcinoma. Int J 

Colorectal Dis 1996; 11(4):172-6. Case-series 

2043. Ilbey O, Apaydin E, Gursan A, et al. Bladder 

leiomyoma: a rare cause of urinary stress 

incontinence. Arch Ital Urol Androl 2000 Jun; 

72(2):85-7. Case Reports 
B-92 

2044. Ilker Y, Tarcan T, Ozveren B, et al. Anterior 

urethropexy according to lapides: how 

effective is it in the treatment of genuine 

female stress incontinence? Arch Esp Urol 

2003 Jan-Feb; 56(1):95-9. Case-series 

2045. Indrekvam S, Fosse OA, Hunskaar S. A 

Norwegian national cohort of 3198 women 

treated with home-managed electrical 

stimulation for urinary incontinence--

demography and medical history. Scand J 

Urol Nephrol 2001 Feb; 35(1):26-31. Not 

eligible outcomes 

2046. Infantino A, Masin A, Melega E, et al. Does 

surgery resolve outlet obstruction from 

rectocele? Int J Colorectal Dis 1995; 10(2):97-

100. Case-series 

2047. Infantino A, Melega E, Negrin P, et al. 

Striated anal sphincter electromyography in 

idiopathic fecal incontinence. Dis Colon 

Rectum 1995 Jan; 38(1):27-31. Not eligible 

outcomes 

2048. Inghilleri M, Conte A, Frasca V, et al. 

Venlafaxine and bladder function. Clin 

Neuropharmacol 2005 Nov-Dec; 28(6):270-3. 

Not eligible target population 

2049. Iosif CS. Effects of protracted administration 

of estriol on the lower genito urinary tract in 

postmenopausal women. Arch Gynecol Obstet 

1992; 251(3):115-20. Case-series 

2050. Irer B, Aslan G, Cimen S, et al. Development 

of vesical calculi following tension-free 

vaginal tape procedure. Int Urogynecol J 

Pelvic Floor Dysfunct 2005 May-Jun; 

16(3):245-6. Case- Reports 

2051. Irvine L. Paving the way to self-control. 

Maintaining continence in elderly people. Prof 

Nurse 1991 Nov; 7(2):94-7. Comment 

2052. Irwin DE, Milsom I, Kopp Z, et al. Impact of 

overactive bladder symptoms on employment, 

social interactions and emotional well-being in 

six European countries. BJU Int 2006 Jan; 

97(1):96-100. Not eligible target population 

2053. Isbister WH. Anal incontinence surgery: a 

small personal experience. ANZ J Surg 2001 

May; 71(5):290-1. Case-series 

2054. Isherwood PJ, Rane A. Comparative 

assessment of pelvic floor strength using a 

perineometer and digital examination. Bjog 

2000 Aug; 107(8):1007-11. Not eligible 

outcomes 

2055. Ishigooka M, Hashimoto T, Hayami S, et al. 

Ice water test in patients with overactive 

bladder due to cerebrovascular accidents and 

bladder outlet obstruction. Urol Int 1997; 

58(2):84-7. Not eligible outcomes 

2056. Ishigooka M, Hashimoto T, Hayami S, et al. 

Electrical pelvic floor stimulation: a possible 

alternative treatment for reflex urinary 

incontinence in patients with spinal cord 

injury. Spinal Cord 1996 Jul; 34(7):411-5. Not 

eligible target population 

2057. Ishigooka M, Hashimoto T, Izumiya K, et al. 

Membranous lipodystrophy (Nasu's disease): a 

rare cause of neuropathic urinary 

incontinence. Urol Int 1993; 50(3):179-81. 

Case Reports 

2058. Ishigooka M, Hashimoto T, Izumiya K, et al. 

Incidence of anal incontinence after long-term 

follow-up of patients treated by 

ureterosigmoidostomy. Int Urol Nephrol 1993; 

25(5):455-60. Case-series 

2059. Ishigooka M, Hashimoto T, Sasagawa I, et al. 

Electrical pelvic floor stimulation by 

percutaneous implantable electrode. Br J Urol 

1994 Aug; 74(2):191-4. Case-series 

2060. Ishigooka M, Ishii N, Hashimoto T, et al. 

Electrical stimulation of pelvic floor 

musculature by percutaneous implantable 

electrodes: a case report. Int Urol Nephrol 

1992; 24(3):277-82. Case- Reports 

2061. Ishigooka M, Suzuki Y, Hashimoto T, et al. A 

new technique for sacral nerve stimulation: a 

percutaneous method for urinary incontinence 

caused by spinal cord injury. Br J Urol 1998 

Feb; 81(2):315-8. Case-series 

2062. Ishiko O, Ushiroyama T, Saji F, et al. beta(2)-

adrenergic agonists and pelvic floor exercises 

for female stress incontinence. Int J Gynaecol 

Obstet 2000 Oct; 71(1):39-44. Not eligible 

exposure 

2063. Ishunina TA, Kamphorst W, Swaab DF. 

Metabolic alterations in the hypothalamus and 

basal forebrain in vascular dementia. J 

Neuropathol Exp Neurol 2004 Dec; 

63(12):1243-54. Not eligible outcomes 

2064. Iskander MN, Kapoor D. Pregnancy following 

tension-free vaginal taping. Int Urogynecol J 

Pelvic Floor Dysfunct 2000 Jun; 11(3):199-

200. Case-reports 

2065. Ismael NN. A study on the menopause in 

Malaysia. Maturitas 1994 Oct; 19(3):205-9. 

Not eligible level of evidence 

2066. Ismael SS, Amarenco G, Bayle B, et al. 

Postpartum lumbosacral plexopathy limited to 

autonomic and perineal manifestations: 

clinical and electrophysiological study of 19 

patients. J Neurol Neurosurg Psychiatry 2000 

Jun; 68(6):771-3. Not eligible exposure 
B-93 

2067. Ismael SS, Epstein T, Bayle B, et al. Bladder 

cooling reflex in patients with multiple 

sclerosis. J Urol 2000 Oct; 164(4):1280-4. 

Case-series 

2068. Isozaki E, Matsubara S, Hayashida T, et al. 

Morphometric study of nucleus ambiguus in 

multiple system atrophy presenting with vocal 

cord abductor paralysis. Clin Neuropathol 

2000 Sep-Oct; 19(5):213-20. Case Reports 

2069. Ivey JF. Understanding and evaluating chronic 

urinary incontinence. J Fla Med Assoc 1992 

Dec; 79(12):823-7. Secondary data analysis 

2070. Iwai N, Deguchi E, Kimura O, et al. Social 

quality of life for adult patients with anorectal 

malformations. J Pediatr Surg 2007 Feb; 

42(2):313-7. Case-series 

2071. Jabs CF, Drutz HP. The role of intraoperative 

cystoscopy in prolapse and incontinence 

surgery. Am J Obstet Gynecol 2001 Dec; 

185(6):1368-71; discussion 72-3. Not eligible 

exposure 

2072. Jackson J, Emerson L, Johnston B, et al. 

Biofeedback: a noninvasive treatment for 

incontinence after radical prostatectomy. Urol 

Nurs 1996 Jun; 16(2):50-4. Not eligible target 

population 

2073. Jackson LA, Benson P, Neuzil KM, et al. 

Burden of community-onset Escherichia coli 

bacteremia in seniors. J Infect Dis 2005 May 

1; 191(9):1523-9. Not eligible outcomes 

2074. Jacobs PP, Scheuer M, Kuijpers JH, et al. 

Obstetric fecal incontinence. Role of pelvic 

floor denervation and results of delayed 

sphincter repair. Dis Colon Rectum 1990 Jun; 

33(6):494-7. Case-series 

2075. Jacome EG, Tutera G, Mattox FT. 

Laparoscopic Burch urethropexy in a private 

clinical practice. J Am Assoc Gynecol 

Laparosc 1999 Feb; 6(1):39-44. Case-series 

2076. Jacquetin B, Wyndaele J. Tolterodine reduces 

the number of urge incontinence episodes in 

patients with an overactive bladder. Eur J 

Obstet Gynecol Reprod Biol 2001 Sep; 

98(1):97-102. Not eligible exposure 

2077. Jaffin BW, Chang P, Spiera H. Fecal 

incontinence in scleroderma. Clinical features, 

anorectal manometric findings, and their 

therapeutic implications. J Clin Gastroenterol 

1997 Oct; 25(3):513-7. Case-series 

2078. Jakobsen H, Kromann-Andersen B, Nielsen 

KK, et al. Pad weighing tests with 50% or 

75% bladder filling. Does it matter? Acta 

Obstet Gynecol Scand 1993 Jul; 72(5):377-81. 

Not eligible level of evidence 

2079. Jameson JS, Rogers J, Chia YW, et al. Pelvic 

floor function in multiple sclerosis. Gut 1994 

Mar; 35(3):388-90. Not eligible outcomes 

2080. Jameson JS, Speakman CT, Darzi A, et al. 

Audit of postanal repair in the treatment of 

fecal incontinence. Dis Colon Rectum 1994 

Apr; 37(4):369-72. Case-series 

2081. Janknegt RA, Hassouna MM, Siegel SW, et 

al. Long-term effectiveness of sacral nerve 

stimulation for refractory urge incontinence. 

Eur Urol 2001 Jan; 39(1):101-6. Not eligible 

target population 

2082. Janknegt RA, Heesakkers JP, Weil EH, et al. 

Electrically stimulated gracilis sphincter 

(dynamic graciloplasty) for treatment of 

intrinsic sphincter deficiency: a pilot study on 

feasibility and side effects. J Urol 1995 Nov; 

154(5):1830-3. Not eligible target population 

2083. Janschek EC, Hohlagschwandtner M, Nather 

A, et al. A study of non-closure of the 

peritoneum at vaginal hysterectomy. Arch 

Gynecol Obstet 2003 Feb; 267(4):213-6. Not 

eligible outcomes 

2084. Janssen LW, van Dijke CF. Selection criteria 

for anterior rectal wall repair in symptomatic 

rectocele and anterior rectal wall prolapse. Dis 

Colon Rectum 1994 Nov; 37(11):1100-7. 

Case-series 

2085. Janssens F, Vandevenne J, Palmers Y. 

Chronic subdural hematoma of the lumbar 

spine. Jbr-Btr 2004 Jan-Feb; 87(1):51. Case 

Reports 

2086. Jarmy-Di Bella ZI, Girao MJ, Sartori MF, et 

al. Power Doppler of the urethra in continent 

or incontinent, pre- and postmenopausal 

women. Int Urogynecol J Pelvic Floor 

Dysfunct 2000 Jun; 11(3):148-54; discussion 

54-5. Not eligible outcomes 

2087. Jarrett ME, Matzel KE, Christiansen J, et al. 

Sacral nerve stimulation for faecal 

incontinence in patients with previous partial 

spinal injury including disc prolapse. Br J 

Surg 2005 Jun; 92(6):734-9. Not eligible 

target population 

2088. Jarrett ME, Matzel KE, Stosser M, et al. 

Sacral nerve stimulation for fecal incontinence 

following surgery for rectal prolapse repair: a 

multicenter study. Dis Colon Rectum 2005 

Jun; 48(6):1243-8. Not eligible target 

population 

2089. Jarrett ME, Matzel KE, Stosser M, et al. 

Sacral nerve stimulation for faecal 

incontinence following a rectosigmoid 

resection for colorectal cancer. Int J Colorectal 

Dis 2005 Sep; 20(5):446-51. Case-series 
B-94 

2090. Jarrett ME, Nicholls RJ, Kamm MA. Effect of 

sacral neuromodulation for faecal 

incontinence on sexual activity. Colorectal Dis 

2005 Sep; 7(5):523-5. Case-series 

2091. Jarrett ME, Varma JS, Duthie GS, et al. Sacral 

nerve stimulation for faecal incontinence in 

the UK. Br J Surg 2004 Jun; 91(6):755-61. 

Case-series 

2092. Jawad SH, Ward AB, Jones P. Study of the 

relationship between premorbid urinary 

incontinence and stroke functional outcome. 

Clin Rehabil 1999 Oct; 13(5):447-52. Not 

eligible outcomes 

2093. Jehle EC, Haehnel T, Starlinger MJ, et al. 

Level of the anastomosis does not influence 

functional outcome after anterior rectal 

resection for rectal cancer. Am J Surg 1995 

Jan; 169(1):147-52; discussion 52-3. Caseseries 

2094. Jenkins KR, Fultz NH. Functional impairment 

as a risk factor for urinary incontinence among 

older Americans. Neurourol Urodyn 2005; 

24(1):51-5. Not eligible level of evidence 

2095. Jenkins VR, 2nd. Uterosacral ligament 

fixation for vaginal vault suspension in uterine 

and vaginal vault prolapse. Am J Obstet 

Gynecol 1997 Dec; 177(6):1337-43; 

discussion 43-4. Case-series 

2096. Jensen H, Nielsen K, Frimodt-Moller C. 

Abacterial cystitis in urinary incontinent 

females. Urol Int 1990; 45(1):20-4. Not 

eligible exposure 

2097. Jensen LL, Lowry AC. Biofeedback improves 

functional outcome after sphincteroplasty. Dis 

Colon Rectum 1997 Feb; 40(2):197-200. 

Case-series 

2098. Jensen LM, Aabech J, Lundvall F, et al. 

Female urethral diverticulum. Clinical aspects 

and a presentation of 15 cases. Acta Obstet 

Gynecol Scand 1996 Sep; 75(8):748-52. Caseseries 

2099. Jervis LL. The pollution of incontinence and 

the dirty work of caregiving in a U.S. nursing 

home. Med Anthropol Q 2001 Mar; 15(1):84-

99. Not eligible outcomes 

2100. Jess P, Christiansen J, Bech P. Quality of life 

after anterior resection versus 

abdominoperineal extirpation for rectal 

cancer. Scand J Gastroenterol 2002 Oct; 

37(10):1201-4. Case-series 

2101. Jesudason SR, Mathai V, Gladwin G, et al. 

Functional outcome of overlapping sphincter 

repair for anal incontinence. Trop 

Gastroenterol 1999 Oct-Dec; 20(4):189-90. 

Comment 

2102. Jeter KF, Wagner DB. Incontinence in the 

American home. A survey of 36,500 people. J 

Am Geriatr Soc 1990 Mar; 38(3):379-83. Not 

eligible level of evidence 

2103. Jetzek-Zader M, Peterschulte G, Ludwig U, et 

al. Muscle weakness and paresthesia 

associated with epidural analgesia in a patient 

with an intrathecal neurofibrolipoma as part of 

a tethered cord syndrome. Anesth Analg 2004 

Jul; 99(1):255-8. Case Reports 

2104. Jha S, Arunkalaivanan AS, Davis J. Surgical 

management of stress urinary incontinence: a 

questionnaire based survey. Eur Urol 2005 

May; 47(5):648-52. Not eligible target 

population 

2105. Jiang JK, Lin JK. Does anastomotic method 

affect functional outcome of low anterior 

resection for rectal carcinoma? Zhonghua Yi 

Xue Za Zhi (Taipei) 1997 Nov; 60(5):252-8. 

Case-series 

2106. Jirovec MM. The impact of daily exercise on 

the mobility, balance and urine control of 

cognitively impaired nursing home residents. 

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2107. Jirovec MM, Jenkins J, Isenberg M, et al. 

Urine control theory derived from Roy's 

conceptual framework. Nurs Sci Q 1999 Jul; 

12(3):251-5. Review 

2108. Jirovec MM, Wells TJ. Urinary incontinence 

in nursing home residents with dementia: the 

mobility-cognition paradigm. Appl Nurs Res 

1990 Aug; 3(3):112-7. Case-series 

2109. Johannsson HO, Graf W, Pahlman L. Bowel 

habits in hemorrhoid patients and normal 

subjects. Am J Gastroenterol 2005 Feb; 

100(2):401-6. Not eligible level of evidence 

2110. Johansson C, Hellstrom L, Ekelund P, et al. 

Urinary incontinence: a minor risk factor for 

hip fractures in elderly women. Maturitas 

1996 Aug; 25(1):21-8. Not eligible outcomes 

2111. Johansson C, Molander U, Milsom I, et al. 

Association between urinary incontinence and 

urinary tract infections, and fractures in 

postmenopausal women. Maturitas 1996 Apr; 

23(3):265-71. Not eligible outcomes 

2112. Johansson C, Nilsson BY, Mellgren A, et al. 

Paradoxical sphincter reaction and associated 

colorectal disorders. Int J Colorectal Dis 1992 

Jun; 7(2):89-94. Case-series 

2113. John H. Bulbourethral composite suspension:: 

a new operative technique for postprostatectomy incontinence. J Urol 2004 May; 

171(5):1866-70; discussion 9-70. Case-series 
B-95 

2114. John H, Hauri D. Seminal vesicle-sparing 

radical prostatectomy: a novel concept to 

restore early urinary continence. Urology 

2000 Jun; 55(6):820-4. Case-series 

2115. John H, Hauri D, Leuener M, et al. Evidence 

of trigonal denervation and reinnervation after 

radical retropubic prostatectomy. J Urol 2001 

Jan; 165(1):111-3. Case-series 

2116. Johnson DE, Muncie HL, O'Reilly JL, et al. 

An external urine collection device for 

incontinent women. Evaluation of long-term 

use. J Am Geriatr Soc 1990 Sep; 38(9):1016-

22. Case-series 

2117. Johnson DW, ElHajj M, EL OB-B, et al. 

Necrotizing fasciitis after tension-free vaginal 

tape (TVT) placement. Int Urogynecol J 

Pelvic Floor Dysfunct 2003 Oct; 14(4):291-3. 

Case-Reports 

2118. Johnson JC, Jayadevappa R, Baccash PD, et 

al. Nonspecific presentation of pneumonia in 

hospitalized older people: age effect or 

dementia? J Am Geriatr Soc 2000 Oct; 

48(10):1316-20. Not eligible outcomes 

2119. Johnson ST. From incontinence to confidence. 

Am J Nurs 2000 Feb; 100(2):69-74, 6. CaseReports 

2120. Johnson TM, 2nd, Bernard SL, Kincade JE, et 

al. Urinary incontinence and risk of death 

among community-living elderly people: 

results from the National Survey on Self-Care 

and Aging. J Aging Health 2000 Feb; 

12(1):25-46. Not eligible level of evidence 

2121. Johnson TM, 2nd, Burgio KL, Redden DT, et 

al. Effects of behavioral and drug therapy on 

nocturia in older incontinent women. J Am 

Geriatr Soc 2005 May; 53(5):846-50. Not 

eligible exposure 

2122. Johnson TM, 2nd, Kincade JE, Bernard SL, et 

al. Self-care practices used by older men and 

women to manage urinary incontinence: 

results from the national follow-up survey on 

self-care and aging. J Am Geriatr Soc 2000 

Aug; 48(8):894-902. Not eligible outcomes 

2123. Johnson TM, Ouslander JG, Uman GC, et al. 

Urinary incontinence treatment preferences in 

long-term care. J Am Geriatr Soc 2001 Jun; 

49(6):710-8. Not eligible outcomes 

2124. Johnson VY, Hubbard D, Vordermark JS. 

Urologic manifestations of postpolio 

syndrome. J Wound Ostomy Continence Nurs 

1996 Jul; 23(4):218-23. Not eligible level of 

evidence 

2125. Johnsson KE, Sass M. Cauda equina 

syndrome in lumbar spinal stenosis: case 

report and incidence in Jutland, Denmark. J 

Spinal Disord Tech 2004 Aug; 17(4):334-5. 

Case-series 

2126. Johnston TE, Betz RR, Smith BT, et al. 

Implantable FES system for upright mobility 

and bladder and bowel function for 

individuals with spinal cord injury. Spinal 

Cord 2005 Dec; 43(12):713-23. Case-series 

2127. Jomaa M. Combined tension-free vaginal tape 

and prolapse repair under local anaesthesia in 

patients with symptoms of both urinary 

incontinence and prolapse. Gynecol Obstet 

Invest 2001; 51(3):184-6. Not eligible 

outcomes 

2128. Jonas U, Hofner K, Madersbacher H, et al. 

Efficacy and safety of two doses of tolterodine 

versus placebo in patients with detrusor 

overactivity and symptoms of frequency, urge 

incontinence, and urgency: urodynamic 

evaluation. The International Study Group. 

World J Urol 1997; 15(2):144-51. Not eligible 

exposure 

2129. Jones D, Perese EF. Promoting selfmanagement of urinary incontinence in a 

geropsychiatric day treatment program. J 

Psychosoc Nurs Ment Health Serv 2003 May; 

41(5):38-43. Case-reports 

2130. Jones F. The accuracy of predicting functional 

recovery in patients following a stroke, by 

physiotherapists and patients. Physiother Res 

Int 1998; 3(4):244-56. Not eligible outcomes 

2131. Jones HJ, Swift RI, Blake H. A prospective 

audit of the usefulness of evacuating 

proctography. Ann R Coll Surg Engl 1998 

Jan; 80(1):40-5. Not eligible outcomes 

2132. Jones JA, Mitchell ME, Rink RC. Improved 

results using a modification of the YoungDees-Leadbetter bladder neck repair. Br J 

Urol 1993 May; 71(5):555-61. Not eligible 

target population 

2133. Jones JS. Management of urethral straddle 

injury after radical prostatectomy. Urology 

2002 May; 59(5):773. Case Reports 

2134. Jones JS, Vasavada SP, Abdelmalak JB, et al. 

Sling may hasten return of continence after 

radical prostatectomy. Urology 2005 Jun; 

65(6):1163-7. Case-series 

2135. Jones LC. Urinary incontinence: a major 

health issue for women. AWHONN Voice 

1995 Sep; 3(8):9-10. Comment 
B-96 

2136. Jones TV, Bunner SH. Approaches to urinary 

incontinence in a rural population: a 

comparison of physician assistants, nurse 

practitioners, and family physicians. J Am 

Board Fam Pract 1998 May-Jun; 11(3):207-

15. Not eligible target population 

2137. Jongen VH, Brouwer WK. Comparison of the 

modified Pereyra procedure using permanent 

suture material and Burch urethropexy. Eur J 

Obstet Gynecol Reprod Biol 1999 May; 

84(1):7-11. Case-series 

2138. Jonler M, Aagaard J, Fuglsig S, et al. The 

spontaneous course of urodynamically 

verified sphincter lesion after surgery for 

benign prostatic hyperplasia. Scand J Urol 

Nephrol 1995 Mar; 29(1):69-74. Case-series 

2139. Jonler M, Madsen FA, Rhodes PR, et al. A 

prospective study of quantification of urinary 

incontinence and quality of life in patients 

undergoing radical retropubic prostatectomy. 

Urology 1996 Sep; 48(3):433-40. Case-series 

2140. Jonler M, Messing EM, Rhodes PR, et al. 

Sequelae of radical prostatectomy. Br J Urol 

1994 Sep; 74(3):352-8. Case-series 

2141. Jonler M, Nielsen OS, Wolf H. Urinary 

symptoms, potency, and quality of life in 

patients with localized prostate cancer 

followed up with deferred treatment. Urology 

1998 Dec; 52(6):1055-62; discussion 63. 

Case-series 

2142. Jonler M, Ritter MA, Brinkmann R, et al. 

Sequelae of definitive radiation therapy for 

prostate cancer localized to the pelvis. 

Urology 1994 Dec; 44(6):876-82. No 

associative hypothesis tested 

2143. Joo JS, Latulippe JF, Alabaz O, et al. Longterm functional evaluation of straight coloanal 

anastomosis and colonic J-pouch: is the 

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sustained? Dis Colon Rectum 1998 Jun; 

41(6):740-6. Case-series 

2144. Jorge JM, Ger GC, Gonzalez L, et al. Patient 

position during cinedefecography. Influence 

on perineal descent and other measurements. 

Dis Colon Rectum 1994 Sep; 37(9):927-31. 

Not eligible outcomes 

2145. Jorge JM, Habr-Gama A. The value of 

sphincter asymmetry index in anal 

incontinence. Int J Colorectal Dis 2000 Nov; 

15(5-6):303-10. Not eligible level of evidence 

2146. Jorge JM, Wexner SD, Ehrenpreis ED, et al. 

Does perineal descent correlate with pudendal 

neuropathy? Dis Colon Rectum 1993 May; 

36(5):475-83. Not eligible outcomes 

2147. Jorge JM, Wexner SD, James K, et al. 

Recovery of anal sphincter function after the 

ileoanal reservoir procedure in patients over 

the age of fifty. Dis Colon Rectum 1994 Oct; 

37(10):1002-5. Case-series 

2148. Jorge JM, Wexner SD, Marchetti F, et al. How 

reliable are currently available methods of 

measuring the anorectal angle? Dis Colon 

Rectum 1992 Apr; 35(4):332-8. Not eligible 

outcomes 

2149. Jorgensen L, Lose G, Alexander N. Acute 

effect of norfenefrine on the urethral pressure 

profile in females with genuine stress 

incontinence. Urol Int 1991; 46(2):176-9. Not 

eligible outcomes 

2150. Jorion JL. Rectus fascial sling suspension of 

the vesicourethral anastomosis after radical 

prostatectomy. J Urol 1997 Mar; 157(3):926-

8. Case-series 

2151. Jorion JL. Endoscopic treatment of bladder 

perforation after tension-free vaginal tape 

procedure. J Urol 2002 Jul; 168(1):197. Case 

Reports 

2152. Joseph AC, Chang MK. Comparison of 

behavior therapy methods for urinary 

incontinence following prostate surgery: a 

pilot study. Urol Nurs 2000 Jun; 20(3):203-4. 

2153. Joseph AC, Sueppel C. Postprostatectomy 

urinary incontinence managed by behavioral 

methods. J Wound Ostomy Continence Nurs 

2000 May; 27(3):194-8. Case- Reports 

2154. Joseph JV, Vicente I, Madeb R, et al. Robotassisted vs pure laparoscopic radical 

prostatectomy: are there any differences? BJU 

Int 2005 Jul; 96(1):39-42. Case-series 

2155. Jost WH. One hundred cases of anal fissure 

treated with botulin toxin: early and long-term 

results. Dis Colon Rectum 1997 Sep; 

40(9):1029-32. Case-series 

2156. Jost WH. Electrostimulation in fecal 

incontinence: relevance of the sphincteric 

compound muscle action potential. Dis Colon 

Rectum 1998 May; 41(5):590-2. Case-series 

2157. Jost WH, Schimrigk K. Therapy of anal 

fissure using botulin toxin. Dis Colon Rectum 

1994 Dec; 37(12):1321-4. Case-series 

2158. Jueng-Anuwat P, Roongruangsilp U, 

Kochakarn W, et al. Risk factors for stress 

urinary incontinence in middle aged and 

elderly Thai women. J Med Assoc Thai 2001 

Aug; 84(8):1121-5. Not eligible level of 

evidence 

2159. Juhasz ES, Fozard B, Dozois RR, et al. Ileal 

pouch-anal anastomosis function following 

childbirth. An extended evaluation. Dis Colon 

Rectum 1995 Feb; 38(2):159-65. Case-series 
B-97 

2160. Julia J, Yacoub M, Levy G. Labial fusion 

causing urinary incontinence in a 

postmenopausal female: a case report. Int 

Urogynecol J Pelvic Floor Dysfunct 2003 

Nov; 14(5):360-1. Case-reports 

2161. Juma S, Little NA, Raz S. Basic evaluation of 

female urinary incontinence. Am J Kidney Dis 

1990 Oct; 16(4):317-21. Guideline 

2162. Jundt K, Peschers UM, Dimpfl T. Long-term 

efficacy of pelvic floor re-education with 

EMG-controlled biofeedback. Eur J Obstet 

Gynecol Reprod Biol 2002 Nov 15; 

105(2):181-5. Case-series 

2163. Junemann KP, Halaska M, Rittstein T, et al. 

Propiverine versus tolterodine: efficacy and 

tolerability in patients with overactive bladder. 

Eur Urol 2005 Sep; 48(3):478-82. Not eligible 

exposure 

2164. Jung BH, Bai SW, Chung BC. Urinary profile 

of endogenous steroids in postmenopausal 

women with stress urinary incontinence. J 

Reprod Med 2001 Nov; 46(11):969-74. Not 

eligible outcomes 

2165. Kaaki B, Gyves M, Goldman H. Spontaneous 

intrapartum vesicouterine fistula. Obstet 

Gynecol 2006 Feb; 107(2 Pt 2):449-50. Casereports 

2166. Kabalin JN. Treatment of post-prostatectomy 

stress urinary incontinence with periurethral 

polytetrafluoroethylene paste injection. J Urol 

1994 Nov; 152(5 Pt 1):1463-6. Not eligible 

target population 

2167. Kabalin JN. Addition of a second urethral cuff 

to enhance performance of the artificial 

urinary sphincter. J Urol 1996 Oct; 

156(4):1302-4. Case-series 

2168. Kaefer M, Retik AB. The Mitrofanoff 

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Urol Clin North Am 1997 Nov; 24(4):795-

811. Review 

2169. Kafka NJ, Coller JA, Barrett RC, et al. 

Pudendal neuropathy is the only parameter 

differentiating leakage from solid stool 

incontinence. Dis Colon Rectum 1997 Oct; 

40(10):1220-7. Not eligible outcomes 

2170. Kageyama S, Kawabe K, Suzuki K, et al. 

Collagen implantation for post-prostatectomy 

incontinence: early experience with a 

transrectal ultrasonographically guided 

method. J Urol 1994 Nov; 152(5 Pt 1):1473-5. 

Case-series 

2171. Kahn MA, Breitkopf CR, Valley MT, et al. 

Pelvic Organ Support Study (POSST) and 

bowel symptoms: straining at stool is 

associated with perineal and anterior vaginal 

descent in a general gynecologic population. 

Am J Obstet Gynecol 2005 May; 

192(5):1516-22. Not eligible level of evidence 

2172. Kahn MA, Stanton SL. Posterior 

colporrhaphy: its effects on bowel and sexual 

function. Br J Obstet Gynaecol 1997 Jan; 

104(1):82-6. Case-series 

2173. Kairaluoma M, Raivio P, Kupila J, et al. The 

role of biofeedback therapy in functional 

proctologic disorders. Scand J Surg 2004; 

93(3):184-90. Case-series 

2174. Kairaluoma MV, Raivio P, Aarnio MT, et al. 

Immediate repair of obstetric anal sphincter 

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47(8):1358-63. Case-series 

2175. Kaiwa Y, Kurokawa Y, Namiki K, et al. 

Outcome of laparoscopic rectopexy for 

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70 years versus younger patients. Surg Today 

2004; 34(9):742-6. Case-series 

2176. Kajbafzadeh AM, Chubak N. Simultaneous 

Malone antegrade continent enema and 

Mitrofanoff principle using the divided 

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prevention of stoma complications. J Urol 

2001 Jun; 165(6 Pt 2):2404-9. Case-series 

2177. Kakizaki H, Shibata T, Shinno Y, et al. 

Fascial sling for the management of urinary 

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Urol 1995 Mar; 153(3 Pt 1):644-7. Not 

eligible target population 

2178. Kalra L, Dale P, Crome P. Evaluation of a 

clinical score for prognostic stratification of 

elderly stroke patients. Age Ageing 1994 Nov; 

23(6):492-8. Not eligible level of evidence 

2179. Kalsi V, Popat RB, Apostolidis A, et al. Costconsequence analysis evaluating the use of 

botulinum neurotoxin-A in patients with 

detrusor overactivity based on clinical 

outcomes observed at a single UK centre. Eur 

Urol 2006 Mar; 49(3):519-27. Not eligible 

target population 

2180. Kaltreider DL, Hu TW, Igou JF, et al. Can 

reminders curb incontinence? Geriatr Nurs 

1990 Jan-Feb; 11(1):17-9. Comment 

2181. Kammerer-Doak DN, Dominguez C, Harner 

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Correlation of sonographic anal sphincter 

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1998 Jul; 43(7):576-80. Case-series 
B-98 

2182. Kane L, Chung T, Lawrie H, et al. The 

pubofascial anchor sling procedure for 

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BJU Int 1999 Jun; 83(9):1010-4. Case-series 

2183. Kane RL, Garrard J, Buchanan JL, et al. 

Improving primary care in nursing homes. J 

Am Geriatr Soc 1991 Apr; 39(4):359-67. Not 

eligible exposure 

2184. Kangas E, Hiltunen KM, Matikainen M. 

Anorectal function in Crohn's disease. Ann 

Chir Gynaecol 1992; 81(1):43-7. Not eligible 

level of evidence 

2185. Kannisto M, Rintala R. Bowel function in 

adults who have sustained spinal cord injury 

in childhood. Paraplegia 1995 Dec; 

33(12):701-3. Not eligible exposure 

2186. Kao TC, Cruess DF, Garner D, et al. 

Multicenter patient self-reporting 

questionnaire on impotence, incontinence and 

stricture after radical prostatectomy. J Urol 

2000 Mar; 163(3):858-64. Not eligible 

outcomes 

2187. Kaplan SA, Roehrborn CG, Dmochowski R, 

et al. Tolterodine extended release improves 

overactive bladder symptoms in men with 

overactive bladder and nocturia. Urology 2006 

Aug; 68(2):328-32. Not eligible exposure 

2188. Kaplan SA, Santarosa RP, Te AE. 

Comparison of fascial and vaginal wall slings 

in the management of intrinsic sphincter 

deficiency. Urology 1996 Jun; 47(6):885-9. 

Case-series 

2189. Kapoor DS, Davila GW, Rosenthal RJ, et al. 

Pelvic floor dysfunction in morbidly obese 

women: pilot study. Obes Res 2004 Jul; 

12(7):1104-7. Not eligible level of evidence 

2190. Kapoor R, Dubey D, Kumar A, et al. Modified 

bulbar urethral sling procedure for the 

treatment of male sphincteric incontinence. J 

Endourol 2001 Jun; 15(5):545-9. Case-series 

2191. Karadag A, Mentes BB, Ayaz S. Colostomy 

irrigation: results of 25 cases with particular 

reference to quality of life. J Clin Nurs 2005 

Apr; 14(4):479-85. Case-series 

2192. Karakayali H, Bilgin N, Moray G, et al. Major 

urological complications in 1051 consecutive 

renal transplants. Transplant Proc 1996 Aug; 

28(4):2339-40. Not eligible level of evidence 

2193. Karan A, Isikoglu M, Aksac B, et al. 

Hypermobility syndrome in 105 women with 

pure urinary stress incontinence and in 105 

controls. Arch Gynecol Obstet 2004 Jan; 

269(2):89-90. Not eligible outcomes 

2194. Karanjgaokar V, Amagada J, Ramaswamy S, 

et al. Successful use of TVT in the 

management of urodynamic stress 

incontinence in a treated case of carcinoma 

cervix. J Obstet Gynaecol 2006 Apr; 

26(3):279-80. Case- Reports 

2195. Karanjia ND, Schache DJ, Heald RJ. Function 

of the distal rectum after low anterior 

resection for carcinoma. Br J Surg 1992 Feb; 

79(2):114-6. Case-series 

2196. Karantanis E, Fynes M, Moore KH, et al. 

Comparison of the ICIQ-SF and 24-hour pad 

test with other measures for evaluating the 

severity of urodynamic stress incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2004 

Mar-Apr; 15(2):111-6; discussion 6. Not 

eligible outcomes 

2197. Karantanis E, O'Sullivan R, Moore KH. The 

24-hour pad test in continent women and men: 

normal values and cyclical alterations. Bjog 

2003 Jun; 110(6):567-71. Not eligible 

outcomes 

2198. Kariv Y, Delaney CP, Casillas S, et al. Longterm outcome after laparoscopic and open 

surgery for rectal prolapse: a case-control 

study. Surg Endosc 2006 Jan; 20(1):35-42. 

Not eligible level of evidence 

2199. Karlbom U, Nilsson S, Pahlman L, et al. 

Defecographic study of rectal evacuation in 

constipated patients and control subjects. 

Radiology 1999 Jan; 210(1):103-8. Not 

eligible outcomes 

2200. Karlin GS, Badlani GH. Endourologic 

management of lower urinary tract 

dysfunction. Clin Geriatr Med 1990 Feb; 

6(1):109-13. Review 

2201. Karon S. A team approach to bladder 

retraining: a pilot study. Urol Nurs 2005 Aug; 

25(4):269-76. Case-series 

2202. Karoui S, Leroi AM, Koning E, et al. Results 

of sphincteroplasty in 86 patients with anal 

incontinence. Dis Colon Rectum 2000 Jun; 

43(6):813-20. Case-series 

2203. Karoui S, Savoye-Collet C, Koning E, et al. 

Prevalence of anal sphincter defects revealed 

by sonography in 335 incontinent patients and 

115 continent patients. AJR Am J Roentgenol 

1999 Aug; 173(2):389-92. Not eligible 

outcomes 

2204. Karram MM, Partoll L, Bilotta V, et al. 

Factors affecting detrusor contraction strength 

during voiding in women. Obstet Gynecol 

1997 Nov; 90(5):723-6. Not eligible outcomes 
B-99 

2205. Karram MM, Partoll L, Rahe J. Efficacy of 

nonsurgical therapy for urinary incontinence. J 

Reprod Med 1996 Apr; 41(4):215-9. No 

associative hypothesis tested 

2206. Katlowitz NM, Karwa G, Lautin E. Stress 

incontinence secondary to a vesicourethral 

fistula: case report. Urol Radiol 1990; 

12(1):37-8. Case- reports 

2207. Kato H. Incorrect positioning of an indwelling 

urethral catheter in the ureter. Int J Urol 1997 

Jul; 4(4):417-8. Case Reports 

2208. Kato H, Igawa Y, Ogawa A. Incontinent ileal 

tube repaired by infolding with the ileal pouch 

wall. Int J Urol 1997 Jul; 4(4):428-30. Case 

Reports 

2209. Kattan SA. Maternal urological injuries 

associated with vaginal deliveries: change of 

pattern. Int Urol Nephrol 1997; 29(2):155-61. 

Case-series 

2210. Katti G. An evaluation of transanal 

endoscopic microsurgery for rectal adenoma 

and carcinoma. Jsls 2004 Apr-Jun; 8(2):123-6. 

Case-series 

2211. Kaum HJ, Wolff F. TVT: on midurethral tape 

positioning and its influence on continence. 

Int Urogynecol J Pelvic Floor Dysfunct 2002; 

13(2):110-5; discussion 5. Case-series 

2212. Kaur G, Gardiner A, Duthie GS. Rectoanal 

reflex parameters in incontinence and 

constipation. Dis Colon Rectum 2002 Jul; 

45(7):928-33. Not eligible outcomes 

2213. Kaur G, Gardiner A, Duthie GS. A new 

method of assessing anal sphincter integrity 

using inverted vectormanometry. Dis Colon 

Rectum 2006 Aug; 49(8):1160-6. Not eligible 

outcomes 

2214. Kavallaris A, Kohler C, Diebolder H, et al. 

Repair of prolapse with vaginal 

sacrocolporectopexy: technique and results. 

Eur J Obstet Gynecol Reprod Biol 2005 Oct 1; 

122(2):237-42. Case-series 

2215. Kawashima H, Hirai K, Okada N, et al. The 

importance of studying pressure-flow for 

predicting postoperative voiding difficulties in 

women with stress urinary incontinence: a 

preliminary study that correlates low Pdet x 

Qave with postoperative residual urine. Urol 

Res 2004 May; 32(2):84-8. Case-series 

2216. Kawsar M, Goh BT. Spinal schwannoma as a 

cause of erectile dysfunction with urinary 

incontinence and groin and testicular pain. Int 

J STD AIDS 2002 Aug; 13(8):584-5. Casereports 

2217. Kayaba H, Kodama K, Shirayama K, et al. 

Evaluation of ability to defecate using saline 

evacuation from the rectum. Dis Colon 

Rectum 1997 Oct; 40(10 Suppl):S96-8. Not 

eligible exposure 

2218. Kayano CE, Sartori MG, Baracat EC, et al. 

Vaginal hysterectomy allied with KellyKennedy surgery and perineal repair for the 

treatment of patients with a prolapsed uterus 

and urinary stress incontinence. Clin Exp 

Obstet Gynecol 2002; 29(1):27-30. Caseseries 

2219. Kaye KW, Creed KE, Wilson GJ, et al. 

Urinary continence after radical retropubic 

prostatectomy. Analysis and synthesis of 

contributing factors: a unified concept. Br J 

Urol 1997 Sep; 80(3):444-501. Case series 

2220. Kayigil O. Our changing strategies on bladder 

neck suspension operations. Int Urol Nephrol 

1999; 31(5):647-54. Case-series 

2221. Kayigil O, Biri A. Double forced sling by 

combining in situ vaginal wall and Infast 

pubic bone suburethral stabilization 

techniques: a new method. J Urol 2002 Jun; 

167(6):2481-3. Case-series 

2222. Kayigil O, Iftekhar Ahmed S, Metin A. The 

coexistence of intrinsic sphincter deficiency 

with type II stress incontinence. J Urol 1999 

Oct; 162(4):1365-6. Not eligible outcomes 

2223. Keachie J. Continence. Island life. Nurs Times 

1993 Sep 29-Oct 5; 89(39):72, 4, 6. Comment 

2224. Keane DP, Eckford SD, Shepherd AM, et al. 

Referral patterns and diagnoses in women 

attending a urodynamic unit. Bmj 1992 Oct 3; 

305(6857):808. Secondary data analysis 

2225. Keane DP, Sims TJ, Abrams P, et al. Analysis 

of collagen status in premenopausal 

nulliparous women with genuine stress 

incontinence. Br J Obstet Gynaecol 1997 Sep; 

104(9):994-8. Not eligible outcomes 

2226. Keane PF, Walsh IK, Kernohan RM. The 

artificial urinary sphincter. A new solution for 

incontinent patients. Ulster Med J 1993 Oct; 

62(2):132-6. Case-series 

2227. Keil K. Urogenital atrophy: diagnosis, 

sequelae, and management. Curr Womens 

Health Rep 2002 Aug; 2(4):305-11. Comment 

2228. Kelleher C, Cardozo L, Kobashi K, et al. 

Solifenacin: as effective in mixed urinary 

incontinence as in urge urinary incontinence. 

Int Urogynecol J Pelvic Floor Dysfunct 2006 

Jun; 17(4):382-8. Secondary data pooled 

analysis 
B-100 

2229. Keller PA, Sinkovic SP, Miles SJ. Skin 

dryness: a major factor in reducing 

incontinence dermatitis. Ostomy Wound 

Manage 1990 Sep-Oct; 30:60-4. Not eligible 

outcomes 

2230. Keller SL. Urinary incontinence: occurrence, 

knowledge, and attitudes among women aged 

55 and older in a rural Midwestern setting. J 

Wound Ostomy Continence Nurs 1999 Jan; 

26(1):30-8. Not eligible level of evidence 

2231. Kemp MG. Protecting the skin from moisture 

and associated irritants. J Gerontol Nurs 1994 

Sep; 20(9):8-14. Not eligible outcomes 

2232. Kendirci M, Gupta S, Shaw K, et al. 

Synchronous prosthetic implantation through 

a transscrotal incision: an outcome analysis. J 

Urol 2006 Jun; 175(6):2218-22. Case-series 

2233. Kenefick NJ. Sacral nerve neuromodulation 

for the treatment of lower bowel motility 

disorders. Ann R Coll Surg Engl 2006 Nov; 

88(7):617-23. No associative hypothesis tested 

2234. Kenefick NJ, Emmanuel A, Nicholls RJ, et al. 

Effect of sacral nerve stimulation on 

autonomic nerve function. Br J Surg 2003 

Oct; 90(10):1256-60. Case-series 

2235. Kenefick NJ, Vaizey CJ, Cohen RC, et al. 

Medium-term results of permanent sacral 

nerve stimulation for faecal incontinence. Br J 

Surg 2002 Jul; 89(7):896-901. Case-series 

2236. Kenefick NJ, Vaizey CJ, Malouf AJ, et al. 

Injectable silicone biomaterial for faecal 

incontinence due to internal anal sphincter 

dysfunction. Gut 2002 Aug; 51(2):225-8. 

Case-series 

2237. Kenefick NJ, Vaizey CJ, Nicholls RJ, et al. 

Sacral nerve stimulation for faecal 

incontinence due to systemic sclerosis. Gut 

2002 Dec; 51(6):881-3. Case-series 

2238. Kennedy A. Continence. Island education. 

Nurs Times 1993 Nov 24-30; 89(47):74-7. 

Comment 

2239. Kennedy CM, Nygaard IE, Saftlas A, et al. 

Vulvar disease: a pelvic floor pain disorder? 

Am J Obstet Gynecol 2005 Jun; 192(6):1829-

34; discussion 34-5. Not eligible outcomes 

2240. Kennedy ML, Lubowski DZ, King DW. 

Transanal endoscopic microsurgery excision: 

is anorectal function compromised? Dis Colon 

Rectum 2002 May; 45(5):601-4. Case-series 

2241. Kennedy ML, Nguyen H, Lubowski DZ, et al. 

Stimulated gracilis neosphincter: a new 

procedure for anal incontinence. Aust N Z J 

Surg 1996 Jun; 66(6):353-7. Case-series 

2242. Kennelly MJ, Kang J. Botulinum-A toxin 

injections as a treatment for refractory 

detrusor hyperreflexia. Topics in Spinal Cord 

Injury Rehabilitation 2003 Winter; 8(3):46-53. 

Case-series 

2243. Kenton K, FitzGerald MP, Brubaker L. 

Multiple foreign body erosions after 

laparoscopic colposuspension with mesh. Am 

J Obstet Gynecol 2002 Jul; 187(1):252-3. 

Case-reports 

2244. Kenton K, Fitzgerald MP, Brubaker L. What 

is a clinician to do-believe the patient or her 

urinary diary? J Urol 2006 Aug; 176(2):633-5; 

discussion 5. Not eligible outcomes 

2245. Kenton K, FitzGerald MP, Shott S, et al. Role 

of urethral electromyography in predicting 

outcome of Burch retropubic urethropexy. Am 

J Obstet Gynecol 2001 Jul; 185(1):51-5. Not 

eligible outcomes 

2246. Kenton K, Mahajan S, Fitzgerald MP, et al. 

Recurrent stress incontinence is associated 

with decreased neuromuscular function in the 

striated urethral sphincter. Am J Obstet 

Gynecol 2006 May; 194(5):1434-7. Not 

eligible outcomes 

2247. Kenton K, Mueller ER. The global burden of 

female pelvic floor disorders. BJU Int 2006 

Sep; 98 Suppl 1:1-5; discussion 6-7. Comment 

2248. Kenton K, Oldham L, Brubaker L. Open 

Burch urethropexy has a low rate of 

perioperative complications. Am J Obstet 

Gynecol 2002 Jul; 187(1):107-10. Case-series 

2249. Keranen U, Luukkonen P, Jarvinen H. 

Functional results after restorative 

proctocolectomy complicated by pouchitis. 

Dis Colon Rectum 1997 Jul; 40(7):764-9. 

Case-series 

2250. Kerr LA, Zincke H. Radical retropubic 

prostatectomy for prostate cancer in the 

elderly and the young: complications and 

prognosis. Eur Urol 1994; 25(4):305-11; 

discussion 11-2. Not eligible outcomes 

2251. Kerschan-Schindl K, Uher E, Wiesinger G, et 

al. Reliability of pelvic floor muscle strength 

measurement in elderly incontinent women. 

Neurourol Urodyn 2002; 21(1):42-7. Not 

eligible outcomes 

2252. Kesarwani PK, Misra R, Goel A, et al. 

Vesicocervical fistula: an unusual 

complication of vesicovaginal [corrected] 

fistula repair. Int Urogynecol J Pelvic Floor 

Dysfunct 2004 Sep-Oct; 15(5):358-9. Case 

Reports 
B-101 

2253. Keshtgar AS, Rickwood AM. Urological 

consequences of incomplete cord lesions in 

patients with myelomeningocele. Br J Urol 

1998 Aug; 82(2):258-60. Not eligible target 

population 

2254. Kessler TM, Burkhard FC, Perimenis P, et al. 

Attempted nerve sparing surgery and age have 

a significant effect on urinary continence and 

erectile function after radical 

cystoprostatectomy and ileal orthotopic 

bladder substitution. J Urol 2004 Oct; 172(4 

Pt 1):1323-7. Case-series 

2255. Kessler TM, Danuser H, Schumacher M, et al. 

Botulinum A toxin injections into the 

detrusor: an effective treatment in idiopathic 

and neurogenic detrusor overactivity? 

Neurourol Urodyn 2005; 24(3):231-6. Not 

eligible target population 

2256. Kessler TM, Lackner J, Kiss G, et al. 

Predictive value of initial urodynamic pattern 

on urinary continence in patients with 

myelomeningocele. Neurourol Urodyn 2006; 

25(4):361-7. Not eligible target population 

2257. Khadilkar S, Menezes K, Lele V, et al. 

Gelastic epilepsy--a case report with SPECT 

studies. J Assoc Physicians India 2001 May; 

49:581-3. Case Reports 

2258. Khair B, Azmy AF, Carachi R, et al. 

Continent urinary diversion using Mitrofanoff 

principle in children with neurogenic bladder. 

Eur J Pediatr Surg 1993 Dec; 3 Suppl 1:8-9. 

Not eligible target population 

2259. Khalid U, McGough C, Hackett C, et al. A 

modified inflammatory bowel disease 

questionnaire and the Vaizey Incontinence 

questionnaire are more sensitive measures of 

acute gastrointestinal toxicity during pelvic 

radiotherapy than RTOG grading. Int J Radiat 

Oncol Biol Phys 2006 Apr 1; 64(5):1432-41. 

Not eligible outcomes 

2260. Khan MS, Chaliha C, Leskova L, et al. The 

relationship between urinary symptom 

questionnaires and urodynamic diagnoses: an 

analysis of two methods of questionnaire 

administration. Bjog 2004 May; 111(5):468-

74. Not eligible level of evidence 

2261. Khanduja KS, Padmanabhan A, Kerner BA, et 

al. Reconstruction of rectovaginal fistula with 

sphincter disruption by combining rectal 

mucosal advancement flap and anal 

sphincteroplasty. Dis Colon Rectum 1999 

Nov; 42(11):1432-7. Case-series 

2262. Khanduja KS, Yamashita HJ, Wise WE, Jr., et 

al. Delayed repair of obstetric injuries of the 

anorectum and vagina. A stratified surgical 

approach. Dis Colon Rectum 1994 Apr; 

37(4):344-9. Case-series 

2263. Kharrazi M, Kharrazi LD. Delayed diagnosis 

of cystic fibrosis and the family perspective. J 

Pediatr 2005 Sep; 147(3 Suppl):S21-5. Not 

eligible outcomes 

2264. Khorsandi M, Ginsberg PC, Harkaway RC. 

Reassessing the role of urodynamics after 

cerebrovascular accident. Males versus 

females. Urol Int 1998; 61(3):142-6. Not 

eligible target population 

2265. Khoury AE, Agarwal SK, Bagli D, et al. 

Concomitant modified bladder neck closure 

and Mitrofanoff urinary diversion. J Urol 1999 

Nov; 162(5):1746-8. Case-series 

2266. Khoury JM, Webster GD, Perez LM. Urethral 

cuff erosion as a result of urinary 

catheterization in patients with an artificial 

urinary sphincter. N C Med J 1994 May; 

55(5):162-4. Case Reports 

2267. Khullar V, Hill S, Laval KU, et al. Treatment 

of urge-predominant mixed urinary 

incontinence with tolterodine extended 

release: a randomized, placebo-controlled 

trial. Urology 2004 Aug; 64(2):269-74; 

discussion 74-5. Not eligible exposure 

2268. Kielb S, Dunn RL, Rashid MG, et al. 

Assessment of early continence recovery after 

radical prostatectomy: patient reported 

symptoms and impairment. J Urol 2001 Sep; 

166(3):958-61. Case-series 

2269. Kielb SJ, Clemens JQ. Endoscopic excision of 

intravesical tension-free vaginal tape with 

laparoscopic instrument assistance. J Urol 

2004 Sep; 172(3):971. Case Reports 

2270. Kielb SJ, Clemens JQ. Comprehensive 

urodynamics evaluation of 146 men with 

incontinence after radical prostatectomy. 

Urology 2005 Aug; 66(2):392-6. Case-series 

2271. Kienle P, Weitz J, Koch M, et al. Biofeedback 

versus electrostimulation in treatment of anal 

sphincter insufficiency. Dig Dis Sci 2003 

Aug; 48(8):1607-13. Not eligible target 

population 

2272. Kilicarslan H, Gokce G, Ayan S, et al. 

Predictors of outcome after in situ anterior 

vaginal wall sling surgery. Int Urogynecol J 

Pelvic Floor Dysfunct 2003 Nov; 14(5):339-

41; discussion 41. Case-series 
B-102 

2273. Kilicarslan H, Guvenal T, Ayan S, et al. 

Comparison of outcomes of three different 

surgical techniques performed for stress 

urinary incontinence. Int J Urol 2003 Mar; 

10(3):126-30; discussion 31. Case-series 

2274. Kim J. The development and evaluation of an 

incontinence intervention program for the 

elderly women at elderly welfare center. 

Taehan Kanho Hakhoe Chi 2004 Dec; 

34(8):1427-33. Case-series 

2275. Kim J, Shim MC, Choi BY, et al. Clinical 

application of continent anal plug in bedridden 

patients with intractable diarrhea. Dis Colon 

Rectum 2001 Aug; 44(8):1162-7. Case-series 

2276. Kim JK, Kim YJ, Choo MS, et al. The urethra 

and its supporting structures in women with 

stress urinary incontinence: MR imaging using 

an endovaginal coil. AJR Am J Roentgenol 

2003 Apr; 180(4):1037-44. Not eligible 

outcomes 

2277. Kim JS, Lee EH, Park HC. Urinary 

incontinence: prevalence and knowledge 

among community-dwelling Korean women 

aged 55 and over. Taehan Kanho Hakhoe Chi 

2004 Jun; 34(4):609-16. Not eligible level of 

evidence 

2278. Kim KJ, Ashton-Miller JA, Strohbehn K, et al. 

The vesico-urethral pressuregram analysis of 

urethral function under stress. J Biomech 1997 

Jan; 30(1):19-25. Not eligible outcomes 

2279. Kim NK, Lim DJ, Yun SH, et al. Ultralow 

anterior resection and coloanal anastomosis 

for distal rectal cancer: functional and 

oncological results. Int J Colorectal Dis 2001 

Aug; 16(4):234-7. Case-series 

2280. Kim SH, Boye M, Bhattacharyya SK, et al. 

Medical visits among adults with symptoms 

commonly associated with an overactive 

bladder. BJU Int 2006 Mar; 97(3):551-4. Not 

eligible outcomes 

2281. Kim SM, Han SW, Choi SH. Left colonic 

antegrade continence enema: experience 

gained from 19 cases. J Pediatr Surg 2006 

Oct; 41(10):1750-4. Case-series 

2282. Kim YH, Kattan MW, Boone TB. Correlation 

of urodynamic results and urethral coaptation 

with success after transurethral collagen 

injection. Urology 1997 Dec; 50(6):941-8. 

Case-series 

2283. Kim YT, Kwon DD, Kim J, et al. Gabapentin 

for overactive bladder and nocturia after 

anticholinergic failure. Int Braz J Urol 2004 

Jul-Aug; 30(4):275-8. Case-series 

2284. Kincade JE, Dougherty MC, BusbyWhitehead J, et al. Self-monitoring and pelvic 

floor muscle exercises to treat urinary 

incontinence. Urol Nurs 2005 Oct; 25(5):353-

63. No associative hypothesis tested 

2285. Kincade JE, Peckous BK, Busby-Whitehead J. 

A pilot study to determine predictors of 

behavioral treatment completion for urinary 

incontinence. Urol Nurs 2001 Feb; 21(1):39-

44. Not eligible outcomes 

2286. Kinchen KS, Long S, Chang S, et al. The 

direct cost of stress urinary incontinence 

among women in a Medicaid population. Am 

J Obstet Gynecol 2005 Dec; 193(6):1936-44. 

Not eligible outcomes 

2287. Kinchen KS, Obenchain R, Swindle R. Impact 

of duloxetine on quality of life for women 

with symptoms of urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2005 

Sep-Oct; 16(5):337-44. Not eligible exposure 

2288. King JC, Currie DM, Wright E. Bowel 

training in spina bifida: importance of 

education, patient compliance, age, and anal 

reflexes. Arch Phys Med Rehabil 1994 Mar; 

75(3):243-7. Not eligible target population 

2289. King JK, Freeman RM. Is antenatal bladder 

neck mobility a risk factor for postpartum 

stress incontinence? Br J Obstet Gynaecol 

1998 Dec; 105(12):1300-7. Not eligible level 

of evidence 

2290. Kingsley AN. Post traumatic anal 

incontinence. Nebr Med J 1990 Dec; 

75(12):321-3. Case-series 

2291. Kinn AC. Burch colposuspension for stress 

urinary incontinence. 5-year results in 153 

women. Scand J Urol Nephrol 1995 Dec; 

29(4):449-55. Case-series 

2292. Kinn AC. Tension-free vaginal tape evaluated 

using patient self-reports and urodynamic 

testing--a two-year follow-up. Scand J Urol 

Nephrol 2001 Dec; 35(6):484-90. Case-series 

2293. Kinn AC, Larsson PO. Desmopressin: a new 

principle for symptomatic treatment of 

urgency and incontinence in patients with 

multiple sclerosis. Scand J Urol Nephrol 1990; 

24(2):109-12. Not eligible exposure 

2294. Kinn AC, Nilsson BY. Urethral sensitivity in 

incontinent women. Eur Urol 2005 Jul; 

48(1):116-20. Not eligible outcomes 

2295. Kinnunen O. Study of constipation in a 

geriatric hospital, day hospital, old people's 

home and at home. Aging (Milano) 1991 Jun; 

3(2):161-70. Not eligible outcomes 
B-103 

2296. Kirchner R, Diaconescu MR. Management of 

perineal impalement injuries. Rev Med Chir 

Soc Med Nat Iasi 1992 Jul-Dec; 96(3-4):141-

5. Case-series 

2297. Kirkeby LT, Beier-Holgersen R, Nordling J. 

Successful pregnancy after ileocystoplasty. 

Case report. Scand J Urol Nephrol 1992; 

26(2):195. Case-reports 

2298. Kirkham AP, Knight SL, Craggs MD, et al. 

Neuromodulation through sacral nerve roots 2 

to 4 with a Finetech-Brindley sacral posterior 

and anterior root stimulator. Spinal Cord 2002 

Jun; 40(6):272-81. Case-series 

2299. Kirkland VL, Palmer MH, Fitzgerald ST. 

Incontinence in a manufacturing setting: 

women's perceptions and responses. Public 

Health Nurs 2001 Sep-Oct; 18(5):312-7. Not 

eligible level of evidence 

2300. Kirschner-Hermanns R, Wein B, Niehaus S, et 

al. The contribution of magnetic resonance 

imaging of the pelvic floor to the 

understanding of urinary incontinence. Br J 

Urol 1993 Nov; 72(5 Pt 2):715-8. Not eligible 

outcomes 

2301. Kirshblum SC, Gulati M, O'Connor KC, et al. 

Bowel care practices in chronic spinal cord 

injury patients. Arch Phys Med Rehabil 1998 

Jan; 79(1):20-3. Not eligible outcomes 

2302. Kisli E, Kisli M, Agargun H, et al. Impaired 

function of the levator ani muscle in the grand 

multipara and great grand multipara. Tohoku J 

Exp Med 2006 Dec; 210(4):365-72. Not 

eligible outcomes 

2303. Kitamura H, Miyao N, Yanase M, et al. 

Quality of life in patients having an ileal 

conduit, continent reservoir or orthotopic 

neobladder after cystectomy for bladder 

carcinoma. Int J Urol 1999 Aug; 6(8):393-9. 

Case-series 

2304. Kives S, Delisle MF, Mitchell GW. 

Vesicouterine fistula in pregnancy: a case 

report. J Obstet Gynaecol Can 2004 Jul; 

26(7):657-9. Case-reports 

2305. Kizilkaya Beji N, Yalcin O, Ayyildiz EH, et 

al. Effect of urinary leakage on sexual 

function during sexual intercourse. Urol Int 

2005; 74(3):250-5. Not eligible outcomes 

2306. Kjerulff KH, Langenberg PW, Rhodes JC, et 

al. Effectiveness of hysterectomy. Obstet 

Gynecol 2000 Mar; 95(3):319-26. Not eligible 

outcomes 

2307. Kjolhede P. Genital prolapse in women treated 

successfully and unsuccessfully by the Burch 

colposuspension. Acta Obstet Gynecol Scand 

1998 Apr; 77(4):444-50. Not eligible 

outcomes 

2308. Kjolhede P. Long-term efficacy of Burch 

colposuspension: a 14-year follow-up study. 

Acta Obstet Gynecol Scand 2005 Aug; 

84(8):767-72. Case-series 

2309. Kjolhede P, Noren B, Ryden G. Prediction of 

genital prolapse after Burch colposuspension. 

Acta Obstet Gynecol Scand 1996 Oct; 

75(9):849-54. Not eligible outcomes 

2310. Kjolhede P, Ryden G. Prognostic factors and 

long-term results of the Burch 

colposuspension. A retrospective study. Acta 

Obstet Gynecol Scand 1994 Sep; 73(8):642-7. 

Case-series 

2311. Kjolhede P, Ryden G. Clinical and 

urodynamic characteristics of women with 

recurrent urinary incontinence after Burch 

colposuspension. Acta Obstet Gynecol Scand 

1997 May; 76(5):461-7. Case-series 

2312. Kjolhede P, Ryden G, Hewardt P. Abdominal 

urethrocystopexy using fibrin sealant. A 

prospective study of long-term efficacy. Int 

Urogynecol J Pelvic Floor Dysfunct 2000; 

11(2):93-6. Case-series 

2313. Kjolhede P, Wahlstrom J, Wingren G. Pelvic 

floor dysfunction after Burch 

colposuspension--a comprehensive study. Part 

I. Acta Obstet Gynecol Scand 2005 Sep; 

84(9):894-901. Not eligible level of evidence 

2314. Kjolseth D, Madsen B, Knudsen LM, et al. 

Biofeedback treatment of children and adults 

with idiopathic detrusor instability. Scand J 

Urol Nephrol 1994 Sep; 28(3):243-7. Not 

eligible target population 

2315. Klaphajone J, Kitisomprayoonkul W, Sriplakit 

S. Botulinum toxin type A injections for 

treating neurogenic detrusor overactivity 

combined with low-compliance bladder in 

patients with spinal cord lesions. Arch Phys 

Med Rehabil 2005 Nov; 86(11):2114-8. Not 

eligible target population 

2316. Klatka LA, Depper MH, Marini AM. 

Infarction in the territory of the anterior 

cerebral artery. Neurology 1998 Aug; 

51(2):620-2. Case Reports 

2317. Klaus A, Hinder RA, DeVault KR, et al. 

Bowel dysfunction after laparoscopic 

antireflux surgery: incidence, severity, and 

clinical course. Am J Med 2003 Jan; 114(1):6-

9. Case-series 

2318. Klauser A, Frauscher F, Strasser H, et al. Agerelated rhabdosphincter function in female 

urinary stress incontinence: assessment of 

intraurethral sonography. J Ultrasound Med 

2004 May; 23(5):631-7; quiz 8-9. Not eligible 

outcomes 
B-104 

2319. Klausner TI. Urologic challenges in the 

menopausal woman: a case study. Urol Nurs 

2003 Aug; 23(4):293-5. Case-reports 

2320. Klay M, Marfyak K. Use of a continence 

nurse specialist in an extended care facility. 

Urol Nurs 2005 Apr; 25(2):101-2, 7-8. Caseseries 

2321. Kleeman S, Goldwasser S, Vassallo B, et al. 

Predicting postoperative voiding efficiency 

after operation for incontinence and prolapse. 

Am J Obstet Gynecol 2002 Jul; 187(1):49-52. 

Not eligible exposure 

2322. Kleeman SD, Vasallo B, Segal J, et al. 

Vesicocervical fistula following insertion of a 

modified McDonald suture. Bjog 2002 Dec; 

109(12):1408-9. Case Reports 

2323. Klein EA. Modified apical dissection for early 

continence after radical prostatectomy. 

Prostate 1993; 22(3):217-23. Case-series 

2324. Klein MC, Gauthier RJ, Jorgensen SH, et al. 

Does episiotomy prevent perineal trauma and 

pelvic floor relaxation? Online J Curr Clin 

Trials 1992 Jul 1; Doc No 10:[6019 words; 65 

paragraphs]. Not eligible level of evidence 

2325. Kleinhans B, Gerharz E, Melekos M, et al. 

Changes of urodynamic findings after radical 

retropubic prostatectomy. Eur Urol 1999; 

35(3):217-21; discussion 21-2. Case-series 

2326. Klemm LW, Creason NS. Self-care practices 

of women with urinary incontinence--a 

preliminary study. Health Care Women Int 

1991 Apr-Jun; 12(2):199-209. Case-series 

2327. Klijn AJ, Hop WC, Mickisch G, et al. The 

artificial urinary sphincter in men incontinent 

after radical prostatectomy: 5 year actuarial 

adequate function rates. Br J Urol 1998 Oct; 

82(4):530-3. Case-series 

2328. Klimo P, Jr., Rao G, Schmidt RH, et al. Nerve 

sheath tumors involving the sacrum. Case 

report and classification scheme. Neurosurg 

Focus 2003 Aug 15; 15(2):E12. Case Reports 

2329. Kling KM, Rongione AJ, Evans B, et al. The 

Delorme procedure: a useful operation for 

complicated rectal prolapse in the elderly. Am 

Surg 1996 Oct; 62(10):857-60. Case-series 

2330. Klingele CJ, Bharucha AE, Fletcher JG, et al. 

Pelvic organ prolapse in defecatory disorders. 

Obstet Gynecol 2005 Aug; 106(2):315-20. Not 

eligible outcomes 

2331. Klingele CJ, Carley ME, Hill RF. Patient 

characteristics that are associated with 

urodynamically diagnosed detrusor instability 

and genuine stress incontinence. Am J Obstet 

Gynecol 2002 May; 186(5):866-8. Not eligible 

target population 

2332. Klingler HC, Madersbacher S, Djavan B, et al. 

Morbidity of the evaluation of the lower 

urinary tract with transurethral multichannel 

pressure-flow studies. J Urol 1998 Jan; 

159(1):191-4. Not eligible outcomes 

2333. Klingler HC, Pycha A, Schmidbauer J, et al. 

Use of peripheral neuromodulation of the S3 

region for treatment of detrusor overactivity: a 

urodynamic-based study. Urology 2000 Nov 

1; 56(5):766-71. Not eligible target population 

2334. Klutke CG, Nadler RB, Tiemann D, et al. 

Early results with antegrade collagen injection 

for post-radical prostatectomy stress urinary 

incontinence. J Urol 1996 Nov; 156(5):1703-

6. Not eligible target population 

2335. Klutke CG, Tiemann DD, Nadler RB, et al. 

Antegrade collagen injection for stress 

incontinence after radical prostatectomy: 

technique and early results. J Endourol 1996 

Jun; 10(3):279-82. Case-series 

2336. Klutke JJ, Bergman J, Klutke CG. 

Transvaginal bladder neck suspension with 

Cooper's ligament fixation. Long-term 

urodynamic results. J Reprod Med 2000 Jul; 

45(7):541-5. Case-series 

2337. Klutke JJ, Klutke CG, Bergman J, et al. 

Bladder neck suspension for stress urinary 

incontinence: how does it work? Neurourol 

Urodyn 1999; 18(6):623-7. Case-series 

2338. Klutke JJ, Klutke CG, Hsieh G. Bladder injury 

during the Burch retropubic urethropexy: is 

routine cystoscopy necessary? Tech Urol 1998 

Sep; 4(3):145-7. Case-series 

2339. Klutke JJ, Subir C, Andriole G, et al. Longterm results after antegrade collagen injection 

for stress urinary incontinence following 

radical retropubic prostatectomy. Urology 

1999 May; 53(5):974-7. Not eligible target 

population 

2340. Knab K, Langhans B, Behrens R, et al. The 

neuropathic bowel in spina bifida--a crosssectional study in 226 patients. Eur J Pediatr 

Surg 2001 Dec; 11 Suppl 1:S41-2. Not eligible 

target population 

2341. Knight J. Positive thinking. Nurs Stand 2000 

Feb 16-22; 14(22):18-9. Comment 

2342. Knoefel WT, Hosch SB, Hoyer B, et al. The 

initial approach to anorectal abscesses: 

fistulotomy is safe and reduces the chance of 

recurrences. Dig Surg 2000; 17(3):274-8. Not 

eligible outcomes 

2343. Knoll M, Madersbacher H. The chances of a 

spina bifida patient becoming 

continent/socially dry by conservative therapy. 

Paraplegia 1993 Jan; 31(1):22-7. Not eligible 

target population 
B-105 

2344. Knutson T, Edlund C, Fall M, et al. BPH with 

coexisting overactive bladder dysfunction--an 

everyday urological dilemma. Neurourol 

Urodyn 2001; 20(3):237-47. Not eligible 

target population 

2345. Knutson T, Pettersson S, Dahlstrand C. The 

use of biodegradable PGA stents to judge the 

risk of post-TURP incontinence in patients 

with combined bladder outlet obstruction and 

overactive bladder. Eur Urol 2002 Sep; 

42(3):262-7. Case-series 

2346. Ko CY, Tong J, Lehman RE, et al. 

Biofeedback is effective therapy for fecal 

incontinence and constipation. Arch Surg 

1997 Aug; 132(8):829-33; discussion 33-4. 

Case-series 

2347. Ko Y, Lin SJ, Salmon JW, et al. The impact of 

urinary incontinence on quality of life of the 

elderly. Am J Manag Care 2005 Jul; 11(4 

Suppl):S103-11. Not eligible level of evidence 

2348. Kobak W, Lu J, Hardart A, et al. Expression 

of lysyl oxidase and transforming growth 

factor beta2 in women with severe pelvic 

organ prolapse. J Reprod Med 2005 Nov; 

50(11):827-31. Not eligible outcomes 

2349. Kobashi KC, Govier FE. Perioperative 

complications: the first 140 polypropylene 

pubovaginal slings. J Urol 2003 Nov; 

170(5):1918-21. Case-series 

2350. Kobashi KC, Leach GE, Chon J, et al. 

Continued multicenter followup of cadaveric 

prolapse repair with sling. J Urol 2002 Nov; 

168(5):2063-8. Case-Series 

2351. Kobashi KC, Mee SL, Leach GE. A new 

technique for cystocele repair and transvaginal 

sling: the cadaveric prolapse repair and sling 

(CAPS). Urology 2000 Dec 4; 56(6 Suppl 

1):9-14. Case-series 

2352. Kobata SA, Girao MJ, Sartori MG, et al. 

Urodynamic and ultrasonographic evaluation 

after continence surgery. Int Urogynecol J 

Pelvic Floor Dysfunct 1999; 10(5):321-4. 

Case-series 

2353. Kobelt G. Economic considerations and 

outcome measurement in urge incontinence. 

Urology 1997 Dec; 50(6A Suppl):100-7; 

discussion 8-10. Secondary data analysis 

2354. Kobelt G, Fianu-Jonasson A. Treatment of 

stress urinary incontinence with non-animal 

stabilised hyaluronic acid/dextranomer 

(NASHA/Dx) gel : An analysis of utility and 

cost. Clin Drug Investig 2006; 26(10):583-91. 

Not eligible outcomes 

2355. Koch SM, Uludag O, Rongen MJ, et al. 

Dynamic graciloplasty in patients born with 

an anorectal malformation. Dis Colon Rectum 

2004 Oct; 47(10):1711-9. Case-series 

2356. Koch SM, van Gemert WG, Baeten CG. 

Determination of therapeutic threshold in 

sacral nerve modulation for faecal 

incontinence. Br J Surg 2005 Jan; 92(1):83-7. 

Case-series 

2357. Koch T, Kelly S. Identifying strategies for 

managing urinary incontinence with women 

who have multiple sclerosis. J Clin Nurs 1999 

Sep; 8(5):550-9. Comment 

2358. Koch T, Kelly S. Understanding what is 

important for women who live with multiple 

sclerosis. Aust J Holist Nurs 1999 Apr; 

6(1):14-24. Not eligible target population 

2359. Koch T, Kralik D. Chronic illness: reflections 

on a community-based action research 

programme. J Adv Nurs 2001 Oct; 36(1):23-

31. Not associative hypothesis tested 

2360. Koch TR. Anal sphincter injury following 

forceps delivery. Am J Gastroenterol 2003 

Dec; 98(12):2798-9. Comment 

2361. Kochakarn W. Tension-free vaginal tape 

procedure for the treatment of stress urinary 

incontinence: the first experience in Thailand. 

J Med Assoc Thai 2002 Jan; 85(1):87-91. 

Case-series 

2362. Kochakarn W, Leenanupunth C, Ratana-Olarn 

K, et al. Pubovaginal sling for the treatment of 

female stress urinary incontinence: experience 

of 100 cases at Ramathibodi Hospital. J Med 

Assoc Thai 2001 Oct; 84(10):1412-5. Caseseries 

2363. Kochakarn W, Pummangura N, Kijvikai K, et 

al. Reliability of a Thai version of King's 

Health Questionnaire in Thai females with 

overactive bladder symptoms. J Med Assoc 

Thai 2005 Nov; 88(11):1526-34. Not eligible 

exposure 

2364. Kocjancic E, Tarrano E, Panella M, et al. 

Evaluation of minimally invasive analysis 

system for cough leak point pressure 

measurement. J Urol 2004 Sep; 172(3):994-7. 

Not eligible outcomes 

2365. Kocoglu H, Goksu S, Erbagci A, et al. Arterial 

blood gases in extraperitoneal laparoscopic 

urethrocystopexy. Int J Urol 2002 Aug; 

9(8):422-6. Not eligible outcomes 

2366. Kodama H, Hieda I, Kuchinomachi Y, et al. 

Non-invasive ultrasonic urination sensor for 

ambulatory patient support. Methods Inf Med 

1994 Mar; 33(1):97-100. No associative 

hypothesis tested 
B-106 

2367. Koelbl H, Saz V, Doerfler D, et al. 

Transurethral injection of silicone 

microimplants for intrinsic urethral sphincter 

deficiency. Obstet Gynecol 1998 Sep; 

92(3):332-6. Not eligible target population 

2368. Koelbl H, Stoerer S, Seliger G, et al. 

Transurethral penetration of a tension-free 

vaginal tape. Bjog 2001 Jul; 108(7):763-5. 

Case Reports 

2369. Koelle D, Stenzl A, Koelbl H, et al. Treatment 

of postoperative urinary retention by 

elongation of tension-free vaginal tape. Am J 

Obstet Gynecol 2001 Jul; 185(1):250-1. Case 

Reports 

2370. Koelle D, Windisch J, Doerfler D, et al. Effect 

of tension-free vaginal tape operation on 

urethral closure function. Urology 2006 Mar; 

67(3):524-8; discussion 8-9. Case-series 

2371. Kohler A, Athanasiadis S. The value of 

posterior levator repair in the treatment of 

anorectal incontinence due to rectal prolapse--

a clinical and manometric study. Langenbecks 

Arch Surg 2001 Apr; 386(3):188-92. Caseseries 

2372. Kohler LW, Pemberton JH, Zinsmeister AR, 

et al. Quality of life after proctocolectomy. A 

comparison of Brooke ileostomy, Kock pouch, 

and ileal pouch-anal anastomosis. 

Gastroenterology 1991 Sep; 101(3):679-84. 

Not eligible level of evidence 

2373. Koivusalo A, Pakarinen M, Rintala RJ. Are 

cecal wrap and fixation necessary for 

antegrade colonic enema appendicostomy? J 

Pediatr Surg 2006 Feb; 41(2):323-6. Not 

eligible target population 

2374. Koldewijn EL, Hommes OR, Lemmens WA, 

et al. Relationship between lower urinary tract 

abnormalities and disease-related parameters 

in multiple sclerosis. J Urol 1995 Jul; 

154(1):169-73. Not eligible level of evidence 

2375. Kolligian ME, Palmer LS, Cheng EY, et al. 

Myofascial wrap to treat intractable urinary 

incontinence in children. Urology 1998 Dec; 

52(6):1122-7. Not eligible target population 

2376. Kolominsky-Rabas PL, Hilz MJ, Neundoerfer 

B, et al. Impact of urinary incontinence after 

stroke: results from a prospective populationbased stroke register. Neurourol Urodyn 2003; 

22(4):322-7. Case Series 

2377. Komatsu J, Oya M, Ishikawa H. Quantitative 

assessment of anal canal sensation in patients 

undergoing low anterior resection for rectal 

cancer. Surg Today 1995; 25(10):867-73. Not 

eligible outcomes 

2378. Komolafe EO, Malomo AO, Ogunniyi A, et 

al. Shunt-responsive dementing illness in a 

Nigerian--a case report. West Afr J Med 2003 

Jun; 22(2):197-8. Case- reports 

2379. Komorowski L, Chen B. Female urinary 

incontinence in China: experiences and 

perspectives. Health Care Women Int 2006 

Feb; 27(2):169-81. Case-series 

2380. Konagaya M, Matsumoto A, Takase S, et al. 

Clinical analysis of longstanding subacute 

myelo-optico-neuropathy: sequelae of 

clioquinol at 32 years after its ban. J Neurol 

Sci 2004 Mar 15; 218(1-2):85-90. Not eligible 

target population 

2381. Kondo A. Status and tasks of today's 

urodynamics. Urol Int 1991; 47 Suppl 1:16-8. 

Secondary data analysis 

2382. Kondo A, Narushima M, Itoh Y, et al. Vaginal 

nylon sling: loop length and surgical outcomes 

in those with urethral hypermobility and 

intrinsic sphincter deficiency. Int Urogynecol 

J Pelvic Floor Dysfunct 1999; 10(3):182-7. 

Case-series 

2383. Kondo A, Yokoyama E, Koshiba K, et al. 

Bladder neck support prosthesis: a 

nonoperative treatment for stress or mixed 

urinary incontinence. J Urol 1997 Mar; 

157(3):824-7. Not eligible target population 

2384. Kondo Y, Homma Y, Takahashi S, et al. 

Transvaginal ultrasound of urethral sphincter 

at the mid urethra in continent and incontinent 

women. J Urol 2001 Jan; 165(1):149-52. Not 

eligible level of evidence 

2385. Kondoh T, Amamoto N, Doi T, et al. 

Dramatic improvement in Down syndromeassociated cognitive impairment with 

donepezil. Ann Pharmacother 2005 Mar; 

39(3):563-6. Case- Reports 

2386. Kong KH, Chan KF, Lim AC, et al. Detrusor 

hyperreflexia in strokes. Ann Acad Med 

Singapore 1994 May; 23(3):319-21. Caseseries 

2387. Kong KH, Chua KS, Tow AP. Clinical 

characteristics and functional outcome of 

stroke patients 75 years old and older. Arch 

Phys Med Rehabil 1998 Dec; 79(12):1535-9. 

Case-series 

2388. Koninger JS, Butters M, Redecke JD, et al. 

Transverse coloplasty pouch after total 

mesorectal excision: functional assessment of 

evacuation. Dis Colon Rectum 2004 Oct; 

47(10):1586-93. Case-series 

2389. Koninger JS, Butters M, Redecke JD, et al. 

Evacuation of neorectal reservoirs after TME. 

Recent Results Cancer Res 2005; 165:180-90. 

Case-series 
B-107 

2390. Konsten J, Baeten CG, Den Dulk K, et al. 

Demonstration of the feasibility of 

implantation of a skeletal muscle pulse 

generator for fecal incontinence in a patient 

with an implanted unipolar DDD pacemaker. 

Pacing Clin Electrophysiol 1992 May; 

15(5):825-30. Case- Reports 

2391. Konsten J, Baeten CG, Havenith MG, et al. 

Evaluation of gracilis muscle transposition for 

fecal incontinence with magnetic resonance 

imaging. Eur J Radiol 1993 Apr; 16(3):190-4. 

Case-series 

2392. Konsten J, Baeten CG, Spaans F, et al. 

Follow-up of anal dynamic graciloplasty for 

fecal continence. World J Surg 1993 May-Jun; 

17(3):404-8; discussion 8-9. Case-series 

2393. Konsten J, Rongen MJ, Ogunbiyi OA, et al. 

Comparison of epineural or intramuscular 

nerve electrodes for stimulated graciloplasty. 

Dis Colon Rectum 2001 Apr; 44(4):581-6. 

Case-series 

2394. Kontturi MJ, Hellstrom PA, Tammela TL, et 

al. Colocystoplasty for the treatment of severe 

interstitial cystitis. Urol Int 1991; 46(1):50-4. 

Case-series 

2395. Koonings PP, Bergman A, Ballard CA. 

Prostaglandins for enhancing detrusor 

function after surgery for stress incontinence 

in women. J Reprod Med 1990 Jan; 35(1):1-5. 

Not eligible exposure 

2396. Koops SE, Bisseling TM, van Brummen HJ, 

et al. What determines a successful tensionfree vaginal tape? A prospective multicenter 

cohort study: results from The Netherlands 

TVT database. Am J Obstet Gynecol 2006 

Jan; 194(1):65-74. Not eligible exposure 

2397. Koraitim MM. On the art of anastomotic 

posterior urethroplasty: a 27-year experience. 

J Urol 2005 Jan; 173(1):135-9. Not eligible 

target population 

2398. Koraitim MM, Atta MA, Foda MK. Impact of 

the prostatic apex on continence and urinary 

flow in patients with intestinal neobladders. Br 

J Urol 1996 Oct; 78(4):534-6. Case-series 

2399. Korn AP, Learman LA. Operations for stress 

urinary incontinence in the United States, 

1988-1992. Urology 1996 Oct; 48(4):609-12. 

Not eligible outcomes 

2400. Korsgen S, Deen KI, Keighley MR. Longterm results of total pelvic floor repair for 

postobstetric fecal incontinence. Dis Colon 

Rectum 1997 Jul; 40(7):835-9. Case-series 

2401. Korsgen S, Keighley MR. Stimulated gracilis 

neosphincter--not as good as previously 

thought. Report of four cases. Dis Colon 

Rectum 1995 Dec; 38(12):1331-3. Case 

Reports 

2402. Korzets A, Gepstein R, Ori Y, et al. 

Quadriparesis and faecal incontinence in a 

long-term haemodialysis patient. Nephrol Dial 

Transplant 1997 Jan; 12(1):224-5. Case 

Reports 

2403. Kossard S, Bear L. A florid papulo-nodular 

eruption in a sexagenarian. Australas J 

Dermatol 1991; 32(3):178-80. Case report 

2404. Kostov DV, Temelkov TD, Dragnev NA, et 

al. Smooth muscle sphincteroplasty in 

colostomy. Dis Colon Rectum 2004 Apr; 

47(4):486-93. Case-series 

2405. Koyanagi T, Ameda K, Nantani M, et al. 

Preoperative cystometrography in patients 

with clinical benign prostatic hypertrophy. 

World J Urol 1995; 13(1):24-9. Case series 

2406. Koyle MA, Kaji DM, Duque M, et al. The 

Malone antegrade continence enema for 

neurogenic and structural fecal incontinence 

and constipation. J Urol 1995 Aug; 154(2 Pt 

2):759-61. Not eligible target population 

2407. Kraemer M, Ho YH, Tan W. Effectiveness of 

anorectal biofeedback therapy for faecal 

incontinence: medium-term results. Tech 

Coloproctol 2001 Dec; 5(3):125-9. Caseseries 

2408. Krahn M, Ritvo P, Irvine J, et al. Patient and 

community preferences for outcomes in 

prostate cancer: implications for clinical 

policy. Med Care 2003 Jan; 41(1):153-64. 

Case-series 

2409. Kralj B. Epidemiology of female urinary 

incontinence, classification of urinary 

incontinence, urinary incontinence in elderly 

women. Eur J Obstet Gynecol Reprod Biol 

1994 May 31; 55(1):39-41. Review 

2410. Krauss JK, Droste DW, Vach W, et al. 

Cerebrospinal fluid shunting in idiopathic 

normal-pressure hydrocephalus of the elderly: 

effect of periventricular and deep white matter 

lesions. Neurosurgery 1996 Aug; 39(2):292-9; 

discussion 9-300. Case-series 

2411. Krauth JS, Rasoamiaramanana H, Barletta H, 

et al. Sub-urethral tape treatment of female 

urinary incontinence--morbidity assessment of 

the trans-obturator route and a new tape (ISTOP): a multi-centre experiment involving 

604 cases. Eur Urol 2005 Jan; 47(1):102-6; 

discussion 6-7. Case-series 
B-108 

2412. Kreder K, Das AK, Webster GD. The hemiKock ileocystoplasty: a versatile procedure in 

reconstructive urology. J Urol 1992 May; 

147(5):1248-51. Case-series 

2413. Kreder KJ, Jr., Brubaker L, Mainprize T. 

Tolterodine is equally effective in patients 

with mixed incontinence and those with urge 

incontinence alone. BJU Int 2003 Sep; 

92(4):418-21. Not eligible exposure 

2414. Kreder KJ, Webster GD. Management of the 

bladder outlet in patients requiring 

enterocystoplasty. J Urol 1992 Jan; 147(1):38-

41. Case-series 

2415. Kreis ME, Jehle EC, Haug V, et al. Functional 

results after transanal endoscopic 

microsurgery. Dis Colon Rectum 1996 Oct; 

39(10):1116-21. Case-series 

2416. Kreis ME, Jehle EC, Ohlemann M, et al. 

Functional results after transanal rectal 

advancement flap repair of trans-sphincteric 

fistula. Br J Surg 1998 Feb; 85(2):240-2. 

Case-series 

2417. Krishna A, Gough DC, Fishwick J, et al. 

Ileocystoplasty in children: assessing safety 

and success. Eur Urol 1995; 27(1):62-6. Not 

eligible target population 

2418. Krissi H, Adam JE, Stanton SL. MRI 

visualization of the female pelvis in the plane 

of the tension-free vaginal tape (TVT) 

procedure. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Nov; 14(5):342-5; discussion 

5-6. Not eligible outcomes 

2419. Krissi H, Pansky M, Halperin R, et al. 

Maximal urethral closure pressure < 20 cm 

H2O: does it predict intrinsic sphincteric 

deficiency? J Reprod Med 2005 Nov; 

50(11):824-6. Case-series 

2420. Kristiansson P, Samuelsson E, von Schoultz 

B, et al. Reproductive hormones and stress 

urinary incontinence in pregnancy. Acta 

Obstet Gynecol Scand 2001 Dec; 

80(12):1125-30. Not eligible level of evidence 

2421. Krogh K, Christensen P, Sabroe S, et al. 

Neurogenic bowel dysfunction score. Spinal 

Cord 2006 Oct; 44(10):625-31. Not eligible 

outcomes 

2422. Krogh K, Laurberg S. Malone antegrade 

continence enema for faecal incontinence and 

constipation in adults. Br J Surg 1998 Jul; 

85(7):974-7. Case-series 

2423. Krogh K, Nielsen J, Djurhuus JC, et al. 

Colorectal function in patients with spinal 

cord lesions. Dis Colon Rectum 1997 Oct; 

40(10):1233-9. Not eligible target population 

2424. Kron M, Loy S, Sturm E, et al. Risk indicators 

for falls in institutionalized frail elderly. Am J 

Epidemiol 2003 Oct 1; 158(7):645-53. Not 

eligible outcomes 

2425. Krumholz HM, Chen J, Chen YT, et al. 

Predicting one-year mortality among elderly 

survivors of hospitalization for an acute 

myocardial infarction: results from the 

Cooperative Cardiovascular Project. J Am 

Coll Cardiol 2001 Aug; 38(2):453-9. Not 

eligible outcomes 

2426. Krupski TL, Saigal CS, Litwin MS. Variation 

in continence and potency by definition. J 

Urol 2003 Oct; 170(4 Pt 1):1291-4. Case 

series 

2427. Kruyt RH, Delemarre JB, Gooszen HG, et al. 

Defecography and anorectal manometry. Eur J 

Radiol 1992 Sep; 15(2):166-70. Not eligible 

outcomes 

2428. Krygowska-Wajs A, Hussey JM, Hulihan M, 

et al. Two large Polish kindreds with 

levodopa-responsive Parkinsonism not linked 

to known Parkinsonian genes and loci. 

Parkinsonism Relat Disord 2003 Mar; 

9(4):193-200. Case- Reports 

2429. Ku JH, Jeong IG, Lim DJ, et al. Voiding diary 

for the evaluation of urinary incontinence and 

lower urinary tract symptoms: prospective 

assessment of patient compliance and burden. 

Neurourol Urodyn 2004; 23(4):331-5. Not 

eligible outcomes 

2430. Ku JH, Oh JG, Shin JW, et al. Outcome of 

mid-urethral sling procedures in Korean 

women with stress urinary incontinence 

according to body mass index. Int J Urol 2006 

Apr; 13(4):379-84. Case-series 

2431. Ku JH, Oh JG, Shin JW, et al. Age is not a 

limiting factor for midurethral sling 

procedures in the elderly with urinary 

incontinence. Gynecol Obstet Invest 2006; 

61(4):194-9. Case-series 

2432. Ku JH, Shin JW, Oh SJ, et al. Clinical and 

urodynamic features according to subjective 

symptom severity in female urinary 

incontinence. Neurourol Urodyn 2006; 

25(3):215-20. Not eligible outcomes 

2433. Kubik K, Blackwell L, Heit M. Does 

socioeconomic status explain racial 

differences in urinary incontinence 

knowledge? Am J Obstet Gynecol 2004 Jul; 

191(1):188-93. Not eligible outcomes 
B-109 

2434. Kuczyk MA, Klein S, Grunewald V, et al. A 

questionnaire-based outcome analysis of the 

Stamey bladder neck suspension procedure for 

the treatment of urinary stress incontinence: 

the Hannover experience. Br J Urol 1998 Aug; 

82(2):174-80. Case-series 

2435. Kudo T, Mima T, Hashimoto R, et al. Tau 

protein is a potential biological marker for 

normal pressure hydrocephalus. Psychiatry 

Clin Neurosci 2000 Apr; 54(2):199-202. Not 

eligible outcomes 

2436. Kuehn BM. Silence masks prevalence of fecal 

incontinence. Jama 2006 Mar 22; 

295(12):1362-3. News 

2437. Kuhn W, Rist M, Zaech GA. Intermittent 

urethral self-catheterisation: long term results 

(bacteriological evolution, continence, 

acceptance, complications). Paraplegia 1991 

May; 29(4):222-32. Case-series 

2438. Kuijpers HC, Scheuer M. Disorders of 

impaired fecal control. A clinical and 

manometric study. Dis Colon Rectum 1990 

Mar; 33(3):207-11. Not eligible outcomes 

2439. Kulkarni S, Davies AJ, Gowreeson G, et al. 

Flank abscess and bladder stone--late 

complications of permanent suture material 

used in colposuspension. J Obstet Gynaecol 

2004 Nov; 24(8):938-9. Case Reports 

2440. Kuller JA, Katz VL, McCoy MC, et al. 

Pregnancy complicated by Guillain-Barre 

syndrome. South Med J 1995 Sep; 88(9):987-

9. Case-reports 

2441. Kulseng-Hanssen S. The development of a 

national database of the results of surgery for 

urinary incontinence in women. BJOG 2003 

Nov; 110(11):975-82. Not eligible outcomes 

2442. Kulseng-Hanssen S, Berild GH. Subjective 

and objective incontinence 5 to 10 years after 

Burch colposuspension. Neurourol Urodyn 

2002; 21(2):100-5. Case-series 

2443. Kulseng-Hanssen S, Husby H, Schiotz HA. 

The tension free vaginal tape operation for 

women with mixed incontinence: Do 

preoperative variables predict the outcome? 

Neurourol Urodyn 2007; 26(1):115-21; 

discussion 22. Case-series 

2444. Kumar D, Benson MJ, Bland JE. 

Glutaraldehyde cross-linked collagen in the 

treatment of faecal incontinence. Br J Surg 

1998 Jul; 85(7):978-9. Case-series 

2445. Kumar D, Hutchinson R, Grant E. Bilateral 

gracilis neosphincter construction for 

treatment of faecal incontinence. Br J Surg 

1995 Dec; 82(12):1645-7. Case-series 

2446. Kumar V, Toussi H, Marr C, et al. The 

benefits of radical prostatectomy beyond 

cancer control in symptomatic men with 

prostate cancer. BJU Int 2004 Mar; 93(4):507-

9. Case-series 

2447. Kung RC, Lie K, Lee P, et al. The costeffectiveness of laparoscopic versus 

abdominal Burch procedures in women with 

urinary stress incontinence. J Am Assoc 

Gynecol Laparosc 1996 Aug; 3(4):537-44. 

Case-series 

2448. Kuo HC. Transrectal sonography of the 

female urethra in incontinence and frequencyurgency syndrome. J Ultrasound Med 1996 

May; 15(5):363-70. Not eligible outcomes 

2449. Kuo HC. Clinical outcome and quality of life 

after enterocystoplasty for contracted 

bladders. Urol Int 1997; 58(3):160-5. Caseseries 

2450. Kuo HC. Transrectal sonographic 

investigation of urethral and paraurethral 

structures in women with stress urinary 

incontinence. J Ultrasound Med 1998 May; 

17(5):311-20. Not eligible outcomes 

2451. Kuo HC. Quality of life after active urological 

management of chronic spinal cord injury in 

eastern Taiwan. Eur Urol 1998; 34(1):37-46. 

Not eligible target population 

2452. Kuo HC. Videourodynamic results after 

pubovaginal sling procedure for stress urinary 

incontinence. Urology 1999 Nov; 54(5):802-6; 

discussion 6-7. Case-series 

2453. Kuo HC. Sonographic evaluation of anatomic 

results after the pubovaginal sling procedure 

for stress urinary incontinence. J Ultrasound 

Med 2001 Jul; 20(7):739-47. Case-series 

2454. Kuo HC. Anatomical and functional results of 

pubovaginal sling procedure using 

polypropylene mesh for the treatment of stress 

urinary incontinence. J Urol 2001 Jul; 

166(1):152-7. Not eligible target population 

2455. Kuo HC. Long-term results of surgical 

treatment for female stress urinary 

incontinence. Urol Int 2001; 66(1):13-7. Caseseries 

2456. Kuo HC. Analysis of the pathophysiology of 

lower urinary tract symptoms in patients after 

prostatectomy. Urol Int 2002; 68(2):99-104. 

Case series 

2457. Kuo HC. Effectiveness of intravesical 

resiniferatoxin in treating detrusor hyperreflexia and external sphincter dyssynergia in 

patients with chronic spinal cord lesions. BJU 

Int 2003 Oct; 92(6):597-601. Case-series 
B-110 

2458. Kuo HC. Effectiveness of urethral injection of 

botulinum A toxin in the treatment of voiding 

dysfunction after radical hysterectomy. Urol 

Int 2005; 75(3):247-51. Case-series 

2459. Kuo HC. Clinical effects of suburothelial 

injection of botulinum A toxin on patients 

with nonneurogenic detrusor overactivity 

refractory to anticholinergics. Urology 2005 

Jul; 66(1):94-8. Not eligible target population 

2460. Kuo HC, Chang SC, Hsu T. A new 

classification of female stress urinary 

incontinence--based on transrectal 

sonographic cystourethrography. J Formos 

Med Assoc 1991 Aug; 90(8):769-75. Caseseries 

2461. Kuo HC, Liu HT, Yang WC. Therapeutic 

effect of multiple resiniferatoxin intravesical 

instillations in patients with refractory 

detrusor overactivity: a randomized, doubleblind, placebo controlled study. J Urol 2006 

Aug; 176(2):641-5. Not eligible exposure 

2462. Kupeli B, Kordan Y, Alkibay T. Urinary 

incontinence after pelvic trauma: a case report. 

Int Urol Nephrol 2001; 32(3):363-5. Case 

Reports 

2463. Kurabayashi H, Kubota K, Kawada E, et al. 

Complete cure of urinary and faecal 

incontinence after intravenous vitamin B12 

therapy in a patient with post-gastrectomy 

megaloblastic anaemia. J Intern Med 1992 

Mar; 231(3):313-5. Case- Reports 

2464. Kurfuerst S. Stop before it starts. Rehab 

Manag 2003 Oct; 16(8):42-4, 54. Comment 

2465. Kursh ED. Factors influencing the outcome of 

a no incision endoscopic urethropexy. Surg 

Gynecol Obstet 1992 Sep; 175(3):254-8. 

Case-series 

2466. Kurzrock EA, Lowe P, Hardy BE. Bladder 

wall pedicle wraparound sling for neurogenic 

urinary incontinence in children. J Urol 1996 

Jan; 155(1):305-8. Not eligible target 

population 

2467. Kushwaha RS, Hayne D, Vaizey CJ, et al. 

Physiologic changes of the anorectum after 

pelvic radiotherapy for the treatment of 

prostate and bladder cancer. Dis Colon 

Rectum 2003 Sep; 46(9):1182-8. Case-series 

2468. Kusunoki M, Okamoto T, Yoshikawa H, et al. 

Defecographic assessment after colonic J 

pouch-anal anastomosis. Surg Today 1996; 

26(12):971-4. Case-series 

2469. Kusunoki M, Shoji Y, Ikeuchi H, et al. 

Usefulness of valproate sodium for treatment 

of incontinence after ileoanal anastomosis. 

Surgery 1990 Mar; 107(3):311-5. Not eligible 

target population 

2470. Kusunoki M, Shoji Y, Yanagi H, et al. 

Function after anoabdominal rectal resection 

and colonic J pouch--anal anastomosis. Br J 

Surg 1991 Dec; 78(12):1434-8. Case-series 

2471. Kuuva N, Nilsson CG. Tension-free vaginal 

tape procedure: an effective minimally 

invasive operation for the treatment of 

recurrent stress urinary incontinence? Gynecol 

Obstet Invest 2003; 56(2):93-8. Case-series 

2472. Kuuva N, Nilsson CG. Long-term results of 

the tension-free vaginal tape operation in an 

unselected group of 129 stress incontinent 

women. Acta Obstet Gynecol Scand 2006; 

85(4):482-7. Case-series 

2473. Kwon CH, Culligan PJ, Koduri S, et al. The 

development of pelvic organ prolapse 

following isolated Burch retropubic 

urethropexy. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Nov; 14(5):321-5; discussion 

5. Case-series 

2474. Kwon E, Schulz JA, Flood CG. Success of 

pubovaginal sling in patients with stress 

urinary incontinence and efficacy of vaginal 

sling release in patients with post-sling 

voiding dysfunction. J Obstet Gynaecol Can 

2006 Jun; 28(6):519-25. Case-series 

2475. Kylmala T, Tainio H, Raitanen M, et al. 

Treatment of postoperative male urinary 

incontinence using transurethral 

macroplastique injections. J Endourol 2003 

Mar; 17(2):113-5. Case-series 

2476. Kylyc S, Sargin SY, Gunes A, et al. A rare 

condition: the ureteritis cystica. 

ScientificWorldJournal 2004 Jun 7; 4 Suppl 

1:175-8. Case Reports 

2477. Kyne L, Merry C, O'Connell B, et al. Factors 

associated with prolonged symptoms and 

severe disease due to Clostridium difficile. 

Age Ageing 1999 Mar; 28(2):107-13. Not 

eligible target population 

2478. La Torre F, Masoni L, Montori J, et al. The 

surgical treatment of fecal incontinence with 

artificial anal sphincter implant. Preliminary 

clinical report. Hepatogastroenterology 2004 

Sep-Oct; 51(59):1358-61. Case-series 

2479. Lachs MS, Feinstein AR, Cooney LM, Jr., et 

al. A simple procedure for general screening 

for functional disability in elderly patients. 

Ann Intern Med 1990 May 1; 112(9):699-706. 

No associative hypothesis tested 

2480. Lacima G, Espuna M, Pera M, et al. Clinical, 

urodynamic, and manometric findings in 

women with combined fecal and urinary 

incontinence. Neurourol Urodyn 2002; 

21(5):464-9. Not eligible outcomes 
B-111 

2481. Lacima G, Pera M, Valls-Sole J, et al. 

Electrophysiologic studies and clinical 

findings in females with combined fecal and 

urinary incontinence: a prospective study. Dis 

Colon Rectum 2006 Mar; 49(3):353-9. Not 

eligible outcomes 

2482. Lacy BE, Zayat E, Crowell MD. Generalized 

intestinal dysmotility in a patient with 

syringomyelia. Am J Gastroenterol 2001 Apr; 

96(4):1282-5. Case Reports 

2483. Lagerveld BW, Laguna MP, Debruyne FM, et 

al. Holmium:YAG laser for treatment of 

strictures of vesicourethral anastomosis after 

radical prostatectomy. J Endourol 2005 May; 

19(4):497-501. Case-series 

2484. Lagro-Janssen AL, Debruyne FM, Van Weel 

C. Psychological aspects of female urinary 

incontinence in general practice. Br J Urol 

1992 Nov; 70(5):499-502. Not eligible 

outcomes 

2485. Laguna MP, Brenninkmeier M, Belon JA, et 

al. Long-term functional and urodynamic 

results of 50 patients receiving a modified 

sigmoid neobladder created with a short distal 

segment. J Urol 2005 Sep; 174(3):963-7. 

Case-series 

2486. Lai HH, Hsu EI, Teh BS, et al. 13 years of 

experience with artificial urinary sphincter 

implantation at Baylor College of Medicine. J 

Urol 2007 Mar; 177(3):1021-5. Case-series 

2487. Lal R, Bhatnagar V, Agarwala S, et al. 

Urodynamic evaluation in boys treated for 

posterior urethral valves. Pediatr Surg Int 

1999 Jul; 15(5-6):358-62. Not eligible target 

population 

2488. Lalos O, Berglund AL, Bjerle P. The longterm outcome of retropubic urethrocystopexy 

(sutures and fibrin sealant) and pubococcygeal 

repair. Acta Obstet Gynecol Scand 2000 Feb; 

79(2):135-9. Case-series 

2489. Lalos O, Berglund AL, Lalos A. Impact of 

urinary and climacteric symptoms on social 

and sexual life after surgical treatment of 

stress urinary incontinence in women: a longterm outcome. J Adv Nurs 2001 Feb; 

33(3):316-27. Case-series 

2490. Lalos O, Lalos A. Urinary, climacteric and 

sexual symptoms one year after treatment of 

endometrial and cervical cancer. Eur J 

Gynaecol Oncol 1996; 17(2):128-36. Caseseries 

2491. Lam AM, Jenkins GJ, Hyslop RS. 

Laparoscopic Burch colposuspension for 

stress incontinence: preliminary results. Med J 

Aust 1995 Jan 2; 162(1):18-21. Not eligible 

outcomes 

2492. Lam GW, Foldspang A, Elving LB, et al. 

Social context, social abstention, and problem 

recognition correlated with adult female 

urinary incontinence. Dan Med Bull 1992 

Dec; 39(6):565-70. Not eligible level of 

evidence 

2493. Lam SP, Fong SY, Kwok A, et al. Delayed 

neuropsychiatric impairment after carbon 

monoxide poisoning from burning charcoal. 

Hong Kong Med J 2004 Dec; 10(6):428-31. 

Case Reports 

2494. Lan Z, Jinghe L, Zhufeng L, et al. Comparison 

the efficiency of different surgical procedures 

for urinary stress incontinence. Chin Med Sci 

J 2000 Jun; 15(2):107-10. Case-series 

2495. Landi F, Cesari M, Onder G, et al. Indwelling 

urethral catheter and mortality in frail elderly 

women living in community. Neurourol 

Urodyn 2004; 23(7):697-701. Not eligible 

target population 

2496. Landi F, Onder G, Cesari M, et al. Functional 

decline in frail community-dwelling stroke 

patients. Eur J Neurol 2006 Jan; 13(1):17-23. 

Not eligible outcomes 

2497. Landis JR, Kaplan S, Swift S, et al. Efficacy 

of antimuscarinic therapy for overactive 

bladder with varying degrees of incontinence 

severity. J Urol 2004 Feb; 171(2 Pt 1):752-6. 

Not eligible exposure 

2498. Lang J, Zhu L, Sun Z, et al. Clinical study on 

collagen and stress urinary incontinence. Clin 

Exp Obstet Gynecol 2002; 29(3):180-2. Not 

eligible outcomes 

2499. Lang JH, Zhu L, Sun ZJ, et al. Estrogen levels 

and estrogen receptors in patients with stress 

urinary incontinence and pelvic organ 

prolapse. Int J Gynaecol Obstet 2003 Jan; 

80(1):35-9. Not eligible outcomes 

2500. Lange V, Meyer G, Schardey HM, et al. 

Laparoscopic creation of a loop colostomy. J 

Laparoendosc Surg 1991 Oct; 1(5):307-12. 

Case Reports 

2501. Langebrekke A, Dahlstrom B, Eraker R, et al. 

The laparoscopic Burch procedure. A 

preliminary report. Acta Obstet Gynecol 

Scand 1995 Feb; 74(2):153-5. Case-series 

2502. Langer R, Golan A, Arad D, et al. Effects of 

induced menopause on Burch colposuspension 

for urinary stress incontinence. J Reprod Med 

1992 Dec; 37(12):956-8. Not eligible target 

population 

2503. Langer R, Golan A, Neuman M, et al. The 

effect of large uterine fibroids on urinary 

bladder function and symptoms. Am J Obstet 

Gynecol 1990 Oct; 163(4 Pt 1):1139-41. 

Case-series 
B-112 

2504. Langer R, Golan A, Ron-El R, et al. 

Colposuspension for urinary stress 

incontinence in premenopausal and 

postmenopausal women. Surg Gynecol Obstet 

1990 Jul; 171(1):13-6. Case-series 

2505. Langer R, Lipshitz Y, Halperin R, et al. LongTerm (10-15 years) follow-up after Burch 

colposuspension for urinary stress 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2001; 12(5):323-6; discussion 6-7. 

Not eligible target population 

2506. Lantzsch T, Goepel C, Wolters M, et al. 

Sacrospinous ligament fixation for vaginal 

vault prolapse. Arch Gynecol Obstet 2001 

Mar; 265(1):21-5. Not eligible level of 

evidence 

2507. Lao TT, Halpern SH, MacDonald D, et al. 

Spinal subdural haematoma in a parturient 

after attempted epidural anaesthesia. Can J 

Anaesth 1993 Apr; 40(4):340-5. Case Reports 

2508. Lara LL, Troop PR, Beadleson-Baird M. The 

risk of urinary tract infection in bowel 

incontinent men. J Gerontol Nurs 1990 May; 

16(5):24-6. Not eligible outcomes 

2509. Larsen WI, Yavorek TA. Pelvic organ 

prolapse and urinary incontinence in 

nulliparous women at the United States 

Military Academy. Int Urogynecol J Pelvic 

Floor Dysfunct 2006 May; 17(3):208-10. Not 

eligible level of evidence 

2510. Larson B, Collins A, Landgren BM. 

Urogenital and vasomotor symptoms in 

relation to menopausal status and the use of 

hormone replacement therapy (HRT) in 

healthy women during transition to 

menopause. Maturitas 1997 Dec 15; 28(2):99-

105. Not eligible level of evidence 

2511. Larson DW, Chrouser K, Young-Fadok T, et 

al. Rectal complications after modern 

radiation for prostate cancer: a colorectal 

surgical challenge. J Gastrointest Surg 2005 

Apr; 9(4):461-6. Case-series 

2512. LaSala CA. Incomplete bladder emptying 

after the tension-free vaginal tape procedure, 

necessitating release of the mesh. A report of 

three cases. J Reprod Med 2003 May; 

48(5):387-90. Case Reports 

2513. LaSala CA, Schimpf MO, Udoh E, et al. 

Outcome of tension-free vaginal tape 

procedure when complicated by intraoperative 

cystotomy. Am J Obstet Gynecol 2006 Dec; 

195(6):1857-61. Not eligible outcomes 

2514. Lasheen AE, Khalifa S, El Askry SM, et al. 

Closed rectopexy with transanal resection for 

complete rectal prolapse in adults. J 

Gastrointest Surg 2005 Sep-Oct; 9(7):980-4. 

Case-series 

2515. Lasser P, Dube P, Guillot JM, et al. 

Pseudocontinent perineal colostomy following 

abdominoperineal resection: technique and 

findings in 49 patients. Eur J Surg Oncol 2001 

Feb; 27(1):49-53. Case-series 

2516. Latini JM, Alipour M, Kreder KJ, Jr. Efficacy 

of sacral neuromodulation for symptomatic 

treatment of refractory urinary urge 

incontinence. Urology 2006 Mar; 67(3):550-3; 

discussion 3-4. Case-series 

2517. Laubach J. The problem of urinary 

incontinence in the elderly. N C Med J 1999 

Jan-Feb; 60(1):42-5. Comment 

2518. Lauer D, Netsch D, Amick N. Product 

notebook: occlusive skin paste. Ostomy 

Wound Manage 1992 Sep; 38(7):20-2, 4, 6-8. 

Case- Reports 

2519. Laurberg S, Swash M, Henry MM. Effect of 

postanal repair on progress of neurogenic 

damage to the pelvic floor. Br J Surg 1990 

May; 77(5):519-22. Case-series 

2520. Laurikainen E, Kiilholma P. The tension-free 

vaginal tape procedure for female urinary 

incontinence without preoperative urodynamic 

evaluation. J Am Coll Surg 2003 Apr; 

196(4):579-83. Case-series 

2521. Laurikainen E, Kiilholma P. A nationwide 

analysis of transvaginal tape release for 

urinary retention after tension-free vaginal 

tape procedure. Int Urogynecol J Pelvic Floor 

Dysfunct 2006 Feb; 17(2):111-9. Case-series 

2522. Laurikainen E, Rosti J, Pitkanen Y, et al. The 

Rosti sling: a new, minimally invasive, 

tension-free technique for the surgical 

treatment of female urinary incontinence-the 

first 217 patients. J Urol 2004 Apr; 

171(4):1576-80; discussion 80. Case-series 

2523. Laurikkala J, Juhola M, Lammi S, et al. 

Analysis of the imputed female urinary 

incontinence data for the evaluation of expert 

system parameters. Comput Biol Med 2001 

Jul; 31(4):239-57. Not eligible outcomes 

2524. Laurikkala J, Juhola M, Penttinen J, et al. 

Parameter evaluation of the differential 

diagnosis of female urinary incontinence for 

the construction of an expert system. Stud 

Health Technol Inform 1997; 43 Pt B:671-5. 
B-113 

2525. Law PA, Danin JC, Lamb GM, et al. Dynamic 

imaging of the pelvic floor using an openconfiguration magnetic resonance scanner. J 

Magn Reson Imaging 2001 Jun; 13(6):923-9. 

Not eligible outcomes 

2526. Law PJ, Kamm MA, Bartram CI. A 

comparison between electromyography and 

anal endosonography in mapping external anal 

sphincter defects. Dis Colon Rectum 1990 

May; 33(5):370-3. Not eligible outcomes 

2527. Law PJ, Kamm MA, Bartram CI. Anal 

endosonography in the investigation of faecal 

incontinence. Br J Surg 1991 Mar; 78(3):312-

4. Not eligible outcomes 

2528. Law WL, Tung HM, Chu KW, et al. 

Ambulatory stapled haemorrhoidectomy: a 

safe and feasible surgical technique. Hong 

Kong Med J 2003 Apr; 9(2):103-7. Not 

eligible outcomes 

2529. Laycock J. Incontinence. Pelvic floor reeducation. Nursing (Lond) 1991 Jul 25-Aug 

21; 4(39):15-7. Comment 

2530. Layward L, Holmes P. Research to combat 

urinary incontinence. Br J Community Nurs 

2006 Oct; 11(10):433-6. Review 

2531. Lazorthes F, Gamagami R, Cabarrot P, et al. 

Is rectal intussusception a cause of idiopathic 

incontinence? Dis Colon Rectum 1998 May; 

41(5):602-5. Case-series 

2532. Lazzeri M, Calo G, Spinelli M, et al. 

Urodynamic effects of intravesical 

nociceptin/orphanin FQ in neurogenic 

detrusor overactivity: a randomized, placebocontrolled, double-blind study. Urology 2003 

May; 61(5):946-50. Not eligible exposure 

2533. Le Lievre S. The management and prevention 

of incontinence dermatitis. Br J Community 

Nurs 2001 Apr; 6(4):180-5. Not eligible 

outcomes 

2534. Leach GE, Trockman B, Wong A, et al. Postprostatectomy incontinence: urodynamic 

findings and treatment outcomes. J Urol 1996 

Apr; 155(4):1256-9. Case-series 

2535. Leandri P, Rossignol G, Gautier JR, et al. 

Radical retropubic prostatectomy: morbidity 

and quality of life. Experience with 620 

consecutive cases. J Urol 1992 Mar; 147(3 Pt 

2):883-7. Case series 

2536. Leaver R, Pressland D. Intermittent selfcatheterisation in urinary tract reconstruction. 

Br J Community Nurs 2001 May; 6(5):253-8. 

2537. Leboeuf L, Mendez LE, Gousse AE. Small 

bowel obstruction associated with tension-free 

vaginal tape. Urology 2004 Jun; 63(6):1182-4. 

Case Reports 

2538. Lechaux JP, Atienza P, Goasguen N, et al. 

Prosthetic rectopexy to the pelvic floor and 

sigmoidectomy for rectal prolapse. Am J Surg 

2001 Nov; 182(5):465-9. Case-series 

2539. Lechaux JP, Lechaux D, Perez M. Results of 

Delorme's procedure for rectal prolapse. 

Advantages of a modified technique. Dis 

Colon Rectum 1995 Mar; 38(3):301-7. Caseseries 

2540. Leduc BE, Spacek E, Lepage Y. Colonic 

transit time after spinal cord injury: any 

clinical significance? J Spinal Cord Med 2002 

Fall; 25(3):161-6. Case-series 

2541. Lee AH, Somerford PJ, Yau KK. Factors 

influencing survival after stroke in Western 

Australia. Med J Aust 2003 Sep 15; 

179(6):289-93. Not eligible level of evidence 

2542. Lee AH, Somerford PJ, Yau KK. Risk factors 

for ischaemic stroke recurrence after 

hospitalisation. Med J Aust 2004 Sep 6; 

181(5):244-6. Not eligible outcomes 

2543. Lee CL, Yen CF, Wang CJ, et al. Trocarassisted sling suspension for stress urinary 

incontinence. J Am Assoc Gynecol Laparosc 

2002 Nov; 9(4):500-2. Case-series 

2544. Lee GY, Paradiso G, Tator CH, et al. Surgical 

management of tethered cord syndrome in 

adults: indications, techniques, and long-term 

outcomes in 60 patients. J Neurosurg Spine 

2006 Feb; 4(2):123-31. Case-series 

2545. Lee HY, Lee SH, Kim SN. Castleman's 

disease: unusual case of inflammatory spinal 

dorsal epidural mass: case report. 

Neurosurgery 2002 Feb; 50(2):396-8. Case 

Reports 

2546. Lee IS, Choi ES. Pelvic floor muscle exercise 

by biofeedback and electrical stimulation to 

reinforce the pelvic floor muscle after normal 

delivery. Taehan Kanho Hakhoe Chi 2006 

Dec; 36(8):1374-80. Not eligible target 

population 

2547. Lee JG, Hong JY, Choo MS, et al. 

Tolterodine: as effective but better tolerated 

than oxybutynin in Asian patients with 

symptoms of overactive bladder. Int J Urol 

2002 May; 9(5):247-52. Not eligible exposure 

2548. Lee JY, Kim HW, Lee SJ, et al. Comparison 

of doxazosin with or without tolterodine in 

men with symptomatic bladder outlet 

obstruction and an overactive bladder. BJU Int 

2004 Oct; 94(6):817-20. Case-series 

2549. Lee KS, Chan CJ, Merriman A, et al. Clinical 

profile of elderly urinary incontinence in 

Singapore: a community-based study. Ann 

Acad Med Singapore 1991 Nov; 20(6):736-9. 

Not eligible level of evidence 
B-114 

2550. Lee KS, Choo MS, Kim DY, et al. 

Combination treatment with propiverine 

hydrochloride plus doxazosin controlled 

release gastrointestinal therapeutic system 

formulation for overactive bladder and 

coexisting benign prostatic obstruction: a 

prospective, randomized, controlled 

multicenter study. J Urol 2005 Oct; 174(4 Pt 

1):1334-8. Not eligible outcomes 

2551. Lee KS, Han DH, Choi YS, et al. A 

prospective trial comparing tension-free 

vaginal tape and transobturator vaginal tape 

inside-out for the surgical treatment of female 

stress urinary incontinence: 1-year followup. J 

Urol 2007 Jan; 177(1):214-8. Not eligible 

target population 

2552. Lee KS, Owen RE, Choo PW, et al. Urinary 

incontinence in the elderly. Singapore Med J 

1991 Apr; 32(2):161-3. No associative 

hypothesis tested 

2553. Lee KS, Owen RE, Choo PW, et al. Faecal 

incontinence in the elderly. Singapore Med J 

1991 Apr; 32(2):164-5. 

2554. Lee PS, Reid DW, Saltmarche A, et al. 

Measuring the psychosocial impact of urinary 

incontinence: the York Incontinence 

Perceptions Scale (YIPS). J Am Geriatr Soc 

1995 Nov; 43(11):1275-8. Not eligible level of 

evidence 

2555. Lee SJ, Park YS. Serial evaluation of 

anorectal function following low anterior 

resection of the rectum. Int J Colorectal Dis 

1998; 13(5-6):241-6. Case-series 

2556. Lee YH, Creasey GH. Self-controlled dorsal 

penile nerve stimulation to inhibit bladder 

hyperreflexia in incomplete spinal cord injury: 

a case report. Arch Phys Med Rehabil 2002 

Feb; 83(2):273-7. Case- Reports 

2557. Lee YT, Cho TW, Jeong HS, et al. 

Reconfigured sigmoid colon neourethra: 

substitution of refractory posterior urethral 

stricture. Urology 2005 Jan; 65(1):157-9. Case 

Reports 

2558. Lefaucheur JP. Excitability of the motor 

cortical representation of the external anal 

sphincter. Exp Brain Res 2005 Jan; 

160(2):268-72. Not eligible target population 

2559. Lefevre JH, Parc Y, Giraudo G, et al. 

Outcome of antegrade continence enema 

procedures for faecal incontinence in adults. 

Br J Surg 2006 Oct; 93(10):1265-9. Caseseries 

2560. Leger JM, Henin D, Belec L, et al. 

Lymphoma-induced polyradiculopathy in 

AIDS: two cases. J Neurol 1992 Mar; 

239(3):132-4. Not eligible exposure 

2561. Lehtoranta K, Tainio H, Lukkari-Lax E, et al. 

Pharmacokinetics, efficacy, and safety of 

intravesical formulation of oxybutynin in 

patients with detrusor overactivity. Scand J 

Urol Nephrol 2002 Feb; 36(1):18-24. Not 

eligible exposure 

2562. Lehur PA, Glemain P, Bruley des Varannes S, 

et al. Outcome of patients with an implanted 

artificial anal sphincter for severe faecal 

incontinence. A single institution report. Int J 

Colorectal Dis 1998; 13(2):88-92. Case-series 

2563. Lehur PA, Michot F, Denis P, et al. Results of 

artificial sphincter in severe anal incontinence. 

Report of 14 consecutive implantations. Dis 

Colon Rectum 1996 Dec; 39(12):1352-5. 

Case-series 

2564. Lehur PA, Roig JV, Duinslaeger M. Artificial 

anal sphincter: prospective clinical and 

manometric evaluation. Dis Colon Rectum 

2000 Aug; 43(8):1100-6. Case-series 

2565. Lehur PA, Zerbib F, Neunlist M, et al. 

Comparison of quality of life and anorectal 

function after artificial sphincter implantation. 

Dis Colon Rectum 2002 Apr; 45(4):508-13. 

Not eligible target population 

2566. Leibovici D, Zisman A, Siegel YI, et al. 

Cryosurgical ablation for prostate cancer: 

preliminary results of a new advanced 

technique. Isr Med Assoc J 2001 Jul; 

3(7):484-7. Case-series 

2567. Leiby DM, Shanahan N. Clinical study: 

assessing the performance and skin 

environments of two reusable underpads. 

Ostomy Wound Manage 1994 Oct; 40(8):30-

2, 4-7. Not eligible outcomes 

2568. Leighton JA, Valdovinos MA, Pemberton JH, 

et al. Anorectal dysfunction and rectal 

prolapse in progressive systemic sclerosis. Dis 

Colon Rectum 1993 Feb; 36(2):182-5. Caseseries 

2569. Leissner J, Allhoff EP, Naumann G, et al. 

Inguinovaginal sling procedure for female 

stress incontinence: introduction of a 

minimally invasive technique. Tech Urol 2001 

Jun; 7(2):105-9. Case-series 

2570. Lekan-Rutledge D. Behavioral vs drug 

treatment for urge urinary incontinence in 

older women: a randomized controlled trial. J 

Wound Ostomy Continence Nurs 1999 May; 

26(3):27A-8A. Not eligible exposure 

2571. Lekan-Rutledge D. Diffusion of innovation. A 

model for implementation of prompted 

voiding in long-term care settings. J Gerontol 

Nurs 2000 Apr; 26(4):25-33. No associative 

hypothesis tested 
B-115 

2572. Lekan-Rutledge D, Palmer MH, Belyea M. In 

their own words: nursing assistants' 

perceptions of barriers to implementation of 

prompted voiding in long-term care. 

Gerontologist 1998 Jun; 38(3):370-8. Not 

eligible target population 

2573. Lemack GE, Frohman EM, Zimmern PE, et al. 

Urodynamic distinctions between idiopathic 

detrusor overactivity and detrusor overactivity 

secondary to multiple sclerosis. Urology 2006 

May; 67(5):960-4. Not eligible outcomes 

2574. Lemelle JL, Guillemin F, Aubert D, et al. A 

multicenter evaluation of urinary incontinence 

management and outcome in spina bifida. J 

Urol 2006 Jan; 175(1):208-12. Not eligible 

target population 

2575. Lemelle JL, Guillemin F, Aubert D, et al. A 

multicentre study of the management of 

disorders of defecation in patients with spina 

bifida. Neurogastroenterol Motil 2006 Feb; 

18(2):123-8. Not eligible target population 

2576. Lemelle JL, Simo AK, Schmitt M. 

Comparative study of the Yang-Monti channel 

and appendix for continent diversion in the 

Mitrofanoff and Malone principles. J Urol 

2004 Nov; 172(5 Pt 1):1907-10. Not eligible 

target population 

2577. Lemesh RA. Accidental chronic salicylate 

intoxication in an elderly patient: major 

morbidity despite early recognition. Vet Hum 

Toxicol 1993 Feb; 35(1):34-6. Case- Reports 

2578. Leng WW, Faerber G, Del Terzo M, et al. 

Long-term outcome of incontinent 

ileovesicostomy management of severe lower 

urinary tract dysfunction. J Urol 1999 Jun; 

161(6):1803-6. Case-series 

2579. Lenihan JP, Palacios P, Sotomayor M. Oral 

and local anesthesia in the nonsurgical 

radiofrequency-energy treatment of stress 

urinary incontinence. J Minim Invasive 

Gynecol 2005 Sep-Oct; 12(5):415-9. Not 

eligible target population 

2580. Lentz SS, Homesley HD. Radiation-induced 

vesicosacral fistula: treatment with continent 

urinary diversion. Gynecol Oncol 1995 Aug; 

58(2):278-80. Case- Reports 

2581. Leong AF, Yunos AB. Stoma management in 

a tropical country: colostomy irrigation versus 

natural evacuation. Ostomy Wound Manage 

1999 Nov; 45(11):52-6. Case-series 

2582. Leonhardt C, Krysl J, Arenson AM, et al. 

Periurethral injection of collagen in the 

treatment of urinary stress incontinence: 

ultrasonographic appearance. Can Assoc 

Radiol J 1995 Jun; 46(3):189-93. Case-series 

2583. Lepisto A, Sarna S, Tiitinen A, et al. Female 

fertility and childbirth after ileal pouch-anal 

anastomosis for ulcerative colitis. Br J Surg 

2007 Apr; 94(4):478-82. Not eligible 

outcomes 

2584. Lepisto M, Eriksson E, Hietanen H, et al. 

Developing a pressure ulcer risk assessment 

scale for patients in long-term care. Ostomy 

Wound Manage 2006 Feb; 52(2):34-46. Not 

eligible outcomes 

2585. Lepor H, Guerena M, Dixon CM. 

Perianastomotic injection of autologous fat at 

the time of radical retropubic prostatectomy. 

Urology 1994 Nov; 44(5):783-8. Case-series 

2586. Lepor H, Kaci L, Xue X. Continence 

following radical retropubic prostatectomy 

using self-reporting instruments. J Urol 2004 

Mar; 171(3):1212-5. Not eligible outcomes 

2587. Lepor H, Nieder AM, Fraiman MC. Early 

removal of urinary catheter after radical 

retropubic prostatectomy is both feasible and 

desirable. Urology 2001 Sep; 58(3):425-9. Not 

eligible exposure 

2588. Lepor H, Theune C. Randomized double-blind 

study comparing the efficacy of terazosin 

versus placebo in women with prostatism-like 

symptoms. J Urol 1995 Jul; 154(1):116-8. Not 

eligible exposure 

2589. Lerner SE, Fleischmann J, Taub HC, et al. 

Combined laparoscopic pelvic lymph node 

dissection and modified belt radical perineal 

prostatectomy for localized prostatic 

adenocarcinoma. Urology 1994 Apr; 

43(4):493-8. Case-series 

2590. Leroi AM, Dorival MP, Lecouturier MF, et al. 

Pudendal neuropathy and severity of 

incontinence but not presence of an anal 

sphincter defect may determine the response 

to biofeedback therapy in fecal incontinence. 

Dis Colon Rectum 1999 Jun; 42(6):762-9. 

Case-series 

2591. Leroi AM, Kamm MA, Weber J, et al. Internal 

anal sphincter repair. Int J Colorectal Dis 

1997; 12(4):243-5. Case-series 

2592. Leroi AM, Michot F, Grise P, et al. Effect of 

sacral nerve stimulation in patients with fecal 

and urinary incontinence. Dis Colon Rectum 

2001 Jun; 44(6):779-89. Not eligible target 

population 

2593. Leron E, Stanton SL. Vaginal leiomyoma--an 

imitator of prolapse. Int Urogynecol J Pelvic 

Floor Dysfunct 2000 Jun; 11(3):196-8. Case 

Reports 
B-116 

2594. Leung HY, Yip SK, Cheon C, et al. A 

randomized controlled trial of tolterodine and 

oxybutynin on tolerability and clinical 

efficacy for treating Chinese women with an 

overactive bladder. BJU Int 2002 Sep; 

90(4):375-80. Not eligible exposure 

2595. Lev N, Maimon S, Rappaport ZH, et al. Spinal 

dural arteriovenous fistulae--a diagnostic 

challenge. Isr Med Assoc J 2001 Jul; 

3(7):492-6. Case-series 

2596. Levin I, Groutz A, Gold R, et al. Surgical 

complications and medium-term outcome 

results of tension-free vaginal tape: a 

prospective study of 313 consecutive patients. 

Neurourol Urodyn 2004; 23(1):7-9. Not 

eligible target population 

2597. Levitt MA, Soffer SZ, Pena A. Continent 

appendicostomy in the bowel management of 

fecally incontinent children. J Pediatr Surg 

1997 Nov; 32(11):1630-3. Not eligible target 

population 

2598. Levitt MD, Kamm MA, Groom J, et al. 

Ileoanal pouch compliance and motor 

function. Br J Surg 1992 Feb; 79(2):126-8. 

Case-series 

2599. Levy BJ, Wight TN. Structural changes in the 

aging submucosa: new morphologic criteria 

for the evaluation of the unstable human 

bladder. J Urol 1990 Oct; 144(4):1044-55. Not 

eligible outcomes 

2600. Levy-Storms L, Schnelle JF, Simmons SF. 

What do family members notice following an 

intervention to improve mobility and 

incontinence care for nursing home residents? 

An analysis of open-ended comments. 

Gerontologist 2007 Feb; 47(1):14-20. Not 

eligible outcomes 

2601. Lewicky CE, Valentin C, Saclarides TJ. 

Sexual function following sphincteroplasty for 

women with third- and fourth-degree perineal 

tears. Dis Colon Rectum 2004 Oct; 

47(10):1650-4. Case-series 

2602. Lewis CM, Schrader R, Many A, et al. 

Diabetes and urinary incontinence in 50- to 

90-year-old women: a cross-sectional 

population-based study. Am J Obstet Gynecol 

2005 Dec; 193(6):2154-8. Not eligible level of 

evidence 

2603. Lewis WG, Holdsworth PJ, Sagar PM, et al. 

Coordinated activity of the new "rectum" and 

anal sphincter after sphincter-saving resection 

of the rectum for colitis or carcinoma. Dis 

Colon Rectum 1994 Oct; 37(10):1012-9. 

2604. Lewis WG, Martin IG, Williamson ME, et al. 

Why do some patients experience poor 

functional results after anterior resection of 

the rectum for carcinoma? Dis Colon Rectum 

1995 Mar; 38(3):259-63. Not eligible 

outcomes 

2605. Lewis WG, Miller AS, Williamson ME, et al. 

The perfect pelvic pouch--what makes the 

difference? Gut 1995 Oct; 37(4):552-6. Caseseries 

2606. Lewis-Abney K, Rosenkranz CF. Content 

validation of impaired skin integrity and 

urinary incontinence in the home health 

setting. Nurs Diagn 1994 Jan-Mar; 5(1):36-42. 

Question 4 

2607. Lewis-Byers K, Thayer D. An evaluation of 

two incontinence skin care protocols in a longterm care setting. Ostomy Wound Manage 

2002 Dec; 48(12):44-51. Not eligible 

outcomes 

2608. Li FL, Low LP, Lee DT. Chinese women's 

experiences in coping with urinary 

incontinence. J Clin Nurs 2007 Mar; 

16(3):610-2. Case-series 

2609. Li YW, Hung WT, Chen CC, et al. 

Postoperative MRI of anorectal malformation. 

J Formos Med Assoc 1997 Mar; 96(3):199-

204. Case-series 

2610. Liang CC, Chang SD, Chang YL, et al. Threedimensional power Doppler measurement of 

perfusion of the periurethral tissue in 

incontinent women -- a preliminary report. 

Acta Obstet Gynecol Scand 2006; 85(5):608-

13. Not eligible outcomes 

2611. Liang CC, Chang YL, Chang SD, et al. 

Pessary test to predict postoperative urinary 

incontinence in women undergoing 

hysterectomy for prolapse. Obstet Gynecol 

2004 Oct; 104(4):795-800. Not eligible 

exposure 

2612. Liang HM, Huang KH, Kung FT, et al. 

Combination of a tension-free vaginal tape 

procedure and laparoscopic-assisted vaginal 

hysterectomy for the treatment of benign 

uterine disease associated with stress urinary 

incontinence. Chang Gung Med J 2005 Mar; 

28(3):166-73. Case-series 

2613. Liao YM, Dougherty MC, Liou YS, et al. 

Pelvic floor muscle training effect on urinary 

incontinence knowledge, attitudes, and 

severity: an experimental study. Int J Nurs 

Stud 2006 Jan; 43(1):29-37. Case-series 

2614. Liapis A, Bakas P, Creatsas G. Management 

of stress urinary incontinence in women with 

the use of tension-free vaginal tape. Eur Urol 

2001 Nov; 40(5):548-51. Case-series 
B-117 

2615. Liapis A, Bakas P, Pafiti A, et al. Changes of 

collagen type III in female patients with 

genuine stress incontinence and pelvic floor 

prolapse. Eur J Obstet Gynecol Reprod Biol 

2001 Jul; 97(1):76-9. Not eligible outcomes 

2616. Liapis A, Bakas P, Pafiti A, et al. Changes in 

the quantity of collagen type I in women with 

genuine stress incontinence. Urol Res 2000 

Oct; 28(5):323-6. Not eligible outcomes 

2617. Liapis A, Bakas P, Salamalekis E, et al. 

Tension-free vaginal tape (TVT) in women 

with low urethral closure pressure. Eur J 

Obstet Gynecol Reprod Biol 2004 Sep 10; 

116(1):67-70. Case-series 

2618. Liapis A, Papoulias I, Chryssicopoulos A, et 

al. Results of the colposuspension operation in 

pre and postmenopausal incontinent women. 

Maturitas 1998 Nov 30; 31(1):69-75. Caseseries 

2619. Liapis AH, Kalovidoyris A, Logis CD, et al. 

Transvaginal sonography in the postoperative 

evaluation of colposuspension. J Gynecol 

Surg 1993 Fall; 9(3):155-9. Case-series 

2620. Liberman H, Faria J, Ternent CA, et al. A 

prospective evaluation of the value of 

anorectal physiology in the management of 

fecal incontinence. Dis Colon Rectum 2001 

Nov; 44(11):1567-74. Not eligible outcomes 

2621. Licht MR, Klein EA, Tuason L, et al. Impact 

of bladder neck preservation during radical 

prostatectomy on continence and cancer 

control. Urology 1994 Dec; 44(6):883-7. 

Case-series 

2622. Lieb J, Das AK. Urethral erosion of tensionfree vaginal tape. Scand J Urol Nephrol 2003; 

37(2):184-5. Case Reports 

2623. Lieu PK, Chia HH, Heng LC, et al. Carerassisted intermittent urethral catheterisation in 

the management of persistent retention of 

urine in elderly women. Ann Acad Med 

Singapore 1996 Jul; 25(4):562-5. Case-series 

2624. Light JK, Marks JL. Total bladder 

replacement in the male and female using the 

ileocolonic segment (LeBag). Br J Urol 1990 

May; 65(5):467-72. Case-series 

2625. Lii FN, Chen YM, Shu CH, et al. Metastatic 

nasopharyngeal carcinoma with epidural 

spinal cord compression: report of an unusual 

and catastrophic event. Zhonghua Yi Xue Za 

Zhi (Taipei) 1995 Feb; 55(2):195-8. CaseReports 

2626. Lilleby W, Fossa SD, Waehre HR, et al. 

Long-term morbidity and quality of life in 

patients with localized prostate cancer 

undergoing definitive radiotherapy or radical 

prostatectomy. Int J Radiat Oncol Biol Phys 

1999 Mar 1; 43(4):735-43. Case series 

2627. Lilli P, Mercuriali M, Fiori M, et al. Impact of 

preoperative biofeedback on incontinence in 

cancer patients undergoing radical 

prostatectomy. Arch Ital Urol Androl 2006 

Sep; 78(3):92-6. Not eligible target population 

2628. Liloku RB, Mure PY, Braga L, et al. The left 

Monti-Malone procedure: Preliminary results 

in seven cases. J Pediatr Surg 2002 Feb; 

37(2):228-31. Case-series 

2629. Lim AG, Langmead FL, Feakins RM, et al. 

Diversion colitis: a trigger for ulcerative 

colitis in the in-stream colon? Gut 1999 Feb; 

44(2):279-82. Case Reports 

2630. Lim AJ, Brandon AH, Fiedler J, et al. Quality 

of life: radical prostatectomy versus radiation 

therapy for prostate cancer. J Urol 1995 Oct; 

154(4):1420-5. Not eligible level of evidence 

2631. Lim HJ, Lee MS, Lee MS. Relation of urinary 

incontinence, menopausal symptoms, and life 

satisfaction in middle-age Korean women. 

Psychol Rep 2005 Aug; 97(1):203-4. Not 

eligible level of evidence 

2632. Lim JF, Ho YH. Total colectomy with 

ileorectal anastomosis leads to appreciable 

loss in quality of life irrespective of primary 

diagnosis. Tech Coloproctol 2001 Aug; 

5(2):79-83. Case-series 

2633. Lim JF, Tjandra JJ, Hiscock R, et al. 

Preoperative chemoradiation for rectal cancer 

causes prolonged pudendal nerve terminal 

motor latency. Dis Colon Rectum 2006 Jan; 

49(1):12-9. Case-series 

2634. Lim PP, Sahadevan S, Choo GK, et al. Burden 

of caregiving in mild to moderate dementia: 

an Asian experience. Int Psychogeriatr 1999 

Dec; 11(4):411-20. Not eligible target 

population 

2635. Lim YN, Rane A. Suburethral vaginal erosion 

and pyogenic granuloma formation: an 

unusual complication of intravaginal 

slingplasty (IVS). Int Urogynecol J Pelvic 

Floor Dysfunct 2004 Jan-Feb; 15(1):56-8. 

Case Reports 

2636. Lima SV, Araujo LA, Vilar FO. Nonsecretory 

intestinocystoplasty: a 10-year experience. J 

Urol 2004 Jun; 171(6 Pt 2):2636-39; 

discussion 9-40. Not eligible target population 
B-118 

2637. Lima SV, Araujo LA, Vilar FO, et al. 

Combined use of enterocystoplasty and a new 

type of artificial sphincter in the treatment of 

urinary incontinence. J Urol 1996 Aug; 156(2 

Pt 2):622-4. Not eligible target population 

2638. Limb J, Wood K, Weinberger M, et al. Sacral 

colpopexy using mersilene mesh in the 

treatment of vaginal vault prolapse. World J 

Urol 2005 Feb; 23(1):55-60. Case-series 

2639. Lin AT, Wang SJ, Chen KK, et al. In vivo 

tension sustained by fascial sling in 

pubovaginal sling surgery for female stress 

urinary incontinence. J Urol 2005 Mar; 

173(3):894-7. Case-series 

2640. Lin CC, Bai YM, Chen JY, et al. A 

retrospective study of clozapine and urinary 

incontinence in Chinese in-patients. Acta 

Psychiatr Scand 1999 Aug; 100(2):158-61. 

Case-series 

2641. Lin DW, Santucci RA, Mayo ME, et al. 

Urodynamic evaluation and long-term results 

of the orthotopic gastric neobladder in men. J 

Urol 2000 Aug; 164(2):356-9. Case-series 

2642. Lin HH, Sheu BC, Lo MC, et al. Abnormal 

urodynamic findings after radical 

hysterectomy or pelvic irradiation for cervical 

cancer. Int J Gynaecol Obstet 1998 Nov; 

63(2):169-74. Case-series 

2643. Lin HH, Torng PL, Sheu BC, et al. 

Urodynamically age-specific prevalence of 

urinary incontinence in women with urinary 

symptoms. Neurourol Urodyn 2003; 22(1):29-

32. Not eligible target population 

2644. Lin HH, Yu HJ, Sheu BC, et al. Importance of 

urodynamic study before radical hysterectomy 

for cervical cancer. Gynecol Oncol 2001 May; 

81(2):270-2. Not eligible level of evidence 

2645. Lin LY, Yeh NH, Lin CY, et al. Comparisons 

of urodynamic characteristics between female 

patients with overactive bladder and 

overactive bladder plus stress urinary 

incontinence. Urology 2004 Nov; 64(5):945-9. 

Not eligible outcomes 

2646. Lin SY, Dougherty MC. Incontinence impact, 

symptom distress and treatment-seeking 

behavior in women with involuntary urine loss 

in Southern Taiwan. Int J Nurs Stud 2003 

Mar; 40(3):227-34. Not eligible outcomes 

2647. Lin YH, Liang CC, Lo TS, et al. Concomitant 

tension-free vaginal tape for urinary 

incontinence during laparoscopic 

hysterectomy. Aust N Z J Obstet Gynaecol 

2005 Aug; 45(4):304-7. Case-series 

2648. Lindboe CF, Stolt-Nielsen A, Dale LG. 

Hemorrhage in a highly vascularized 

subependymoma of the septum pellucidum: 

case report. Neurosurgery 1992 Oct; 

31(4):741-5. Case Reports 

2649. Lindesay J, Matthews R, Jagger C. Factors 

associated with antipsychotic drug use in 

residential care: changes between 1990 and 

1997. Int J Geriatr Psychiatry 2003 Jun; 

18(6):511-9. Not eligible outcomes 

2650. Lindsay J, Sykes E, McDowell I, et al. More 

than the epidemiology of Alzheimer's disease: 

contributions of the Canadian Study of Health 

and Aging. Can J Psychiatry 2004 Feb; 

49(2):83-91. Not eligible outcomes 

2651. Lindsay R, James EL, Kippen S. The Timed 

Up and Go Test: unable to predict falls on the 

acute medical ward. Aust J Physiother 2004; 

50(4):249-51. Not eligible outcomes 

2652. Lindsey I, Jones OM, Smilgin-Humphreys 

MM, et al. Patterns of fecal incontinence after 

anal surgery. Dis Colon Rectum 2004 Oct; 

47(10):1643-9. Case-series 

2653. Link RE, Su LM, Bhayani SB, et al. 

Laparoscopic sacral colpoperineopexy for 

treatment of perineal body descent and vaginal 

vault prolapse. Urology 2004 Jul; 64(1):145-7. 

Case Reports 

2654. Linkletter D. No more surgery--biofeedback 

for continence. Ostomy Wound Manage 1997 

Nov-Dec; 43(10):50-2. Comment 

2655. Lionis C, Vlachonikolis L, Bathianaki M, et 

al. Urinary incontinence, the hidden health 

problem of Cretan women: report from a 

primary care survey in Greece. Women Health 

2000; 31(4):59-66. Not eligible level of 

evidence 

2656. Liptak GS, Revell GM. Management of bowel 

dysfunction in children with spinal cord 

disease or injury by means of the enema 

continence catheter. J Pediatr 1992 Feb; 120(2 

Pt 1):190-4. Not eligible target population 

2657. Lipton RB, Kolodner K, Wesnes K. 

Assessment of cognitive function of the 

elderly population: effects of darifenacin. J 

Urol 2005 Feb; 173(2):493-8. Not eligible 

exposure 

2658. Liratzopoulos N, Efremidou EI, Papageorgiou 

MS, et al. Lateral subcutaneous internal 

sphincterotomy in the treatment of chronic 

anal fissure: our experience. J Gastrointestin 

Liver Dis 2006 Jun; 15(2):143-7. Case-series 

2659. Little JS, Jr., Bihrle R, Foster RS. Early 

urethral catheter removal following radical 

prostatectomy: a pilot study. Urology 1995 

Sep; 46(3):429-31. Case-series 
B-119 

2660. Litwiller SE, Kim KB, Fone PD, et al. Postprostatectomy incontinence and the artificial 

urinary sphincter: a long-term study of patient 

satisfaction and criteria for success. J Urol 

1996 Dec; 156(6):1975-80. Case-series 

2661. Liu S, Christmas TJ, Nagendran K, et al. 

Sphincter electromyography in patients after 

radical prostatectomy and cystoprostatectomy. 

Br J Urol 1992 Apr; 69(4):397-403. Question 

4 

2662. Lo TS, Chang TC, Chao AS, et al. Tensionfree vaginal tape procedure on genuine stress 

incontinent women with coexisting genital 

prolapse. Acta Obstet Gynecol Scand 2003 

Nov; 82(11):1049-53. Case-series 

2663. Lo TS, Horng SG, Chang CL, et al. Tensionfree vaginal tape procedure after previous 

failure in incontinence surgery. Urology 2002 

Jul; 60(1):57-61. Case-series 

2664. Lo TS, Horng SG, Liang CC, et al. Ultrasound 

and urodynamic comparison between 

caudocranial and craniocaudal tension-free 

vaginal tape for stress urinary incontinence. 

Urology 2005 Oct; 66(4):754-8; discussion 8-

9. Case-series 

2665. Lo TS, Horng SG, Liang CC, et al. Ultrasound 

assessment of mid-urethra tape at three-year 

follow-up after tension-free vaginal tape 

procedure. Urology 2004 Apr; 63(4):671-5. 

Case-series 

2666. Lo TS, Huang HJ, Chang CL, et al. Use of 

intravenous anesthesia for tension-free vaginal 

tape therapy in elderly women with genuine 

stress incontinence. Urology 2002 Mar; 

59(3):349-53. Case-series 

2667. Lo TS, Lee SJ. Treatment of recurrent genuine 

stress incontinence by shortening previously 

implanted tension-free vaginal tape. Acta 

Obstet Gynecol Scand 2004 Oct; 83(10):1005-

6. Case Reports 

2668. Lo TS, Lin CT, Huang HJ, et al. The use of 

general anesthesia for the tension-free vaginal 

tape procedure and concomitant surgery. Acta 

Obstet Gynecol Scand 2003 Apr; 82(4):367-

73. Case-series 

2669. Lo TS, Wang AC, Horng SG, et al. 

Ultrasonographic and urodynamic evaluation 

after tension free vagina tape procedure 

(TVT). Acta Obstet Gynecol Scand 2001 Jan; 

80(1):65-70. Case-series 

2670. Lo TS, Wang AC, Liang CC, et al. Treatment 

for unsuccessful tension-free vaginal tape 

operation by shortening pre-implanted tape. J 

Urol 2006 Jun; 175(6):2196-9; discussion 9-

200. Case-series 

2671. Lobel RW, Davis GD. Long-term results of 

laparoscopic Burch urethropexy. J Am Assoc 

Gynecol Laparosc 1997 May; 4(3):341-5. 

Case-series 

2672. Lobel RW, Sand PK. Incisional hernia after 

suprapubic catheterization. Obstet Gynecol 

1997 May; 89(5 Pt 2):844-6. Case Reports 

2673. Locher JL, Burgio KL, Goode PS, et al. 

Effects of age and causal attribution to aging 

on health-related behaviors associated with 

urinary incontinence in older women. 

Gerontologist 2002 Aug; 42(4):515-21. Not 

eligible outcomes 

2674. Locher JL, Goode PS, Roth DL, et al. 

Reliability assessment of the bladder diary for 

urinary incontinence in older women. J 

Gerontol A Biol Sci Med Sci 2001 Jan; 

56(1):M32-5. Not eligible outcomes 

2675. Lock G, Zeuner M, Lang B, et al. Anorectal 

function in systemic sclerosis: correlation with 

esophageal dysfunction? Dis Colon Rectum 

1997 Nov; 40(11):1328-35. Case-series 

2676. Lockhart JL, Ellis GF, Helal M, et al. 

Combined cystourethropexy for the treatment 

of type 3 and complicated female urinary 

incontinence. J Urol 1990 Apr; 143(4):722-5. 

Case-series 

2677. Lockhart JL, Pow-Sang JM, Persky L, et al. A 

continent colonic urinary reservoir: the Florida 

pouch. J Urol 1990 Oct; 144(4):864-7. Caseseries 

2678. Lockhart JL, Pow-Sang JM, Persky L, et al. 

Results, complications and surgical 

indications of the Florida pouch. Surg 

Gynecol Obstet 1991 Oct; 173(4):289-96. 

Case-series 

2679. Loening-Baucke V. Efficacy of biofeedback 

training in improving faecal incontinence and 

anorectal physiologic function. Gut 1990 Dec; 

31(12):1395-402. Not eligible target 

population 

2680. Loharuka S, Barrett J, Roe B. Incontinence 

and falls in older people: is there a link? Nurs 

Times 2005 Nov 22-28; 101(47):52, 4. 

Comment 

2681. Londono-Schimmer EE, Garcia-Duperly R, 

Nicholls RJ, et al. Overlapping anal sphincter 

repair for faecal incontinence due to sphincter 

trauma: five year follow-up functional results. 

Int J Colorectal Dis 1994 May; 9(2):110-3. 

Review 

2682. Long CY, Hsu SC, Chang Y, et al. The 

clinical and urodynamic effects of the tension 

free bladder neck sling procedure. Int 

Urogynecol J Pelvic Floor Dysfunct 2004 

Sep-Oct; 15(5):344-9. Case-series 
B-120 

2683. Long CY, Hsu SC, Wu TP, et al. Urodynamic 

comparison of continent and incontinent 

women with severe uterovaginal prolapse. J 

Reprod Med 2004 Jan; 49(1):33-7. Not 

eligible outcomes 

2684. Long CY, Juan YS, Liu CM, et al. 

Concomitant resection of congenital vaginal 

septum during the tension-free vaginal tape 

procedure. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Jul-Aug; 16(4):311-2. Casereports 

2685. Long R. Continence by design. Contemp 

Longterm Care 1999 Aug; 22(8):36-8, 40. 

Comment 

2686. Long R. Ingenuity encounters incontinence. 

Contemp Longterm Care 2001 Jun; 24(6):24-

8. Comment 

2687. Lopez A, Holmstrom B, Nilsson BY, et al. 

Paradoxical sphincter reaction is influenced by 

rectal filling volume. Dis Colon Rectum 1998 

Aug; 41(8):1017-22. Case-series 

2688. Lopez A, Nilsson BY, Mellgren A, et al. 

Electromyography of the external anal 

sphincter: comparison between needle and 

surface electrodes. Dis Colon Rectum 1999 

Apr; 42(4):482-5. Not eligible exposure 

2689. Lottmann HB, Margaryan M, Lortat-Jacob S, 

et al. Long-term effects of dextranomer 

endoscopic injections for the treatment of 

urinary incontinence: an update of a 

prospective study of 61 patients. J Urol 2006 

Oct; 176(4 Pt 2):1762-6. Not eligible target 

population 

2690. Lovatsis D, Gupta C, Dean E, et al. Tensionfree vaginal tape procedure is an ideal 

treatment for obese patients. Am J Obstet 

Gynecol 2003 Dec; 189(6):1601-4; discussion 

4-5. Case-series 

2691. Low G, Shenoy AK, Gilmour AR, et al. A 

randomized comparison of retention balloon 

and standard tip rectal catheters in preventing 

incontinence during double-contrast barium 

enema. AJR Am J Roentgenol 2006 Sep; 

187(3):702-5. Not eligible outcomes 

2692. Low SJ, Smith KM, Holt EM. Tension free 

vaginal tape: is the intra-operative cough test 

necessary? Int Urogynecol J Pelvic Floor 

Dysfunct 2004 Sep-Oct; 15(5):328-30. Caseseries 

2693. Lowe BA. Preservation of the anterior urethral 

ligamentous attachments in maintaining postprostatectomy urinary continence: a 

comparative study. J Urol 1997 Dec; 

158(6):2137-41. Case-series 

2694. Lu WT, Chen CC. Factors affecting 

postoperative fecal soiling in Hirschsprung's 

disease. J Formos Med Assoc 1998 Mar; 

97(3):170-3. Not eligible target population 

2695. Luangkhot R, Peng BC, Blaivas JG. 

Ileocecocystoplasty for the management of 

refractory neurogenic bladder: surgical 

technique and urodynamic findings. J Urol 

1991 Nov; 146(5):1340-4. Case-series 

2696. Lubeck DP, Prebil LA, Peeples P, et al. A 

health related quality of life measure for use in 

patients with urge urinary incontinence: a 

validation study. Qual Life Res 1999 Jun; 

8(4):337-44. Not eligible outcomes 

2697. Luber KM, Boero S, Choe JY. The 

demographics of pelvic floor disorders: 

current observations and future projections. 

Am J Obstet Gynecol 2001 Jun; 184(7):1496-

501; discussion 501-3. Not eligible level of 

evidence 

2698. Luck AM, Galvin SL, Theofrastous JP. Suture 

erosion and wound dehiscence with permanent 

versus absorbable suture in reconstructive 

posterior vaginal surgery. Am J Obstet 

Gynecol 2005 May; 192(5):1626-9. Not 

eligible outcomes 

2699. Luk JK, Cheung RT, Ho SL, et al. Does age 

predict outcome in stroke rehabilitation? A 

study of 878 Chinese subjects. Cerebrovasc 

Dis 2006; 21(4):229-34. Question 1 

2700. Lukac M, Krstic Z, Sindjic S, et al. Continent 

appendicostomy in the treatment of fecal 

incontinence. Acta Chir Iugosl 2004; 

51(2):139-40. Not eligible target population 

2701. Lukacz ES, Lawrence JM, Buckwalter JG, et 

al. Epidemiology of prolapse and incontinence 

questionnaire: validation of a new 

epidemiologic survey. Int Urogynecol J Pelvic 

Floor Dysfunct 2005 Jul-Aug; 16(4):272-84. 

Not eligible outcomes 

2702. Lukacz ES, Luber KM, Nager CW. The 

effects of the tension-free vaginal tape on 

proximal urethral position: a prospective, 

longitudinal evaluation. Int Urogynecol J 

Pelvic Floor Dysfunct 2003 Aug; 14(3):179-

84; discussion 84. Case-series 

2703. Lukacz ES, Luber KM, Nager CW. The 

effects of the tension-free vaginal tape on 

voiding function: a prospective evaluation. Int 

Urogynecol J Pelvic Floor Dysfunct 2004 JanFeb; 15(1):32-8; discussion 8. Not eligible 

target population 
B-121 

2704. Lumley J, Small R, Brown S, et al. PRISM 

(Program of Resources, Information and 

Support for Mothers) Protocol for a 

community-randomised trial 

[ISRCTN03464021]. BMC Public Health 

2003 Nov 20; 3:36. Not associative hypothesis 

tested 

2705. Lumley J, Watson L, Small R, et al. PRISM 

(Program of Resources, Information and 

Support for Mothers): a communityrandomised trial to reduce depression and 

improve women's physical health six months 

after birth [ISRCTN03464021]. BMC Public 

Health 2006; 6:37. Not eligible outcomes 

2706. Lundqvist C, Siosteen A, Blomstrand C, et al. 

Spinal cord injuries. Clinical, functional, and 

emotional status. Spine 1991 Jan; 16(1):78-83. 

Case-series 

2707. Lunniss PJ, Kamm MA, Phillips RK. Factors 

affecting continence after surgery for anal 

fistula. Br J Surg 1994 Sep; 81(9):1382-5. 

Case-series 

2708. Lusky K. Care is the cure. Incontinence calls 

for individualized treatment. Contemp 

Longterm Care 1994 Dec; 17(12):49-50. 

Comment 

2709. Luther SL, Nelson A, Powell-Cope G. 

Provider attitudes and beliefs about clinical 

practice guidelines. SCI Nurs 2004 Winter; 

21(4):206-12. Not eligible target population 

2710. Lyder CH, Clemes-Lowrance C, Davis A, et 

al. Structured skin care regimen to prevent 

perineal dermatitis in the elderly. J ET Nurs 

1992 Jan-Feb; 19(1):12-6. Not eligible 

outcomes 

2711. Lynch AC, Wong C, Anthony A, et al. Bowel 

dysfunction following spinal cord injury: a 

description of bowel function in a spinal cordinjured population and comparison with age 

and gender matched controls. Spinal Cord 

2000 Dec; 38(12):717-23. Not eligible target 

population 

2712. Lyons DL, Blum T, Curtin PM, et al. 

Improving care of the older adult. Medsurg 

Nurs 2006 Jun; 15(3):176-7, 81. Comment 

2713. Lyons SS, Specht JK. Prompted voiding 

protocol for individuals with urinary 

incontinence. J Gerontol Nurs 2000 Jun; 

26(6):5-13. No associative hypothesis tested 

2714. Ma SS. The prevalence of adult female 

urinary incontinence in Hong Kong Chinese. 

Int Urogynecol J Pelvic Floor Dysfunct 1997; 

8(6):327-31. Not eligible level of evidence 

2715. Maas CP, Moriya Y, Steup WH, et al. Radical 

and nerve-preserving surgery for rectal cancer 

in The Netherlands: a prospective study on 

morbidity and functional outcome. Br J Surg 

1998 Jan; 85(1):92-7. Case-series 

2716. Maas CP, Moriya Y, Steup WH, et al. A 

prospective study on radical and nervepreserving surgery for rectal cancer in the 

Netherlands. Eur J Surg Oncol 2000 Dec; 

26(8):751-7. Case-series 

2717. Maas CP, ter Kuile MM, Laan E, et al. 

Objective assessment of sexual arousal in 

women with a history of hysterectomy. Bjog 

2004 May; 111(5):456-62. Not eligible 

outcomes 

2718. Macaulay AJ, Stern RS, Stanton SL. 

Psychological aspects of 211 female patients 

attending a urodynamic unit. J Psychosom Res 

1991; 35(1):1-10. Not eligible outcomes 

2719. Macaulay M, Clarke OS, Fader M, et al. Are 

washable absorbents effective at containing 

urinary incontinence? Nurs Times 2004 Mar 

23-29; 100(12):58-62. Not eligible exposure 

2720. MacDiarmid S, Rosenberg M. Overactive 

bladder in women: symptom impact and 

treatment expectations. Curr Med Res Opin 

2005 Sep; 21(9):1413-21. Not eligible level of 

evidence 

2721. MacDonagh RP, Forster DM, Thomas DG. 

Urinary continence in spinal injury patients 

following complete sacral posterior 

rhizotomy. Br J Urol 1990 Dec; 66(6):618-22. 

Case-series 

2722. MacDonald A, Smith A, McNeill AD, et al. 

Manual dilatation of the anus. Br J Surg 1992 

Dec; 79(12):1381-2. Case-series 

2723. MacDonald CD, Butler L. Silent no more: 

elderly women's stories of living with urinary 

incontinence in long-term care. J Gerontol 

Nurs 2007 Jan; 33(1):14-20. Case-series 

2724. MacGibbon A, Brieger G, Korda A. 

Incisionless cystourethropexy--the Intac 

device--an initial experience. Aust N Z J 

Obstet Gynaecol 2000 Feb; 40(1):59-61. 

Case-series 

2725. Machi J, Oishi AJ, Furumoto NL, et al. 

Sonographically guided radio frequency 

thermal ablation for unresectable recurrent 

tumors in the retroperitoneum and the pelvis. J 

Ultrasound Med 2003 May; 22(5):507-13. 

Case-series 

2726. MacKay K, Hemmett L. Needs assessment of 

women with urinary incontinence in a district 

health authority. Br J Gen Pract 2001 Oct; 

51(471):801-4. Not eligible level of evidence 
B-122 

2727. Mackin B. Evaluating bodyworn continence 

pads. Nurs Stand 1990 Jan 31-Feb 6; 

4(19):36-9. Not eligible target population 

2728. MacLeod M, Kelly R, Robb SA, et al. Bladder 

dysfunction in Duchenne muscular dystrophy. 

Arch Dis Child 2003 Apr; 88(4):347-9. Not 

eligible target population 

2729. Madalinska JB, Essink-Bot ML, de Koning 

HJ, et al. Health-related quality-of-life effects 

of radical prostatectomy and primary 

radiotherapy for screen-detected or clinically 

diagnosed localized prostate cancer. J Clin 

Oncol 2001 Mar 15; 19(6):1619-28. Caseseries 

2730. Madbouly KM, Senagore AJ, Delaney CP, et 

al. Clinically based management of rectal 

prolapse. Surg Endosc 2003 Jan; 17(1):99-

103. Case-series 

2731. Madden MV, Neale KF, Nicholls RJ, et al. 

Comparison of morbidity and function after 

colectomy with ileorectal anastomosis or 

restorative proctocolectomy for familial 

adenomatous polyposis. Br J Surg 1991 Jul; 

78(7):789-92. Case-series 

2732. Madersbacher H, Halaska M, Voigt R, et al. A 

placebo-controlled, multicentre study 

comparing the tolerability and efficacy of 

propiverine and oxybutynin in patients with 

urgency and urge incontinence. BJU Int 1999 

Oct; 84(6):646-51. Not eligible exposure 

2733. Madersbacher HG, Iwatsubo E, Perkash I, et 

al. Clinical Case of the Month: Urology. 

urinary incontinence in a male paraparetic 

patient (able to walk) with a mixed lower 

motor neuron lesion. Spinal Cord 1997 Aug; 

35(8):498-502. Case- Reports 

2734. Madersbacher S, Mohrle K, Burkhard F, et al. 

Long-term voiding pattern of patients with 

ileal orthotopic bladder substitutes. J Urol 

2002 May; 167(5):2052-7. Case-series 

2735. Madiba TE, Moodley MM. Anal sphincter 

reconstruction for incontinence due to nonobstetric sphincter damage. East Afr Med J 

2003 Nov; 80(11):585-8. Case-series 

2736. Madjar S, Beyar M, Nativ O. Transvaginal 

bone anchored sling. Urology 2000 Mar; 

55(3):422-6. Case-series 

2737. Madjar S, Covington-Nichols C, Secrest CL. 

New periurethral bulking agent for stress 

urinary incontinence: modified technique and 

early results. J Urol 2003 Dec; 170(6 Pt 

1):2327-9. Case-series 

2738. Madjar S, Frischer Z, Nieder AM, et al. 

Bladder wall abscess following midurethral 

sling procedure. Int Urogynecol J Pelvic Floor 

Dysfunct 2006 Feb; 17(2):180-1. Case 

Reports 

2739. Madjar S, Gousse A. Postirradiation 

vesicovaginal fistula completely resolved with 

conservative treatment. Int Urogynecol J 

Pelvic Floor Dysfunct 2001; 12(6):405-6. 

Case- Reports 

2740. Madjar S, Jacoby K, Giberti C, et al. Bone 

anchored sling for the treatment of postprostatectomy incontinence. J Urol 2001 Jan; 

165(1):72-6. Case-series 

2741. Madjar S, Tchetgen MB, Van Antwerp A, et 

al. Urethral erosion of tension-free vaginal 

tape. Urology 2002 Apr; 59(4):601. Case 

Reports 

2742. Madoff RD, Rosen HR, Baeten CG, et al. 

Safety and efficacy of dynamic muscle plasty 

for anal incontinence: lessons from a 

prospective, multicenter trial. 

Gastroenterology 1999 Mar; 116(3):549-56. 

Not eligible target population 

2743. Maeda K, Maruta M, Sato H, et al. Effect of 

oral diazepam on anal continence after low 

anterior resection: a preliminary study. Tech 

Coloproctol 2002 Apr; 6(1):15-8. Case-series 

2744. Magera JS, Jr., Elliott DS. Tandem 

transcorporal artificial urinary sphincter cuff 

salvage technique: surgical description and 

results. J Urol 2007 Mar; 177(3):1015-9; 

discussion 9-20. Case-series 

2745. Maglinte DD, Kelvin FM, Fitzgerald K, et al. 

Association of compartment defects in pelvic 

floor dysfunction. AJR Am J Roentgenol 1999 

Feb; 172(2):439-44. Not eligible outcomes 

2746. Mahadewa T, Harsan H, Nugroho S, et al. 

Postoperative recovery of complete sudden 

paraplegia due to lumbar schwannoma. Case 

report. J Neurosurg Spine 2005 May; 

2(5):601-3. Case Reports 

2747. Mahajan ST, Elkadry EA, Kenton KS, et al. 

Patient-centered surgical outcomes: the impact 

of goal achievement and urge incontinence on 

patient satisfaction one year after surgery. Am 

J Obstet Gynecol 2006 Mar; 194(3):722-8. 

Not eligible outcomes 

2748. Mahendrarajah K, Van der Schaaf AA, 

Lovegrove FT, et al. Surgery for severe 

constipation: the use of radioisotope transit 

scan and barium evacuation proctography in 

patient selection. Aust N Z J Surg 1994 Mar; 

64(3):183-6. Case-series 
B-123 

2749. Maher C, Carey M, Dwyer P, et al. 

Pubovaginal or vicryl mesh rectus fascia sling 

in intrinsic sphincter deficiency. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 

12(2):111-6. Case-series 

2750. Maher CF, Dwyer PL, Carey MP, et al. 

Colposuspension or sling for low urethral 

pressure stress incontinence? Int Urogynecol J 

Pelvic Floor Dysfunct 1999; 10(6):384-9. 

Case-series 

2751. Maheswaran CM, MacKinnon AE. Ambulant? 

Continent? The missing link. Eur J Pediatr 

Surg 2002 Dec; 12 Suppl 1:S25-6. Case 

Reports 

2752. Mahran MR, Ghoneim MA. The application 

of the modified rectal bladder in management 

of the compromized urethral damage. Scand J 

Urol Nephrol 1994 Mar; 28(1):49-53. Caseseries 

2753. Maito JM, Quam ZA, Craig E, et al. 

Predictors of successful pessary fitting and 

continued use in a nurse-midwifery pessary 

clinic. J Midwifery Womens Health 2006 

Mar-Apr; 51(2):78-84. Not eligible outcomes 

2754. Major H, Culligan P, Heit M. Urethral 

sphincter morphology in women with detrusor 

instability. Obstet Gynecol 2002 Jan; 

99(1):63-8. Not eligible outcomes 

2755. Majoros A, Bach D, Keszthelyi A, et al. 

Urinary incontinence and voiding dysfunction 

after radical retropubic prostatectomy 

(prospective urodynamic study). Neurourol 

Urodyn 2006; 25(1):2-7. Case-series 

2756. Malaga S, Pardo R, Malaga I, et al. Renal 

involvement in Down syndrome. Pediatr 

Nephrol 2005 May; 20(5):614-7. Case-series 

2757. Maliski SL, Heilemann MV, McCorkle R. 

Mastery of postprostatectomy incontinence 

and impotence: his work, her work, our work. 

Oncol Nurs Forum 2001 Jul; 28(6):985-92. 

Not eligible outcomes 

2758. Mallipeddi PK, Steele AC, Kohli N, et al. 

Anatomic and functional outcome of vaginal 

paravaginal repair in the correction of anterior 

vaginal wall prolapse. Int Urogynecol J Pelvic 

Floor Dysfunct 2001; 12(2):83-8. Case-series 

2759. Malm J, Kristensen B, Stegmayr B, et al. 

Three-year survival and functional outcome of 

patients with idiopathic adult hydrocephalus 

syndrome. Neurology 2000 Aug 22; 

55(4):576-8. Case-series 

2760. Malone DC, Okano GJ. Treatment of urge 

incontinence in Veterans Affairs medical 

centers. Clin Ther 1999 May; 21(5):867-77. 

Not eligible outcomes 

2761. Malone-Lee J, Henshaw DJ, Cummings K. 

Urodynamic verification of an overactive 

bladder is not a prerequisite for antimuscarinic 

treatment response. BJU Int 2003 Sep; 

92(4):415-7. Not eligible outcomes 

2762. Malone-Lee JG, Walsh JB, Maugourd MF. 

Tolterodine: a safe and effective treatment for 

older patients with overactive bladder. J Am 

Geriatr Soc 2001 Jun; 49(6):700-5. Not 

eligible exposure 

2763. Maloney C. Evaluation and treatment of 

urinary incontinence: a primary care approach. 

Nurse Pract 1995 Feb; 20(2):74-5. Comment 

2764. Maloney C. Patient with stress urinary 

incontinence. Answers and discussion of 

urinary health case study. Lippincotts Prim 

Care Pract 1997 Nov-Dec; 1(5):567-71. CaseReports 

2765. Maloney C. Patient with stress urinary 

incontinence. Lippincotts Prim Care Pract 

1997 Sep-Oct; 1(4):448-9. Case report 

2766. Maloney C, Cafiero M. Implementing an 

incontinence program in long-term care 

settings. A multidisciplinary approach. J 

Gerontol Nurs 1999 Jun; 25(6):47-52. Case 

Reports 

2767. Malouf AJ, Halligan S, Williams AB, et al. 

Prospective assessment of interobserver 

agreement for endoanal MRI in fecal 

incontinence. Abdom Imaging 2001 Jan-Feb; 

26(1):76-8. Not eligible outcomes 

2768. Malouf AJ, Norton CS, Engel AF, et al. Longterm results of overlapping anterior analsphincter repair for obstetric trauma. Lancet 

2000 Jan 22; 355(9200):260-5. Case-series 

2769. Malouf AJ, Vaizey CJ, Nicholls RJ, et al. 

Permanent sacral nerve stimulation for fecal 

incontinence. Ann Surg 2000 Jul; 232(1):143-

8. Case-series 

2770. Malouf AJ, Vaizey CJ, Norton CS, et al. 

Internal anal sphincter augmentation for fecal 

incontinence using injectable silicone 

biomaterial. Dis Colon Rectum 2001 Apr; 

44(4):595-600. Case-series 

2771. Malouf AJ, Williams AB, Halligan S, et al. 

Prospective assessment of accuracy of 

endoanal MR imaging and endosonography in 

patients with fecal incontinence. AJR Am J 

Roentgenol 2000 Sep; 175(3):741-5. Not 

eligible outcomes 

2772. Maly RC, Hirsch SH, Reuben DB. The 

performance of simple instruments in 

detecting geriatric conditions and selecting 

community-dwelling older people for geriatric 

assessment. Age Ageing 1997 May; 

26(3):223-31. Not eligible outcomes 
B-124 

2773. Mander BJ, Abercrombie JF, George BD, et 

al. The electrically stimulated gracilis 

neosphincter incorporated as part of total 

anorectal reconstruction after 

abdominoperineal excision of the rectum. Ann 

Surg 1996 Dec; 224(6):702-9; discussion 9-

11. 

2774. Mander BJ, Wexner SD, Williams NS, et al. 

Preliminary results of a multicentre trial of the 

electrically stimulated gracilis neoanal 

sphincter. Br J Surg 1999 Dec; 86(12):1543-8. 

Not eligible target population 

2775. Manderson L. Boundary breaches: the body, 

sex and sexuality after stoma surgery. Soc Sci 

Med 2005 Jul; 61(2):405-15. Not eligible 

outcomes 

2776. Mangnall J, Taylor P, Thomas S, et al. 

Continence problems in care homes: auditing 

assessment and treatment. Nurs Older People 

2006 Mar; 18(2):20-2. Comment 

2777. Manikandan R, Kujawa M, Pearson E, et al. 

Results of the tension-free vaginal tape 

procedure for stress incontinence: patient's 

perspective. Int J Urol 2004 Apr; 11(4):206-

12. Case-series 

2778. Mansi MK. Continent urinary undiversion to 

modified ureterosigmoidostomy in bladder 

extrophy patients. World J Surg 1999 Feb; 

23(2):207-13. Case-series 

2779. Mansson A, Anderson H, Colleen S. Time lag 

to diagnosis of bladder cancer--influence of 

psychosocial parameters and level of healthcare provision. Scand J Urol Nephrol 1993; 

27(3):363-9. Not eligible exposure 

2780. Manunta A, Guille F, Patard JJ, et al. 

Artificial sphincter insertion after 

radiotherapy: is it worthwhile? BJU Int 2000 

Mar; 85(4):490-2. Case-series 

2781. Marano I, Grassi R, Donnianni T, et al. CT 

and anal endosonography in the evaluation of 

electrically stimulated neoanal sphincter: a 

preliminary report. Abdom Imaging 1996 JulAug; 21(4):353-6. Case-series 

2782. Marcello PW, Barrett RC, Coller JA, et al. 

Fatigue rate index as a new measurement of 

external sphincter function. Dis Colon Rectum 

1998 Mar; 41(3):336-43. Case Reports 

2783. Marchal F, Doucet C, Lechaux D, et al. 

Secondary implantation of an artificial 

sphincter after abdominoperineal resection 

and pseudocontinent perineal colostomy for 

rectal cancer. Gastroenterol Clin Biol 2005 

Apr; 29(4):425-8. Case-reports 

2784. Margossian H, Pollard RR, Walters MD. 

Small bowel obstruction in a peritoneal defect 

after laparoscopic Burch procedure. J Am 

Assoc Gynecol Laparosc 1999 Aug; 6(3):343-

5. Case Reports 

2785. Mariano MB, Tefilli MV, Graziottin TM, et 

al. Laparoscopic prostatectomy for benign 

prostatic hyperplasia--a six-year experience. 

Eur Urol 2006 Jan; 49(1):127-31; discussion 

31-2. Case-series 

2786. Marin R, Francis JM. A case of idiopathic 

fecal incontinence. Evaluation and 

management. Am J Phys Med Rehabil 1997 

Jul-Aug; 76(4):333-7. Case- Reports 

2787. Marinkovic S. Adjusting bladder neck sling 

length to maximise same-day voiding. Bjog 

2006 Sep; 113(9):1092-5. Case-series 

2788. Marinkovic SP, Stanton SL. Triple 

compartment prolapse: sacrocolpopexy with 

anterior and posterior mesh extensions. Bjog 

2003 Mar; 110(3):323-6. Case-series 

2789. Marklund-Bau H, Edell-Gustafsson U, 

Spangberg A. Bothersome urinary symptoms 

and disease-specific quality of life in patients 

with benign prostatic obstruction. Scand J 

Urol Nephrol 2007; 41(1):32-41. Case 

Reports 

2790. Marret E, Pruszkowski O, Deleuze A, et al. 

Accelerated idioventricular rhythm associated 

with desflurane administration. Anesth Analg 

2002 Aug; 95(2):319-21, table of contents. 

Case Reports 

2791. Marshall FF, Mostwin JL, Radebaugh LC, et 

al. Ileocolic neobladder post-cystectomy: 

continence and potency. J Urol 1991 Mar; 

145(3):502-4. Case-series 

2792. Marshall K, Walsh DM, Baxter GD. The 

effect of a first vaginal delivery on the 

integrity of the pelvic floor musculature. Clin 

Rehabil 2002 Nov; 16(7):795-9. Case-series 

2793. Marszalek M, Roehlich M, Racz U, et al. 

Sexual function after tension-free vaginal tape 

procedure. Urol Int 2007; 78(2):126-9. Not 

eligible outcomes 

2794. Martan A, Masata J, Halaska M, et al. 

Ultrasound imaging of the lower urinary 

system in women after Burch 

colposuspension. Ultrasound Obstet Gynecol 

2001 Jan; 17(1):58-64. Not eligible outcomes 

2795. Martignoni E, Nappi RE, Citterio A, et al. 

Reproductive life milestones in women with 

Parkinson's disease. Funct Neurol 2003 OctDec; 18(4):211-7. Not eligible level of 

evidence 
B-125 

2796. Martin S. The pharmacists' role in recognizing 

and treating urinary incontinence. Am Pharm 

1990 Jul; NS30(7):42-5. Comment 

2797. Martinez AM, Ramos NM, Requena JF, et al. 

Analysis of retropubic colpourethrosuspension 

results by suburethral sling with REMEEX 

prosthesis. Eur J Obstet Gynecol Reprod Biol 

2003 Feb 10; 106(2):179-83. Case-series 

2798. Martinez Hernandez Magro P, Villanueva 

Saenz E, Jaime Zavala M, et al. Endoanal 

sonography in assessment of fecal 

incontinence following obstetric trauma. 

Ultrasound Obstet Gynecol 2003 Dec; 

22(6):616-21. Case-series 

2799. Martinez R. Erdheim-Chester disease: MR of 

intraaxial and extraaxial brain stem lesions. 

AJNR Am J Neuroradiol 1995 Oct; 

16(9):1787-90. Case Reports 

2800. Martinez-Puente Mdel C, Pascual-Montero 

JA, Garcia-Olmo D. Customized biofeedback 

therapy improves results in fecal incontinence. 

Int J Colorectal Dis 2004 May; 19(3):210-4. 

Case-series 

2801. Martins FE, Bennett CJ, Dunn M, et al. 

Adverse prognostic features of collagen 

injection therapy for urinary incontinence 

following radical retropubic prostatectomy. J 

Urol 1997 Nov; 158(5):1745-9. Not eligible 

target population 

2802. Martins FE, Boyd SD. Artificial urinary 

sphincter in patients following major pelvic 

surgery and/or radiotherapy: are they less 

favorable candidates? J Urol 1995 Apr; 

153(4):1188-93. Case-series 

2803. Martins JL, Pinus J. Use of biofeedback 

(BFB) in the treatment of fecal incontinence 

after surgical correction of anorectal 

malformations by posterior sagittal 

anorectoplasty (PSARP). Sao Paulo Med J 

1997 May-Jun; 115(3):1427-32. Case-series 

2804. Martis G, D'Elia G, Diana M, et al. Prostatic 

capsule- and nerve-sparing cystectomy in 

organ-confined bladder cancer: preliminary 

results. World J Surg 2005 Oct; 29(10):1277-

81. Case-series 

2805. Mason L, Glenn S, Walton I, et al. The 

experience of stress incontinence after 

childbirth. Birth 1999 Sep; 26(3):164-71. 

Case-series 

2806. Mason L, Glenn S, Walton I, et al. Women's 

reluctance to seek help for stress incontinence 

during pregnancy and following childbirth. 

Midwifery 2001 Sep; 17(3):212-21. Not 

eligible outcomes 

2807. Mason L, Glenn S, Walton I, et al. The 

instruction in pelvic floor exercises provided 

to women during pregnancy or following 

delivery. Midwifery 2001 Mar; 17(1):55-64. 

Not eligible outcomes 

2808. Mason M, Tully S. Urinary incontinence in 

the older acute care population: effects of 

knowledge, attitudes and beliefs of nurses on 

continence management. Perspectives 2002 

Fall; 26(3):4-9. Comment 

2809. Mason RC, Roach M. Modified pubovaginal 

sling for treatment of intrinsic sphincteric 

deficiency. J Urol 1996 Dec; 156(6):1991-4. 

Not eligible target population 

2810. Masood S, Djaladat H, Kouriefs C, et al. The 

12-year outcome analysis of an endourethral 

wallstent for treating benign prostatic 

hyperplasia. BJU Int 2004 Dec; 94(9):1271-4. 

Case-series 

2811. Massolt ET, Wooning MM, Stijnen T, et al. 

Prevalence, impact on the quality of life and 

pathophysiological determinants of nocturia in 

urinary incontinent women. Int Urogynecol J 

Pelvic Floor Dysfunct 2005 Mar-Apr; 

16(2):132-7. Not eligible outcomes 

2812. Masson DB, Govier FE. Modified Pereyra 

bladder neck suspension in patients with 

intrinsic sphincter deficiency and bladder neck 

hypermobility: patient satisfaction with a 

mean follow-up of 4 years. Urology 2000 Feb; 

55(2):217-21; discussion 21-2. Case-series 

2813. Matanyi S, Acs N, Fontanyi Z, et al. 

Urodynamic investigation of women operated 

on for genuine stress incontinence. Gynecol 

Obstet Invest 1999; 48(4):263-6. Case-series 

2814. Matharu GS, Assassa RP, Williams KS, et al. 

Objective assessment of urinary incontinence 

in women: comparison of the one-hour and 

24-hour pad tests. Eur Urol 2004 Feb; 

45(2):208-12. Not eligible outcomes 

2815. Matharu GS, Assassa RP, Williams KS, et al. 

Continence nurse treatment of women's 

urinary symptoms. Br J Nurs 2004 Feb 12-25; 

13(3):140-3. Not eligible level of evidence 

2816. Mathers SE, Ingram DA, Swash M. 

Electrophysiology of motor pathways for 

sphincter control in multiple sclerosis. J 

Neurol Neurosurg Psychiatry 1990 Nov; 

53(11):955-60. Not eligible outcomes 

2817. Matsubara A, Yasumoto H, Mutaguchi K, et 

al. Impact of radical perineal prostatectomy on 

urinary continence and quality of life: a 

longitudinal study of Japanese patients. Int J 

Urol 2005 Nov; 12(11):953-8. Case-series 
B-126 

2818. Matsui M, Enoki M, Matsui Y, et al. 

Seronegative myasthenia gravis associated 

with atonic urinary bladder and 

accommodative insufficiency. J Neurol Sci 

1995 Nov; 133(1-2):197-9. Case- Reports 

2819. Matsumoto K, Imaoka T, Tomita S, et al. 

Pineocytoma with massive intratumoral 

hemorrhage after ventriculoperitoneal shunt--

case report. Neurol Med Chir (Tokyo) 1997 

Dec; 37(12):911-5. Case Reports 

2820. Matsuo K, Koyama M, Yoshida S, et al. 

Tension-free vaginal tape procedure with 

manual-tapping method: a potentially useful 

technique. J Obstet Gynaecol Res 2005 Jun; 

31(3):247-51. Case-series 

2821. Matsuo K, Takemura M, Koyama M, et al. 

Bladder tumor found by tension-free vaginal 

tape procedure. Obstet Gynecol 2003 May; 

101(5 Pt 1):937-40. Case Reports 

2822. Matsuoka H, Desai MB, Wexner SD, et al. A 

pilot assessment of whether external coil MRI 

is useful to assess evacuatory disorders. Int J 

Colorectal Dis 2000 Apr; 15(2):91-5. Caseseries 

2823. Matsuoka H, Mavrantonis C, Wexner SD, et 

al. Postanal repair for fecal incontinence--is it 

worthwhile? Dis Colon Rectum 2000 Nov; 

43(11):1561-7. Case-series 

2824. Matsuoka N, Moriya Y, Akasu T, et al. Longterm outcome of urinary function after 

extended lymphadenectomy in patients with 

distal rectal cancer. Eur J Surg Oncol 2001 

Mar; 27(2):165-9. Case-series 

2825. Matsushita K, Yamada K, Sameshima T, et al. 

Prediction of incontinence following low 

anterior resection for rectal carcinoma. Dis 

Colon Rectum 1997 May; 40(5):575-9. Caseseries 

2826. Matsuyama H, Hirata H, Tomimatsu T, et al. 

Follow up of surgical repair of female pelvic 

floor disorders by a mailed questionnaire. Int J 

Urol 2006 Apr; 13(4):389-94. Case-series 

2827. Mattox TF, Bhatia NN. The prevalence of 

urinary incontinence or prolapse among white 

and Hispanic women. Am J Obstet Gynecol 

1996 Feb; 174(2):646-8. Not eligible target 

population 

2828. Matuszczak E, Lenkiewicz T. Results of 

surgical treatment of myelomeningocele. Eur J 

Pediatr Surg 2006 Oct; 16(5):337-42. Not 

eligible target population 

2829. Matza LS, Thompson CL, Krasnow J, et al. 

Test-retest reliability of four questionnaires 

for patients with overactive bladder: the 

overactive bladder questionnaire (OAB-q), 

patient perception of bladder condition 

(PPBC), urgency questionnaire (UQ), and the 

primary OAB symptom questionnaire 

(POSQ). Neurourol Urodyn 2005; 24(3):215-

25. Not eligible outcomes 

2830. Matzel KE, Bittorf B, Gunther K, et al. Rectal 

resection with low anastomosis: functional 

outcome. Colorectal Dis 2003 Sep; 5(5):458-

64. Not eligible level of evidence 

2831. Matzel KE, Kamm MA, Stosser M, et al. 

Sacral spinal nerve stimulation for faecal 

incontinence: multicentre study. Lancet 2004 

Apr 17; 363(9417):1270-6. Not eligible target 

population 

2832. Matzel KE, Madoff RD, LaFontaine LJ, et al. 

Complications of dynamic graciloplasty: 

incidence, management, and impact on 

outcome. Dis Colon Rectum 2001 Oct; 

44(10):1427-35. Not eligible outcomes 

2833. Matzel KE, Stadelmaier U, Bittorf B, et al. 

Bilateral sacral spinal nerve stimulation for 

fecal incontinence after low anterior rectum 

resection. Int J Colorectal Dis 2002 Nov; 

17(6):430-4. Case- Reports 

2834. Matzel KE, Stadelmaier U, Hohenfellner M, et 

al. Electrical stimulation of sacral spinal 

nerves for treatment of faecal incontinence. 

Lancet 1995 Oct 28; 346(8983):1124-7. CaseReports 

2835. Matzel KE, Stadelmaier U, Hohenfellner M, et 

al. Chronic sacral spinal nerve stimulation for 

fecal incontinence: long-term results with 

foramen and cuff electrodes. Dis Colon 

Rectum 2001 Jan; 44(1):59-66. Case-series 

2836. Matzel KE, Stadelmaier U, Muehldorfer S, et 

al. Continence after colorectal reconstruction 

following resection: impact of level of 

anastomosis. Int J Colorectal Dis 1997; 

12(2):82-7. Case-series 

2837. Maubon AJ, Boncoeur-Martel MP, Juhan V, 

et al. Static and dynamic MRI of a urinary 

control intra-vaginal device. Eur Radiol 2000; 

10(6):879-84. Case-series 

2838. Mauk KL. Conservative therapy for urinary 

incontinence can help older adults. Nursing 

2005 Aug; 35(8):20-1. Comment 

2839. Mavrantonis C, Billotti VL, Wexner SD. 

Stimulated graciloplasty for treatment of 

intractable fecal incontinence: critical 

influence of the method of stimulation. Dis 

Colon Rectum 1999 Apr; 42(4):497-504. 

Case-series 
B-127 

2840. May RJ. Fecal incontinence in a 39-year-old 

man. Gastroenterology 1991 Oct; 

101(4):1120-6. Case report 

2841. Mayne CJ, Assassa RP. Epidemiology of 

incontinence and prolapse. Bjog 2004 Dec; 

111 Suppl 1:2-4. No associative hypothesis 

tested 

2842. Mayo ME. Lower urinary tract dysfunction in 

cerebral palsy. J Urol 1992 Feb; 147(2):419-

20. Case-series 

2843. Mazouni C, Karsenty G, Bretelle F, et al. 

Urinary complications and sexual function 

after the tension-free vaginal tape procedure. 

Acta Obstet Gynecol Scand 2004 Oct; 

83(10):955-61. Case-series 

2844. Mazur D, Wehnert J, Dorschner W, et al. 

Clinical and urodynamic effects of propiverine 

in patients suffering from urgency and urge 

incontinence. A multicentre dose-optimizing 

study. Scand J Urol Nephrol 1995 Sep; 

29(3):289-94. Not eligible exposure 

2845. Mazur DJ, Merz JF. Older patients' 

willingness to trade off urologic adverse 

outcomes for a better chance at five-year 

survival in the clinical setting of prostate 

cancer. J Am Geriatr Soc 1995 Sep; 

43(9):979-84. Not eligible outcomes 

2846. McCallum TJ, Moore KN, Griffiths D. 

Urinary incontinence after radical 

prostatectomy: implications and urodynamics. 

Urol Nurs 2001 Apr; 21(2):113-9, 24. Not 

eligible outcomes 

2847. McCammon KA, Kolm P, Main B, et al. 

Comparative quality-of-life analysis after 

radical prostatectomy or external beam 

radiation for localized prostate cancer. 

Urology 1999 Sep; 54(3):509-16. Case series 

2848. McCarthy M, Addington-Hall J, Altmann D. 

The experience of dying with dementia: a 

retrospective study. Int J Geriatr Psychiatry 

1997 Mar; 12(3):404-9. Not eligible target 

population 

2849. McCarthy M, Lay M, Addington-Hall J. 

Dying from heart disease. J R Coll Physicians 

Lond 1996 Jul-Aug; 30(4):325-8. Not eligible 

target population 

2850. McCarthy MJ, Aylott CE, Grevitt MP, et al. 

Cauda equina syndrome: factors affecting 

long-term functional and sphincteric outcome. 

Spine 2007 Jan 15; 32(2):207-16. Case-series 

2851. McClees N, Mikolaj EL, Carlson SL, et al. A 

pilot study assessing the effectiveness of a 

glycerin suppository in controlled colostomy 

emptying. J Wound Ostomy Continence Nurs 

2004 May-Jun; 31(3):123-9. Not eligible 

outcomes 

2852. McClish DK, Fantl JA, Wyman JF, et al. 

Bladder training in older women with urinary 

incontinence: relationship between outcome 

and changes in urodynamic observations. 

Obstet Gynecol 1991 Feb; 77(2):281-6. Not 

eligible target population 

2853. McClish DK, Wyman JF, Sale PG, et al. Use 

and costs of incontinence pads in female study 

volunteers. Continence Program for Women 

Research Group. J Wound Ostomy 

Continence Nurs 1999 Jul; 26(4):207-8, 10-3. 

Not eligible outcomes 

2854. McCormick KA. Research. From clinical trial 

to health policy--research on urinary 

incontinence in the adult, Part I. J Prof Nurs 

1991 May-Jun; 7(3):147. Comment 

2855. McCormick KA, Cella M, Scheve A, et al. 

Cost-effectiveness of treating incontinence in 

severely mobility-impaired long term care 

residents. QRB Qual Rev Bull 1990 Dec; 

16(12):439-43. Not eligible outcomes 

2856. McCue JL, Thomson JP. Rectopexy for 

internal rectal intussusception. Br J Surg 1990 

Jun; 77(6):632-4. Case-series 

2857. McCue JL, Thomson JP. Clinical and 

functional results of abdominal rectopexy for 

complete rectal prolapse. Br J Surg 1991 Aug; 

78(8):921-3. Case-series 

2858. McDowell BJ. Care of urinary incontinence in 

the home. Nurse Pract Forum 1994 Sep; 

5(3):138-45. Secondary data analysis 

2859. McDowell BJ, Burgio KL, Candib D. 

Behavioral and pharmacological treatment of 

persistent urinary incontinence in the elderly. J 

Am Acad Nurse Pract 1990 Jan-Mar; 2(1):17-

23. Comment 

2860. McDowell BJ, Burgio KL, Dombrowski M, et 

al. An interdisciplinary approach to the 

assessment and behavioral treatment of 

urinary incontinence in geriatric outpatients. J 

Am Geriatr Soc 1992 Apr; 40(4):370-4. Caseseries 

2861. McDowell BJ, Engberg S, Weber E, et al. 

Successful treatment using behavioral 

interventions of urinary incontinence in 

homebound older adults. Geriatr Nurs 1994 

Nov-Dec; 15(6):303-7. Case- Reports 

2862. McDowell BJ, Engberg SJ, Rodriguez E, et al. 

Characteristics of urinary incontinence in 

homebound older adults. J Am Geriatr Soc 

1996 Aug; 44(8):963-8. Case-series 

2863. McElveen TL, Waterman FM, Kim H, et al. 

Factors predicting for urinary incontinence 

after prostate brachytherapy. Int J Radiat 

Oncol Biol Phys 2004 Aug 1; 59(5):1395-404. 

Case-series 
B-128 

2864. McFall. Pelvic floor electrical stimulation in 

the treatment of adult urinary incontinence. 

Tecnologica MAP Suppl 2000 Apr:15-7. Not 

eligible target population 

2865. McFall S, Yerkes AM, Bernard M, et al. 

Evaluation and treatment of urinary 

incontinence. Report of a physician survey. 

Arch Fam Med 1997 Mar-Apr; 6(2):114-9. 

Not eligible outcomes 

2866. McFarlane HJ. Anaesthesia and the new 

generation monoamine oxidase inhibitors. 

Anaesthesia 1994 Jul; 49(7):597-9. CaseReports 

2867. McGhee M, O'Neill K, Major K, et al. 

Evaluation of a nurse-led continence service 

in the south-west of Glasgow, Scotland. J Adv 

Nurs 1997 Oct; 26(4):723-8. Not eligible 

exposure 

2868. McGrother CW, Jagger C, Clarke M, et al. 

Handicaps associated with incontinence: 

implications for management. J Epidemiol 

Community Health 1990 Sep; 44(3):246-8. 

Not eligible level of evidence 

2869. McGuigan C, Stevens J, Gabriel CM. A 

synovial cyst in the cervical spine causing 

acute spinal cord compression. Neurology 

2005 Oct 25; 65(8):1293. Case- Reports 

2870. McGuire EJ, Fitzpatrick CC, Wan J, et al. 

Clinical assessment of urethral sphincter 

function. J Urol 1993 Nov; 150(5 Pt 1):1452-

4. Not eligible outcomes 

2871. McIntosh LJ, Frahm JD, Mallett VT, et al. 

Pelvic floor rehabilitation in the treatment of 

incontinence. J Reprod Med 1993 Sep; 

38(9):662-6. Case-series 

2872. McIntosh LJ, Mallett VT, Frahm JD, et al. 

Gynecologic disorders in women with EhlersDanlos syndrome. J Soc Gynecol Investig 

1995 May-Jun; 2(3):559-64. Case-series 

2873. McIntosh LJ, Richardson DA. 30-minute 

evaluation of incontinence in the older 

woman. Geriatrics 1994 Feb; 49(2):35-8, 43-

4. Question 4 

2874. McIntosh LJ, Stanitski DF, Mallett VT, et al. 

Ehlers-Danlos syndrome: relationship between 

joint hypermobility, urinary incontinence, and 

pelvic floor prolapse. Gynecol Obstet Invest 

1996; 41(2):135-9. Case-series 

2875. McIntyre PB, Pemberton JH, Beart RW, Jr., et 

al. Double-stapled vs. handsewn ileal pouchanal anastomosis in patients with chronic 

ulcerative colitis. Dis Colon Rectum 1994 

May; 37(5):430-3. Case-series 

2876. McIntyre PB, Pemberton JH, Wolff BG, et al. 

Comparing functional results one year and ten 

years after ileal pouch-anal anastomosis for 

chronic ulcerative colitis. Dis Colon Rectum 

1994 Apr; 37(4):303-7. Case-series 

2877. McKeever MP. An investigation of 

recognized incontinence within a health 

authority. J Adv Nurs 1990 Oct; 15(10):1197-

207. Not eligible outcomes 

2878. McLean C. Continence. The wraps come off. 

Interview by Jenine Willis. Nurs Times 1996 

Oct 9-15; 92(41):72-5. Case Reports 

2879. McLennan MT. The role of electrodiagnostic 

techniques in the reprogramming of patients 

with a delayed suboptimal response to sacral 

nerve stimulation. Int Urogynecol J Pelvic 

Floor Dysfunct 2003 Jun; 14(2):98-103. Not 

eligible target population 

2880. McLennan MT. Transurethral resection of 

transvaginal tape. Int Urogynecol J Pelvic 

Floor Dysfunct 2004 Sep-Oct; 15(5):360-2. 

Case Reports 

2881. McLennan MT, Alten B, Melick C, et al. 

Patients' satisfaction with and attitudes toward 

vaginal delivery. J Reprod Med 2005 Oct; 

50(10):740-4. Not eligible outcomes 

2882. McLennan MT, Bent AE. Supine empty stress 

test as a predictor of low valsalva leak point 

pressure. Neurourol Urodyn 1998; 17(2):121-

7. Not eligible outcomes 

2883. McLennan MT, Melick C, Bent AE. Urethral 

instability: clinical and urodynamic 

characteristics. Neurourol Urodyn 2001; 

20(6):653-60. Not eligible target population 

2884. McLennan MT, Melick CF, Alten B, et al. 

Patients' knowledge of potential pelvic floor 

changes associated with pregnancy and 

delivery. Int Urogynecol J Pelvic Floor 

Dysfunct 2006 Jan; 17(1):22-6. Not eligible 

outcomes 

2885. McLennan MT, Melick CF, Bent AE. Clinical 

and urodynamic predictors of delayed voiding 

after fascia lata suburethral sling. Obstet 

Gynecol 1998 Oct; 92(4 Pt 1):608-12. Caseseries 

2886. McLennan MT, Melick CF, Bent AE. Leakpoint pressure: clinical application of values at 

two different volumes. Int Urogynecol J 

Pelvic Floor Dysfunct 2000 Jun; 11(3):136-

41. Not eligible level of evidence 

2887. McLennan MT, Melick CF, Cannon S. The 

position of the urethrovesical junction after 

incontinence surgery: early postoperative 

changes. Int Urogynecol J Pelvic Floor 

Dysfunct 2004 Jan-Feb; 15(1):44-8; 

discussion 8. Case-series 
B-129 

2888. McMullen D. Candida albicans and 

incontinence. Dermatol Nurs 1991 Feb; 

3(1):21-4. Not eligible exposure 

2889. McMurdo ME, Davey PG, Elder MA, et al. A 

cost-effectiveness study of the management of 

intractable urinary incontinence by urinary 

catheterisation or incontinence pads. J 

Epidemiol Community Health 1992 Jun; 

46(3):222-6. Not eligible outcomes 

2890. McPherson K, Herbert A, Judge A, et al. Selfreported bladder function five years posthysterectomy. J Obstet Gynaecol 2005 Jul; 

25(5):469-75. Not eligible level of evidence 

2891. McVean RJ, Orr A, Webb AK, et al. 

Treatment of urinary incontinence in cystic 

fibrosis. J Cyst Fibros 2003 Dec; 2(4):171-6. 

Case-series 

2892. McVeigh C. Perimenopause: more than hot 

flushes and night sweats for some Australian 

women. J Obstet Gynecol Neonatal Nurs 2005 

Jan-Feb; 34(1):21-7. Not eligible level of 

evidence 

2893. Meade-D'Alisera P, Merriweather T, 

Wentland M. Impact of commercial marketing 

on patient demand. Urol Nurs 2001 Dec; 

21(6):406-7, 10. Not eligible exposure 

2894. Meade-D'Alisera P, Merriweather T, 

Wentland M, et al. Depressive symptoms in 

women with urinary incontinence: a 

prospective study. Urol Nurs 2001 Dec; 

21(6):397-9. Not eligible outcomes 

2895. Meagher AP, Lubowski DZ, King DW. The 

cough response of the anal sphincter. Int J 

Colorectal Dis 1993 Dec; 8(4):217-9. Not 

eligible outcomes 

2896. Meaglia JP, Joseph AC, Chang M, et al. Postprostatectomy urinary incontinence: response 

to behavioral training. J Urol 1990 Sep; 

144(3):674-6. Case-series 

2897. Medina CA, Takacs P. Shortening the process 

of determining postvoid residual. Int J 

Gynaecol Obstet 2005 Dec; 91(3):266-7. Not 

eligible exposure 

2898. Meehan JJ, Hardin WD, Jr., Georgeson KE. 

Gluteus maximus augmentation for the 

treatment of fecal incontinence. J Pediatr Surg 

1997 Jul; 32(7):1045-7; discussion 7-8. Not 

eligible target population 

2899. Mehta KM, Simonsick EM, Penninx BW, et 

al. Prevalence and correlates of anxiety 

symptoms in well-functioning older adults: 

findings from the health aging and body 

composition study. J Am Geriatr Soc 2003 

Apr; 51(4):499-504. Not eligible outcomes 

2900. Meier U, Zeilinger FS, Kintzel D. Signs, 

symptoms and course of normal pressure 

hydrocephalus in comparison with cerebral 

atrophy. Acta Neurochir (Wien) 1999; 

141(10):1039-48. Not eligible outcomes 

2901. Meijer R, van Limbeek J, Peusens G, et al. 

The Stroke Unit Discharge Guideline, a 

prognostic framework for the discharge 

outcome from the hospital stroke unit. A 

prospective cohort study. Clin Rehabil 2005 

Oct; 19(7):770-8. Not eligible outcomes 

2902. Meinhardt W, Horenblas S. Sexuality 

preserving cystectomy and neobladder 

(SPCN): functional results of a neobladder 

anastomosed to the prostate. Eur Urol 2003 

Jun; 43(6):646-50. Not eligible outcomes 

2903. Melchior H, Kumar V, Muller N, et al. 

National public health policies for prevention 

and care in urinary incontinence in the elderly. 

World J Urol 1998; 16 Suppl 1:S71-3. Not 

eligible outcomes 

2904. Mellgren A, Jensen LL, Zetterstrom JP, et al. 

Long-term cost of fecal incontinence 

secondary to obstetric injuries. Dis Colon 

Rectum 1999 Jul; 42(7):857-65; discussion 

65-7. Case-series 

2905. Mellier G, Benayed B, Bretones S, et al. 

Suburethral tape via the obturator route: is the 

TOT a simplification of the TVT? Int 

Urogynecol J Pelvic Floor Dysfunct 2004 JulAug; 15(4):227-32. Case-series 

2906. Meltomaa S, Backman T, Haarala M. 

Concomitant vaginal surgery did not affect 

outcome of the tension-free vaginal tape 

operation during a prospective 3-year 

followup study. J Urol 2004 Jul; 172(1):222-6. 

Case-series 

2907. Meltomaa S, Haarala M, Makinen J, et al. 

Endoscopic colposuspension with simplified 

extraperitoneal approach. Tech Urol 1997 

Winter; 3(4):216-21. Case-series 

2908. Meltomaa SS, Haarala MA, Taalikka MO, et 

al. Outcome of Burch retropubic urethropexy 

and the effect of concomitant abdominal 

hysterectomy: a prospective long-term followup study. Int Urogynecol J Pelvic Floor 

Dysfunct 2001; 12(1):3-8. Case-series 

2909. Melton L. Targeted treatment for incontinence 

beckons. Lancet 2002 Jan 26; 359(9303):326. 

News 

2910. Melville JL, Delaney K, Newton K, et al. 

Incontinence severity and major depression in 

incontinent women. Obstet Gynecol 2005 Sep; 

106(3):585-92. Not eligible outcomes 
B-130 

2911. Melville JL, Newton K, Fan MY, et al. Health 

care discussions and treatment for urinary 

incontinence in U.S. women. Am J Obstet 

Gynecol 2006 Mar; 194(3):729-37. Not 

eligible outcomes 

2912. Menard C, Trudel C, Cloutier R. Anal 

reeducation for postoperative fecal 

incontinence in congenital diseases of the 

rectum and anus. J Pediatr Surg 1997 Jun; 

32(6):867-9. Not eligible target population 

2913. Menarini M, Del Popolo G, Di Benedetto P, et 

al. Trospium chloride in patients with 

neurogenic detrusor overactivity: is dose 

titration of benefit to the patients? Int J Clin 

Pharmacol Ther 2006 Dec; 44(12):623-32. 

Not eligible target population 

2914. Menefee SA, Chesson R, Wall LL. Stress 

urinary incontinence due to prescription 

medications: alpha-blockers and angiotensin 

converting enzyme inhibitors. Obstet Gynecol 

1998 May; 91(5 Pt 2):853-4. Case Reports 

2915. Mentes BB, Tezcaner T, Yilmaz U, et al. 

Results of lateral internal sphincterotomy for 

chronic anal fissure with particular reference 

to quality of life. Dis Colon Rectum 2006 Jul; 

49(7):1045-51. Not eligible outcomes 

2916. Mercer LJ, Ludtke LJ. Adenoma malignum 

presenting as urinary incontinence. Int J 

Gynaecol Obstet 1991 Oct; 36(2):149-53. 

Case report 

2917. Merrick GS, Butler WM, Lief JH, et al. 

Temporal resolution of urinary morbidity 

following prostate brachytherapy. Int J Radiat 

Oncol Biol Phys 2000 Apr 1; 47(1):121-8. Not 

eligible outcomes 

2918. Merrick GS, Butler WM, Wallner K, et al. 

Permanent prostate brachytherapy-induced 

morbidity in patients with grade II and III 

obesity. Urology 2002 Jul; 60(1):104-8. Caseseries 

2919. Merrick GS, Butler WM, Wallner KE, et al. 

Long-term urinary quality of life after 

permanent prostate brachytherapy. Int J Radiat 

Oncol Biol Phys 2003 Jun 1; 56(2):454-61. 

Case series 

2920. Mertz HR, Beck CK, Dixon W, et al. 

Validation of a new measure of diarrhea. Dig 

Dis Sci 1995 Sep; 40(9):1873-82. Not eligible 

outcomes 

2921. Meschia M, Bruschi F, Amicarelli F, et al. 

The sacrospinous vaginal vault suspension: 

Critical analysis of outcomes. Int Urogynecol 

J Pelvic Floor Dysfunct 1999; 10(3):155-9. 

Case-series 

2922. Meschia M, Busacca M, Pifarotti P, et al. 

Bowel perforation during insertion of tensionfree vaginal tape (TVT). Int Urogynecol J 

Pelvic Floor Dysfunct 2002; 13(4):263-5; 

discussion 5. Case Reports 

2923. Meschia M, Pifarotti P, Bernasconi F, et al. 

Tension-Free vaginal tape: analysis of 

outcomes and complications in 404 stress 

incontinent women. Int Urogynecol J Pelvic 

Floor Dysfunct 2001; 12 Suppl 2:S24-7. Not 

eligible target population 

2924. Meschia M, Pifarotti P, Buonaguidi A, et al. 

Tension-free vaginal tape (TVT) for treatment 

of stress urinary incontinence in women with 

low-pressure urethra. Eur J Obstet Gynecol 

Reprod Biol 2005 Sep 1; 122(1):118-21. 

Case-series 

2925. Meshkinpour H, Movahedi H, Welgan P. 

Clinical value of anorectal manometry index 

in neurogenic fecal incontinence. Dis Colon 

Rectum 1997 Apr; 40(4):457-61. Not eligible 

outcomes 

2926. Messick GM, Powe CE. Applying behavioral 

research to incontinence. Ostomy Wound 

Manage 1997 Nov-Dec; 43(10):40-6, 8. Casereports 

2927. Metin A, Kayigil, Ahmed SI. The rate of 

urgency symptoms in women with stress 

urinary incontinence and nomogram based 

bladder outlet obstruction. Int Urol Nephrol 

2000; 32(2):251-3. Case-series 

2928. Metin A, Kayigil O, Ahmed SI. Modified 

insitu vaginal wall sling in stress incontinence. 

Int Urol Nephrol 2001; 32(4):641-5. Caseseries 

2929. Meulen T, Zambon JV, Janknegt RA. 

Treatment of anastomotic strictures and 

urinary incontinence after radical 

prostatectomy with urolume wallstent and 

AMS 800 artificial sphincter. J Endourol 1999 

Sep; 13(7):517-20. Case Reports 

2930. Mevorach RA, Bogaert GA, Baskin LS, et al. 

Lower urinary tract function in ambulatory 

children with spina bifida. Br J Urol 1996 

Apr; 77(4):593-6. Not eligible target 

population 

2931. Meyenberger C, Bertschinger P, Zala GF, et 

al. Anal sphincter defects in fecal 

incontinence: correlation between 

endosonography and surgery. Endoscopy 1996 

Feb; 28(2):217-24. Case-series 
B-131 

2932. Meyer S, Achtari C, Hohlfeld P, et al. Effects 

of epidural analgesia on pelvic floor function 

after spontaneous delivery: a longitudinal 

retrospective study. Int Urogynecol J Pelvic 

Floor Dysfunct 2002 Nov; 13(6):359-64; 

discussion 64-5. Case-series 

2933. Meyer S, Bachelard O, De Grandi P. Do 

bladder neck mobility and urethral sphincter 

function differ during pregnancy compared 

with during the non-pregnant state? Int 

Urogynecol J Pelvic Floor Dysfunct 1998; 

9(6):397-404. Question 2 

2934. Meyer S, de Grandi P, Caccia G, et al. 

Pressure transmission ratio: is it a reliable 

parameter in increased urethro-vesical 

junction mobility? Neurourol Urodyn 1997; 

16(4):277-84. Not eligible outcomes 

2935. Meyer S, Dhenin T, Schmidt N, et al. 

Subjective and objective effects of 

intravaginal electrical myostimulation and 

biofeedback in patients with genuine stress 

urinary incontinence. Br J Urol 1992 Jun; 

69(6):584-8. Case-series 

2936. Meyer S, Kuntzer T, Newsom N, et al. Stress 

urinary incontinence due to a low-pressure 

urethra: a socially invalidizing disease. 

Neurourol Urodyn 1996; 15(3):177-86. Not 

eligible outcomes 

2937. Meyer S, Schreyer A, De Grandi P, et al. The 

effects of birth on urinary continence 

mechanisms and other pelvic-floor 

characteristics. Obstet Gynecol 1998 Oct; 

92(4 Pt 1):613-8. Not eligible level of evidence 

2938. Michel MC, de la Rosette JJ, Piro M, et al. 

Does concomitant stress incontinence alter the 

efficacy of tolterodine in patients with 

overactive bladder? J Urol 2004 Aug; 

172(2):601-4. Not eligible target population 

2939. Michel MS, Koehrmann KU, Knoll T, et al. 

Clinical evaluation of a newly developed 

endoscopic resection device (Rotoresect): 

physical principle and first clinical results. 

Surg Endosc 2001 Dec; 15(12):1395-400. Not 

eligible exposure 

2940. Michelassi F, Melis M, Rubin M, et al. 

Surgical treatment of anorectal complications 

in Crohn's disease. Surgery 2000 Oct; 

128(4):597-603. Not eligible outcomes 

2941. Michelsen HB, Buntzen S, Krogh K, et al. 

Rectal volume tolerability and anal pressures 

in patients with fecal incontinence treated with 

sacral nerve stimulation. Dis Colon Rectum 

2006 Jul; 49(7):1039-44. Case-series 

2942. Michielsen DP, Wyndaele JJ. Urodynamics 

and lower urinary tract symptoms. Acta Urol 

Belg 1998 Oct; 66(3):7-9. Not eligible 

outcomes 

2943. Michot F, Costaglioli B, Leroi AM, et al. 

Artificial anal sphincter in severe fecal 

incontinence: outcome of prospective 

experience with 37 patients in one institution. 

Ann Surg 2003 Jan; 237(1):52-6. Case-series 

2944. Midthun S, Paur R, Bruce AW. Pyuria 

detection using a dipstick applied to urine in 

incontinence pads. Urol Nurs 2003 Dec; 

23(6):430-5, 7. Not eligible exposure 

2945. Midthun SJ, Paur RA, Lindseth G, et al. 

Bacteriuria detection with a urine dipstick 

applied to incontinence pads of nursing home 

residents. Geriatr Nurs 2003 Jul-Aug; 

24(4):206-9. Not eligible exposure 

2946. Migliari R, De Angelis M, Madeddu G, et al. 

Tension-free vaginal mesh repair for anterior 

vaginal wall prolapse. Eur Urol 2000 Aug; 

38(2):151-5. Case-series 

2947. Migliari R, Leone P, Berdondini E, et al. 

Dorsal buccal mucosa graft urethroplasty for 

female urethral strictures. J Urol 2006 Oct; 

176(4 Pt 1):1473-6. Case-reports 

2948. Migliari R, Pistolesi D, De Angelis M. 

Polypropilene sling of the bulbar urethra for 

post-radical prostatectomy incontinence. Eur 

Urol 2003 Feb; 43(2):152-7. Case-series 

2949. Migliari R, Usai E. Treatment results using a 

mixed fiber mesh in patients with grade IV 

cystocele. J Urol 1999 Apr; 161(4):1255-8. 

Case-series 

2950. Mikami O, Osawa O, Matsuda T, et al. The 

augmented rectal bladder for urinary 

diversion: experience with the original valved 

rectum and a valve-less modification. Int J 

Urol 1994 Mar; 1(1):57-60; discussion 1. Not 

eligible exposure 

2951. Miklos JR, Sze EH, Karram MM. A critical 

appraisal of the methods of measuring leakpoint pressures in women with stress 

incontinence. Obstet Gynecol 1995 Sep; 

86(3):349-52. Not eligible outcomes 

2952. Milani R, Salvatore S, Soligo M, et al. 

Functional and anatomical outcome of anterior 

and posterior vaginal prolapse repair with 

prolene mesh. Bjog 2005 Jan; 112(1):107-11. 

Case-series 

2953. Miles AJ, Allen-Mersh TG, Wastell C. Effect 

of anoreceptive intercourse on anorectal 

function. J R Soc Med 1993 Mar; 86(3):144-7. 

Not eligible level of evidence 
B-132 

2954. Miles BJ, Khera M. Can preoperative 

behavioral training reduce postprostatectomy 

incontinence? Nat Clin Pract Urol 2006 Jun; 

3(6):302-3. Comment 

2955. Millard R, Tuttle J, Moore K, et al. Clinical 

efficacy and safety of tolterodine compared to 

placebo in detrusor overactivity. J Urol 1999 

May; 161(5):1551-5. Not eligible exposure 

2956. Millard RJ, Halaska M. Efficacy of 

solifenacin in patients with severe symptoms 

of overactive bladder: a pooled analysis. Curr 

Med Res Opin 2006 Jan; 22(1):41-8. Review, 

meta-analysis 

2957. Millard RJ, Moore K, Rencken R, et al. 

Duloxetine vs placebo in the treatment of 

stress urinary incontinence: a four-continent 

randomized clinical trial. BJU Int 2004 Feb; 

93(3):311-8. Not eligible exposure 

2958. Millard RJ, Wang Y. Early clinical experience 

with continent urinary diversion. Aust N Z J 

Surg 1996 Dec; 66(12):826-9. Case-series 

2959. Miller AS, Lewis WG, Williamson ME, et al. 

Factors that influence functional outcome after 

coloanal anastomosis for carcinoma of the 

rectum. Br J Surg 1995 Oct; 82(10):1327-30. 

Case-series 

2960. Miller AS, Lewis WG, Williamson ME, et al. 

Does eversion of the anorectum during 

restorative proctocolectomy influence 

functional outcome? Dis Colon Rectum 1996 

May; 39(5):489-93. Not eligible outcomes 

2961. Miller CA. Medications can cause or treat 

urinary incontinence. Geriatr Nurs 1995 SepOct; 16(5):253-4. Review 

2962. Miller EJ, Quan SH, Thaler HT. Treatment of 

squamous cell carcinoma of the anal canal. 

Cancer 1991 Apr 15; 67(8):2038-41. Caseseries 

2963. Miller GV, Finan PJ. Flap advancement and 

core fistulectomy for complex rectal fistula. 

Br J Surg 1998 Jan; 85(1):108-10. Case-series 

2964. Miller JM, Ashton-Miller JA, Delancey JO. 

Quantification of cough-related urine loss 

using the paper towel test. Obstet Gynecol 

1998 May; 91(5 Pt 1):705-9. Case-series 

2965. Miller JS, Ferguson CM, Amerson JR, et al. 

Ileal pouch-anal anastomosis. The Emory 

University experience. Am Surg 1991 Feb; 

57(2):89-95. Case-series 

2966. Miller K, Richardson DA, Siegel SW, et al. 

Pelvic floor electrical stimulation for genuine 

stress incontinence: who will benefit and 

when? Int Urogynecol J Pelvic Floor Dysfunct 

1998; 9(5):265-70. Not eligible target 

population 

2967. Miller K, Wenderoth UK, de Petriconi R, et 

al. The ileal neobladder. Operative technique 

and results. Urol Clin North Am 1991 Nov; 

18(4):623-30. Comment 

2968. Miller NL, Bissonette EA, Bahnson R, et al. 

Impact of a novel neoadjuvant and adjuvant 

hormone-deprivation approach on quality of 

life, voiding function, and sexual function 

after prostate brachytherapy. Cancer 2003 Mar 

1; 97(5):1203-10. Not eligible level of 

evidence 

2969. Miller R, Bartolo DC, Orrom WJ, et al. 

Improvement of anal sensation with 

preservation of the anal transition zone after 

ileoanal anastomosis for ulcerative colitis. Dis 

Colon Rectum 1990 May; 33(5):414-8. Caseseries 

2970. Milne J. The impact of information on health 

behaviors of older adults with urinary 

incontinence. Clin Nurs Res 2000 May; 

9(2):161-76. Not eligible outcomes 

2971. Milsom I. The prevalence of urinary 

incontinence. Acta Obstet Gynecol Scand 

2000 Dec; 79(12):1056-9. Review 

2972. Milsom I, Abrams P, Cardozo L, et al. How 

widespread are the symptoms of an overactive 

bladder and how are they managed? A 

population-based prevalence study. BJU Int 

2001 Jun; 87(9):760-6. Not eligible target 

population 

2973. Mimura T, Kaminishi M, Kamm MA. 

Diagnostic evaluation of patients with faecal 

incontinence at a specialist institution. Dig 

Surg 2004; 21(3):235-41; discussion 41. Not 

eligible outcomes 

2974. Minaglia S, Ozel B, Bizhang R, et al. 

Increased prevalence of interstitial cystitis in 

women with detrusor overactivity refractory to 

anticholinergic therapy. Urology 2005 Oct; 

66(4):702-6. Not eligible outcomes 

2975. Minaglia S, Ozel B, Hurtado E, et al. Effect of 

transobturator tape procedure on proximal 

urethral mobility. Urology 2005 Jan; 65(1):55-

9. Case-series 

2976. Minaglia S, Ozel B, Klutke C, et al. Bladder 

injury during transobturator sling. Urology 

2004 Aug; 64(2):376-7. Case-series 

2977. Minassian VA, Al-Badr A, Drutz HP, et al. 

Tension-free vaginal tape, Burch, and slings: 

are there predictors for early postoperative 

voiding dysfunction? Int Urogynecol J Pelvic 

Floor Dysfunct 2004 May-Jun; 15(3):183-7. 

Case-series 
B-133 

2978. Minassian VA, Al-Badr A, Pascali DU, et al. 

Tension-free vaginal tape: do patients who fail 

to follow-up have the same results as those 

who do? Neurourol Urodyn 2005; 24(1):35-8. 

Case-series 

2979. Minassian VA, Lovatsis D, Pascali D, et al. 

Effect of childhood dysfunctional voiding on 

urinary incontinence in adult women. Obstet 

Gynecol 2006 Jun; 107(6):1247-51. Not 

eligible exposure 

2980. Minervini A, Salinitri G, Minervini R. 

Retroperitoneal urinoma complicating Burch 

colposuspension. Int J Gynaecol Obstet 2003 

Jul; 82(1):85-6. Not eligible exposure 

2981. Minervini R, Felipetto R, Morelli G, et al. 

Urodynamic evaluation of urinary 

incontinence following radical prostatectomy: 

our experience. Acta Urol Belg 1996 Dec; 

64(4):5-8. Case-series 

2982. Minervini R, Felipetto R, Morelli G, et al. 

Bladder instability and incontinence after 

radical prostatectomy. Biomed Pharmacother 

1996; 50(8):383-5. Case-series 

2983. Mingin GC, Nguyen HT, Mathias RS, et al. 

Growth and metabolic consequences of 

bladder augmentation in children with 

myelomeningocele and bladder exstrophy. 

Pediatrics 2002 Dec; 110(6):1193-8. Not 

eligible target population 

2984. Minguez M, Garrigues V, Soria MJ, et al. 

Adaptation to Spanish language and validation 

of the fecal incontinence quality of life scale. 

Dis Colon Rectum 2006 Apr; 49(4):490-9. Not 

eligible exposure 

2985. Minguez M, Melo F, Espi A, et al. 

Therapeutic effects of different doses of 

botulinum toxin in chronic anal fissure. Dis 

Colon Rectum 1999 Aug; 42(8):1016-21. Not 

eligible outcomes 

2986. Mishra VC, Mishra N, Karim OM, et al. 

Voiding dysfunction after tension-free vaginal 

tape: a conservative approach is often 

successful. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 May-Jun; 16(3):210-4; 

discussion 4. Case-series 

2987. Mitrani C, Chun A, Desautels S, et al. 

Anorectal manometric characteristics in men 

and women with idiopathic fecal incontinence. 

J Clin Gastroenterol 1998 Apr; 26(3):175-8. 

Not eligible outcomes 

2988. Mitropoulos D, Papadoukakis S, Zervas A, et 

al. Efficacy of tolterodine in preventing urge 

incontinence immediately after prostatectomy. 

Int Urol Nephrol 2006; 38(2):263-8. Not 

eligible exposure 

2989. Mitterberger M, Pinggera GM, Mueller T, et 

al. Dynamic transurethral sonography and 3-

dimensional reconstruction of the 

rhabdosphincter and urethra: initial experience 

in continent and incontinent women. J 

Ultrasound Med 2006 Mar; 25(3):315-20. Not 

eligible outcomes 

2990. Miura T, Tanaka H, Makino Y, et al. Human 

T cell leukemia virus type I-associated 

myelopathy in a patient with systemic lupus 

erythematosus. Intern Med 1999 Jun; 

38(6):512-5. Case Reports 

2991. Mizunaga M, Miyata M, Kaneko S, et al. 

Intravesical instillation of oxybutynin 

hydrochloride therapy for patients with a 

neuropathic bladder. Paraplegia 1994 Jan; 

32(1):25-9. Case-series 

2992. Moalli PA, Jones Ivy S, Meyn LA, et al. Risk 

factors associated with pelvic floor disorders 

in women undergoing surgical repair. Obstet 

Gynecol 2003 May; 101(5 Pt 1):869-74. Not 

eligible target population 

2993. Moghimi K, Valbo A. Genital prolapse: a 

follow-up study assessing subjective and 

objective results five years or more after 

surgical intervention. Eur J Obstet Gynecol 

Reprod Biol 2005 Jun 1; 120(2):198-201. 

Case-series 

2994. Mogielnicki RP, Nelson WA, Dulac J. A 

study of the dying process in elderly 

hospitalized males. J Cancer Educ 1990; 

5(2):135-45. Case-series 

2995. Mohan KP, Massey JA. Neurofibromatous 

outflow obstruction. Br J Urol 1994 Sep; 

74(3):386-7. Case Reports 

2996. Molander U. Urinary incontinence and related 

urogenital symptoms in elderly women. Acta 

Obstet Gynecol Scand Suppl 1993; 158:1-22. 

Not eligible level of evidence 

2997. Molander U, Arvidsson L, Milsom I, et al. A 

longitudinal cohort study of elderly women 

with urinary tract infections. Maturitas 2000 

Feb 15; 34(2):127-31. Not eligible level of 

evidence 

2998. Molander U, Milsom I, Ekelund P, et al. A 

health care program for the investigation and 

treatment of elderly women with urinary 

incontinence and related urogenital symptoms. 

Acta Obstet Gynecol Scand 1991; 70(2):137-

42. Not eligible target population 
B-134 

2999. Molander U, Sundh V, Steen B. Urinary 

incontinence and related symptoms in older 

men and women studied longitudinally 

between 70 and 97 years of age. A population 

study. Archives of Gerontology and Geriatrics 

2002 Nov-Dec; 35(3):237-44. Not eligible 

level of evidence 

3000. Mollard P, Mouriquand P, Joubert P. Urethral 

lengthening for neurogenic urinary 

incontinence (Kropp's procedure): results of 

16 cases. J Urol 1990 Jan; 143(1):95-7. Not 

eligible target population 

3001. Molmenti EP, Pinto PA, Montgomery RA, et 

al. Concomitant surgery with laparoscopic live 

donor nephrectomy. Am J Transplant 2003 

Feb; 3(2):219-23. Case-reports 

3002. Mommsen S, Foldspang A, Elving L, et al. 

Association between urinary incontinence in 

women and a previous history of surgery. Br J 

Urol 1993 Jul; 72(1):30-7. Not eligible level of 

evidence 

3003. Monk DN, Mills P, Jeacock J, et al. 

Combining the strength-duration curve of the 

external anal sphincter with manometry for 

the assessment of faecal incontinence. Br J 

Surg 1998 Oct; 85(10):1389-93. Not eligible 

outcomes 

3004. Montague DK. The artificial urinary sphincter 

(AS 800): experience in 166 consecutive 

patients. J Urol 1992 Feb; 147(2):380-2. Caseseries 

3005. Montella JM, Ewing S, Cater J. Visual 

assessment of urethrovesical junction 

mobility. Int Urogynecol J Pelvic Floor 

Dysfunct 1997; 8(1):13-7. Not eligible 

outcomes 

3006. Montorsi F, Guazzoni G, Bergamaschi F, et al. 

A comparison of transrectal hyperthermia, 

transurethral thermotherapy, urolume 

wallstent, and prostatic spiral for benign 

prostatic hyperplasia patients at poor operative 

risk. Prostate 1994; 24(3):156-61. Case-series 

3007. Montorsi F, Salonia A, Suardi N, et al. 

Improving the preservation of the urethral 

sphincter and neurovascular bundles during 

open radical retropubic prostatectomy. Eur 

Urol 2005 Dec; 48(6):938-45. Case-series 

3008. Montoya A, Weiss AP, Price BH, et al. 

Magnetic resonance imaging-guided 

stereotactic limbic leukotomy for treatment of 

intractable psychiatric disease. Neurosurgery 

2002 May; 50(5):1043-9; discussion 9-52. 

Case-series 

3009. Monz B, Pons ME, Hampel C, et al. Patientreported impact of urinary incontinence--

results from treatment seeking women in 14 

European countries. Maturitas 2005 Nov 30; 

52 Suppl 2:S24-34. Not eligible outcomes 

3010. Moody G, Probert CS, Srivastava EM, et al. 

Sexual dysfunction amongst women with 

Crohn's disease: a hidden problem. Digestion 

1992; 52(3-4):179-83. Not eligible outcomes 

3011. Moody JA, Lingeman JE. Holmium laser 

enucleation of the prostate with tissue 

morcellation: initial United States experience. 

J Endourol 2000 Mar; 14(2):219-23. Caseseries 

3012. Moore C, Kogan BA, Parekh A. Impact of 

urinary incontinence on self-concept in 

children with spina bifida. J Urol 2004 Apr; 

171(4):1659-62. Not eligible target population 

3013. Moore K, Allen M, Voaklander DC. Pad tests 

and self-reports of continence in men awaiting 

radical prostatectomy: establishing baseline 

norms for males. Neurourol Urodyn 2004; 

23(7):623-6. No associative hypothesis tested 

3014. Moore K, Griffiths D, Latimer G, et al. 

Twenty four-hour monitoring of incontinence 

and bladder function in a community hospital. 

J ET Nurs 1993 Jul-Aug; 20(4):163-8. Caseseries 

3015. Moore KH, Foote A, Burton G, et al. An open 

study of the bladder neck support prosthesis in 

genuine stress incontinence. Br J Obstet 

Gynaecol 1999 Jan; 106(1):42-9. Not eligible 

target population 

3016. Moore KH, Gilpin SA, Dixon JS, et al. 

Increase in presumptive sensory nerves of the 

urinary bladder in idiopathic detrusor 

instability. Br J Urol 1992 Oct; 70(4):370-2. 

Not eligible outcomes 

3017. Moore KH, Goldstein M, Hay D. The 

treatment of detrusor instability in 

postmenopausal women with oxybutynin 

chloride: a double blind placebo controlled 

study. Br J Obstet Gynaecol 1990 Nov; 

97(11):1063-4. Letter 

3018. Moore KH, Ray FR, Barden JA. Loss of 

purinergic P2X(3) and P2X(5) receptor 

innervation in human detrusor from adults 

with urge incontinence. J Neurosci 2001 Sep 

15; 21(18):RC166. Not eligible outcomes 

3019. Moore KH, Richmond DH, Parys BT. Sex 

distribution of adult idiopathic detrusor 

instability in relation to childhood bedwetting. 

Br J Urol 1991 Nov; 68(5):479-82. Not 

eligible exposure 
B-135 

3020. Moore KH, Simons A, Dowell C, et al. 

Efficacy and user acceptability of the urethral 

occlusive device in women with urinary 

incontinence. J Urol 1999 Aug; 162(2):464-8. 

Not eligible target population 

3021. Moore KH, Simons A, Mukerjee C, et al. The 

relative incidence of detrusor instability and 

bacterial cystitis detected on the urodynamictest day. BJU Int 2000 May; 85(7):786-92. 

Not eligible outcomes 

3022. Moore KN, Estey A. The early post-operative 

concerns of men after radical prostatectomy. J 

Adv Nurs 1999 May; 29(5):1121-9. Caseseries 

3023. Moore RD, Miklos JR, Kohli N. Rectovaginal 

fistula repair using a porcine dermal graft. 

Obstet Gynecol 2004 Nov; 104(5 Pt 2):1165-

7. Not eligible exposure 

3024. Moore TF, Saltmarche A. Developing and 

testing an instrument to assess the information 

needs of persons with urinary incontinence. 

Perspectives 1993 Spring; 17(1):2-6. Not 

eligible outcomes 

3025. Moran F, Bradley JM, Boyle L, et al. 

Incontinence in adult females with cystic 

fibrosis: a Northern Ireland survey. Int J Clin 

Pract 2003 Apr; 57(3):182-3. Case-series 

3026. Moran PA, Carey MP, Dwyer PL. Urethral 

diverticula in pregnancy. Aust N Z J Obstet 

Gynaecol 1998 Feb; 38(1):102-6. Casereports 

3027. Moran PA, Ward KL, Johnson D, et al. 

Tension-free vaginal tape for primary genuine 

stress incontinence: a two-centre follow-up 

study. BJU Int 2000 Jul; 86(1):39-42. Caseseries 

3028. Morey AF, Medendorp AR, Noller MW, et al. 

Transobturator versus transabdominal mid 

urethral slings: a multi-institutional 

comparison of obstructive voiding 

complications. J Urol 2006 Mar; 175(3 Pt 

1):1014-7. Case-series 

3029. Morgan DJ, Blackburn M, Bax M. Adults 

with spina bifida and/or hydrocephalus. 

Postgrad Med J 1995 Jan; 71(831):17-21. 

Case-series 

3030. Morgan DM, Dunn RL, Fenner DE, et al. 

Comparative analysis of urinary incontinence 

severity after autologous fascia pubovaginal 

sling, pubovaginal sling and tension-free 

vaginal tape. J Urol 2007 Feb; 177(2):604-8; 

discussion 8-9. Case-series 

3031. Morgan JE, Heritz DM, Stewart FE, et al. The 

polypropylene pubovaginal sling for the 

treatment of recurrent stress urinary 

incontinence. J Urol 1995 Sep; 154(3):1013-4; 

discussion 5-6. Case-series 

3032. Morgan JL, O'Connell HE, McGuire EJ. Is 

intrinsic sphincter deficiency a complication 

of simple hysterectomy? J Urol 2000 Sep; 

164(3 Pt 1):767-9. Not eligible target 

population 

3033. Morgan R, Patel B, Beynon J, et al. Surgical 

management of anorectal incontinence due to 

internal anal sphincter deficiency. Br J Surg 

1997 Feb; 84(2):226-30. Case-series 

3034. Mori K. Management of idiopathic normalpressure hydrocephalus: a multiinstitutional 

study conducted in Japan. J Neurosurg 2001 

Dec; 95(6):970-3. Not eligible exposure 

3035. Morin M, Bourbonnais D, Gravel D, et al. 

Pelvic floor muscle function in continent and 

stress urinary incontinent women using 

dynamometric measurements. Neurourol 

Urodyn 2004; 23(7):668-74. Not eligible 

outcomes 

3036. Morin M, Dumoulin C, Bourbonnais D, et al. 

Pelvic floor maximal strength using vaginal 

digital assessment compared to dynamometric 

measurements. Neurourol Urodyn 2004; 

23(4):336-41. Not eligible outcomes 

3037. Morkved S, Bo K. Prevalence of urinary 

incontinence during pregnancy and 

postpartum. Int Urogynecol J Pelvic Floor 

Dysfunct 1999; 10(6):394-8. Not eligible level 

of evidence 

3038. Morkved S, Bo K. Effect of postpartum pelvic 

floor muscle training in prevention and 

treatment of urinary incontinence: a one-year 

follow up. Bjog 2000 Aug; 107(8):1022-8. 

Case-series 

3039. Morkved S, Salvesen KA, Bo K, et al. Pelvic 

floor muscle strength and thickness in 

continent and incontinent nulliparous pregnant 

women. Int Urogynecol J Pelvic Floor 

Dysfunct 2004 Nov-Dec; 15(6):384-9; 

discussion 90. Question 4 

3040. Morren GL, Walter S, Hallbook O, et al. 

Effects of magnetic sacral root stimulation on 

anorectal pressure and volume. Dis Colon 

Rectum 2001 Dec; 44(12):1827-33. Caseseries 

3041. Morren GL, Walter S, Lindehammar H, et al. 

Evaluation of the sacroanal motor pathway by 

magnetic and electric stimulation in patients 

with fecal incontinence. Dis Colon Rectum 

2001 Feb; 44(2):167-72. Not eligible 

outcomes 
B-136 

3042. Morris AR, Ho MT, Lapsley H, et al. Costs of 

managing urinary and faecal incontinence in a 

sub-acute care facility: a "bottom-up" 

approach. Neurourol Urodyn 2005; 24(1):56-

62. Case-series 

3043. Morrison A, Levy R. Fraction of nursing 

home admissions attributable to urinary 

incontinence. Value Health 2006 Jul-Aug; 

9(4):272-4. Not eligible outcomes 

3044. Mort J. Medications exacerbating urinary 

incontinence in the elderly. S D J Med 1997 

Oct; 50(10):361-2. Comment 

3045. Mortensen N, Humphreys MS. The anal 

continence plug: a disposable device for 

patients with anorectal incontinence. Lancet 

1991 Aug 3; 338(8762):295-7. Case-series 

3046. Mortensen S, Lose G, Thyssen H. 

Repeatability of cystometry and pressure-flow 

parameters in female patients. Int Urogynecol 

J Pelvic Floor Dysfunct 2002; 13(2):72-5. 

Case-series 

3047. Moss E, Toozs-Hobson P, Cardozo L, et al. A 

multicentre review of the tension-free vaginal 

tape procedure in clinical practice. J Obstet 

Gynaecol 2002 Sep; 22(5):519-22. Not 

eligible exposure 

3048. Mouritsen L, Bach P. Ultrasonic evaluation of 

bladder neck position and mobility: the 

influence of urethral catheter, bladder volume, 

and body position. Neurourol Urodyn 1994; 

13(6):637-46. Case-series 

3049. Mouritsen L, Rasmussen A. Bladder neck 

mobility evaluated by vaginal 

ultrasonography. Br J Urol 1993 Feb; 

71(2):166-71. Not eligible outcomes 

3050. Mouritsen L, Strandberg C. Vaginal 

ultrasonography versus colpo-cystourethrography in the evaluation of female 

urinary incontinence. Acta Obstet Gynecol 

Scand 1994 Apr; 73(4):338-42. Not eligible 

outcomes 

3051. Mouritsen L, Strandberg C, Frimodt-Moller C. 

Bladder neck anatomy and mobility: effect of 

vaginal ultrasound probe. Br J Urol 1994 Dec; 

74(6):749-52. Not eligible outcomes 

3052. Movig KL, Leufkens HG, Belitser SV, et al. 

Selective serotonin reuptake inhibitor-induced 

urinary incontinence. Pharmacoepidemiol 

Drug Saf 2002 Jun; 11(4):271-9. Not eligible 

level of evidence 

3053. Mowschenson PM, Critchlow JF, Rosenberg 

SJ, et al. Factors favoring continence, the 

avoidance of a diverting ileostomy and small 

intestinal conservation in the ileoanal pouch 

operation. Surg Gynecol Obstet 1993 Jul; 

177(1):17-26. Case-series 

3054. Mraz JP, Sutory M, Zerhau P. Simple flap 

valve for continent urinary diversion. Br J 

Urol 1994 Sep; 74(3):328-32. Case-series 

3055. Mueller C, Cain H. Comprehensive 

management of urinary incontinence through 

quality improvement efforts. Geriatr Nurs 

2002 Mar-Apr; 23(2):82-7. No associative 

hypothesis tested 

3056. Mueller MH, Kreis ME, Gross ML, et al. 

Anorectal functional disorders in the absence 

of anorectal inflammation in patients with 

Crohn's disease. Br J Surg 2002 Aug; 

89(8):1027-31. Not eligible outcomes 

3057. Mukamel DB, Watson NM, Meng H, et al. 

Development of a risk-adjusted urinary 

incontinence outcome measure of quality for 

nursing homes. Med Care 2003 Apr; 

41(4):467-78. Not eligible outcomes 

3058. Mukherjee K, Constantine G. Urinary stress 

incontinence in obese women: tension-free 

vaginal tape is the answer. BJU Int 2001 Dec; 

88(9):881-3. Not eligible target population 

3059. Mularczyk A, Basilisco G. Fecal incontinence 

induced by spontaneous internal anal sphincter 

relaxation: report of a case. Dis Colon Rectum 

2002 Jul; 45(7):973-6. Case- Reports 

3060. Mulholland TL, Huynh PN, Huang RR, et al. 

Urinary incontinence after radical retropubic 

prostatectomy is not related to patient body 

mass index. Prostate Cancer Prostatic Dis 

2006; 9(2):153-9. Not eligible level of 

evidence 

3061. Muller J, Seppi K, Stefanova N, et al. 

Freezing of gait in postmortem-confirmed 

atypical parkinsonism. Mov Disord 2002 Sep; 

17(5):1041-5. Case-series 

3062. Muller N. WHO initiatives for the incontinent 

elderly. Ostomy Wound Manage 1997 NovDec; 43(10):64-6. Review 

3063. Muller N. Promoting urinary health. Provider 

2002 Mar; 28(3):51-3. Comment 

3064. Muller N. What Americans understand and 

how they are affected by bladder control 

problems: highlights of recent nationwide 

consumer research. Urol Nurs 2005 Apr; 

25(2):109-15. Not eligible outcomes 

3065. Munchiando JF, Kendall K. Comparison of 

the effectiveness of two bowel programs for 

CVA patients. Rehabil Nurs 1993 May-Jun; 

18(3):168-72. Case-series 

3066. Muncie HL, Jr., Warren JW. Reasons for 

replacement of long-term urethral catheters: 

implications for randomized trials. J Urol 

1990 Mar; 143(3):507-9. Not eligible 

outcomes 
B-137 

3067. Munir N, Bunce C, Gelister J, et al. Outcome 

following TVT sling procedure: a comparison 

of outcome recorded by surgeons to that 

reported by their patients at a London district 

general hospital. Eur Urol 2005 May; 

47(5):635-40; discussion 40. Case-series 

3068. Munoz Yague T, Alvarez Sanchez V, Ibanez 

Pinto A, et al. Clinical, anorectal manometry 

and surface electromyography in the study of 

patients with fecal incontinence. Rev Esp 

Enferm Dig 2003 Sep; 95(9):635-9, 29-34. 

Case-series 

3069. Muqim RU, Naz T. Urethral diverticulum in 

female. J Coll Physicians Surg Pak 2004 Jan; 

14(1):55-6. Case report 

3070. Murphy EL, Fridey J, Smith JW, et al. HTLVassociated myelopathy in a cohort of HTLV-I 

and HTLV-II-infected blood donors. The 

REDS investigators. Neurology 1997 Feb; 

48(2):315-20. Not eligible outcomes 

3071. Murphy GP, Mettlin C, Menck H, et al. 

National patterns of prostate cancer treatment 

by radical prostatectomy: results of a survey 

by the American College of Surgeons 

Commission on Cancer. J Urol 1994 Nov; 

152(5 Pt 2):1817-9. Not eligible level of 

evidence 

3072. Murphy KP, Kliever EM, Moore MJ. The 

voiding alert system: a new application in the 

treatment of incontinence. Arch Phys Med 

Rehabil 1994 Aug; 75(8):924-7. Case Reports 

3073. Murphy M, Culligan PJ, Arce CM, et al. Is the 

cough-stress test necessary when placing the 

tension-free vaginal tape? Obstet Gynecol 

2005 Feb; 105(2):319-24. Not eligible 

exposure 

3074. Murphy M, Culligan PJ, Arce CM, et al. 

Construct validity of the incontinence severity 

index. Neurourol Urodyn 2006; 25(5):418-23. 

Not eligible outcomes 

3075. Murphy S, Denman S, Bennett RG, et al. 

Methicillin-resistant Staphylococcus aureus 

colonization in a long-term-care facility. J Am 

Geriatr Soc 1992 Mar; 40(3):213-7. Not 

eligible outcomes 

3076. Murphy S, Rea D, O'Mahony J, et al. A 

comparison of the functional durability of the 

AMS 800 artificial urinary sphincter between 

cases with and without an underlying 

neurogenic aetiology. Ir J Med Sci 2003 JulSep; 172(3):136-8. Case-series 

3077. Murray C, Goh JT, Fynes M, et al. Urinary 

and faecal incontinence following delayed 

primary repair of obstetric genital fistula. Bjog 

2002 Jul; 109(7):828-32. Case-series 

3078. Mushkat Y, Bukovsky I, Langer R. Female 

urinary stress incontinence--does it have 

familial prevalence? Am J Obstet Gynecol 

1996 Feb; 174(2):617-9. Not eligible level of 

evidence 

3079. Muskat Y, Bukovsky I, Schneider D, et al. 

The use of scopolamine in the treatment of 

detrusor instability. J Urol 1996 Dec; 

156(6):1989-90. Not eligible exposure 

3080. Musselman DM, Ford AP, Gennevois DJ, et 

al. A randomized crossover study to evaluate 

Ro 115-1240, a selective alpha1A/1Ladrenoceptor partial agonist in women with 

stress urinary incontinence. BJU Int 2004 Jan; 

93(1):78-83. Not eligible exposure 

3081. Mustafa M, Wadie BS. Placard-shaped in situ 

vaginal wall sling for the treatment of stress 

urinary incontinence. Int J Urol 2006 Feb; 

13(2):132-4. Not eligible target population 

3082. Mutone N, Brizendine E, Hale D. Factors that 

influence voiding function after the tensionfree vaginal tape procedure for stress urinary 

incontinence. Am J Obstet Gynecol 2003 Jun; 

188(6):1477-81; discussion 81-3. Case-series 

3083. Myers AH, Palmer MH, Engel BT, et al. 

Mobility in older patients with hip fractures: 

examining prefracture status, complications, 

and outcomes at discharge from the acute-care 

hospital. J Orthop Trauma 1996; 10(2):99-

107. Not eligible outcomes 

3084. Myers DL, Arya LA, Friedman JH. Is urinary 

incontinence different in women with 

Parkinson's disease? Int Urogynecol J Pelvic 

Floor Dysfunct 1999; 10(3):188-91. Not 

eligible level of evidence 

3085. Myers DL, LaSala CA. Conservative surgical 

management of Mersilene mesh suburethral 

sling erosion. Am J Obstet Gynecol 1998 Dec; 

179(6 Pt 1):1424-8; discussion 8-9. Caseseries 

3086. Myers DL, Lasala CA, Hogan JW, et al. The 

effect of posterior wall support defects on 

urodynamic indices in stress urinary 

incontinence. Obstet Gynecol 1998 May; 91(5 

Pt 1):710-4. Not eligible outcomes 

3087. Myers DL, Peipert JF, Rosenblatt PL, et al. 

Patient satisfaction with laparoscopic Burch 

retropubic urethropexy. J Reprod Med 2000 

Nov; 45(11):939-43. Case-series 

3088. Nacmias B, Tedde A, Guarnieri BM, et al. 

Analysis of apolipoprotein E, alpha1-

antichymotrypsin and presenilin-1 genes 

polymorphisms in dementia caused by normal 

pressure hydrocephalus in man. Neurosci Lett 

1997 Jul 4; 229(3):177-80. Not eligible 

outcomes 
B-138 

3089. Nager C, Stanton S. Can HRT help 

incontinence? Community Nurse 1997 May; 

3(4):32-3. Comment 

3090. Naglie G, Radomski SB, Brymer C, et al. A 

randomized, double-blind, placebo controlled 

crossover trial of nimodipine in older persons 

with detrusor instability and urge 

incontinence. J Urol 2002 Feb; 167(2 Pt 

1):586-90. Not eligible exposure 

3091. Naidu A, Lim YN, Barry C, et al. 

Transobturator tape for stress incontinence: 

the North Queensland experience. Aust N Z J 

Obstet Gynaecol 2005 Oct; 45(5):446-9. 

Case-series 

3092. Nair KP, Taly AB, Maheshwarappa BM, et al. 

Nontraumatic spinal cord lesions: a 

prospective study of medical complications 

during in-patient rehabilitation. Spinal Cord 

2005 Sep; 43(9):558-64. Case-series 

3093. Nakagami G, Sanada H, Kitagawa A, et al. 

Incontinence induces stratum corneum 

vulnerability and impairs the skin barrier 

function in the perianal region. Dermatology 

2006; 213(4):293-9. Not eligible outcomes 

3094. Nakai S, Yoshizawa H, Kobayashi S, et al. 

Anorectal and bladder function after sacrifice 

of the sacral nerves. Spine 2000 Sep 1; 

25(17):2234-9. Case-reports 

3095. Nakamura T, Ishiko O, Hirai K, et al. Clinical 

evaluation of the Q-tip test in normal pregnant 

women. Gynecol Obstet Invest 2001; 

51(2):92-5. Not eligible level of evidence 

3096. Nakanishi N, Tatara K, Shinsho F, et al. 

Mortality in relation to urinary and faecal 

incontinence in elderly people living at home. 

Age Ageing 1999 May; 28(3):301-6. Not 

eligible exposure 

3097. Nakayama Y, Tanaka A, Ohshiro S, et al. 

Extensive edema in the thalamus caused by 

thrombosed basilar artery aneurysm. Neurol 

Med Chir (Tokyo) 1998 May; 38(5):274-7. 

Case-reports 

3098. Namiki S, Ishidoya S, Saito S, et al. Natural 

history of voiding function after radical 

retropubic prostatectomy. Urology 2006 Jul; 

68(1):142-7. Not eligible exposure 

3099. Namiki S, Kuwahara M, Ioritani N, et al. An 

evaluation of urinary function after radical 

prostatectomy in Japanese men: concordance 

with definitions of urinary continence. BJU Int 

2005 Mar; 95(4):530-3. Case series 

3100. Namiki S, Saito S, Ishidoya S, et al. Adverse 

effect of radical prostatectomy on nocturia and 

voiding frequency symptoms. Urology 2005 

Jul; 66(1):147-51. Not eligible outcomes 

3101. Narayan P, Konety B, Aslam K, et al. 

Neuroanatomy of the external urethral 

sphincter: implications for urinary continence 

preservation during radical prostate surgery. J 

Urol 1995 Feb; 153(2):337-41. Not eligible 

target population 

3102. Nataluk EA, Assimos DG, Kroovand RL. 

Collagen injections for treatment of urinary 

incontinence secondary to intrinsic sphincter 

deficiency. J Endourol 1995 Oct; 9(5):403-6. 

Case-series 

3103. Nativ O, Levine S, Madjar S, et al. 

Incisionless per vaginal bone anchor 

cystourethropexy for the treatment of female 

stress incontinence: experience with the first 

50 patients. J Urol 1997 Nov; 158(5):1742-4. 

Case-series 

3104. Natsume O, Kondo H, Cho M, et al. The 

impact of radical prostatectomy on patient 

well-being: a prospective urodynamic study 

focused on detrusor function. Hinyokika Kiyo 

2004 Jan; 50(1):1-6. Case-series 

3105. Navarro M, Dotor E, Rivera F, et al. A Phase 

II study of preoperative radiotherapy and 

concomitant weekly irinotecan in combination 

with protracted venous infusion 5-fluorouracil, 

for resectable locally advanced rectal cancer. 

Int J Radiat Oncol Biol Phys 2006 Sep 1; 

66(1):201-5. Not eligible outcomes 

3106. Nazarko L. Care of the elderly: incontinence 

through incompetence. Nurs Stand 1993 Apr 

28-May 4; 7(32):52-3. Comment 

3107. Nazarko L. In search of relief. Nurs Times 

1996 Aug 7-13; 92(32):68, 70. Case Reports 

3108. Nazarko L. Educating Elsie. Nurs Times 1997 

Oct 22-28; 93(43):68, 71. Case Reports 

3109. Nazarko L. The whole story. Nurs Times 1997 

Oct 22-28; 93(43):63-6, 8. Comment 

3110. Nazarko L. Back to the future. Nurs Times 

1998 Oct 21-27; 94(42):79-80, 3-4. Case 

Reports 

3111. Nazarko L. Continence. Assess all areas. Nurs 

Times 1999 Feb 10-16; 95(6):68, 71-2. Case 

Reports 

3112. Nazarko L. A new perspective on an old 

problem. Nurs Times 2001 Jul 26-Aug 1; 

97(30):52-3. Secondary data analysis 

3113. Nazir M, Carlsen E, Jacobsen AF, et al. Is 

there any correlation between objective anal 

testing, rupture grade, and bowel symptoms 

after primary repair of obstetric anal sphincter 

rupture?: an observational cohort study. Dis 

Colon Rectum 2002 Oct; 45(10):1325-31. Not 

eligible outcomes 
B-139 

3114. Nazir M, Carlsen E, Nesheim BI. Do occult 

anal sphincter injuries, vector volume 

manometry and delivery variables have any 

predictive value for bowel symptoms after 

first time vaginal delivery without third and 

fourth degree rupture? A prospective study. 

Acta Obstet Gynecol Scand 2002 Aug; 

81(8):720-6. Case-series 

3115. N'Dow J, Leung HY, Marshall C, et al. Bowel 

dysfunction after bladder reconstruction. J 

Urol 1998 May; 159(5):1470-4; discussion 4-

5. Case-series 

3116. Neal LJ. Rehab's role in incontinence 

treatment and ostomy care. Rehab Manag 

2000 Jun-Jul; 13(5):28-30, 100. Comment 

3117. Neale EJ. Abdominal hysterectomy after 

insertion of tension-free vaginal tape. Bjog 

2002 Jun; 109(6):731-2. Case Reports 

3118. Nelson RL, Prasad ML, Pearl RK, et al. 

Inverted U-pouch construction for restoration 

of function in patients with failed straight 

ileoanal pull-throughs. Dis Colon Rectum 

1991 Nov; 34(11):1040-2. Case Reports 

3119. Nesathurai S, Jessiman TL. L4-5 disk lesion 

resulting in back pain with bowel, bladder and 

sexual dysfunction without paraparesis. Spinal 

Cord 1999 Mar; 37(3):228-30. Case Reports 

3120. Nesbakken A, Nygaard K, Bull-Njaa T, et al. 

Bladder and sexual dysfunction after 

mesorectal excision for rectal cancer. Br J 

Surg 2000 Feb; 87(2):206-10. Case-series 

3121. Nesrallah LJ, Almeida FG, Dall'oglio MF, et 

al. Experience with the orthotopic ileal 

neobladder in women: a mid-term follow-up. 

BJU Int 2005 May; 95(7):1045-7. Case-series 

3122. Nesrallah LJ, Srougi M, Dall'Oglio MF. 

Orthotopic ileal neobladder: the influence of 

reservoir volume and configuration on urinary 

continence and emptying properties. BJU Int 

2004 Feb; 93(3):375-8. Case-series 

3123. Neuman M. Low incidence of post-TVT 

genital prolapse. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Aug; 14(3):191-2; discussion 

2. Case-reports 

3124. Neuman M. Trans vaginal tape readjustment 

after unsuccessful tension-free vaginal tape 

operation. Neurourol Urodyn 2004; 23(3):282-

3. Case-series 

3125. Neumann C, Schmid H. Relationship between 

the degree of cardiovascular autonomic 

dysfunction and symptoms of neuropathy and 

other complications of diabetes mellitus. Braz 

J Med Biol Res 1995 Jul; 28(7):751-7. Not 

eligible target population 

3126. Neumann P, Blizzard L, Grimmer K, et al. 

Expanded paper towel test: an objective test of 

urine loss for stress incontinence. Neurourol 

Urodyn 2004; 23(7):649-55. Not eligible 

outcomes 

3127. Neumann PB, Grimmer KA, Grant RE, et al. 

Physiotherapy for female stress urinary 

incontinence: a multicentre observational 

study. Aust N Z J Obstet Gynaecol 2005 Jun; 

45(3):226-32. Case-series 

3128. Newey ML, Sen PK, Fraser RD. The longterm outcome after central cord syndrome: a 

study of the natural history. J Bone Joint Surg 

Br 2000 Aug; 82(6):851-5. Case-series 

3129. Newman DK. Aging and the problem of 

urinary incontinence: AHCPR's 1996 clinical 

practice guidance. Urol Nurs 1996 Dec; 

16(4):121-2. Guidance 

3130. Newman DK. What's new: the AHCPR 

guideline update on urinary incontinence. 

Ostomy Wound Manage 1996 Nov-Dec; 

42(10):46-50, 2-4, 6 passim. Guideline 

3131. Newman DK. Bladder control requires active 

management. J Womens Health 1998 May; 

7(4):425-6. Comment 

3132. Newman DK. New treatment options for 

overactive bladder and incontinence. Director 

2002 Summer; 10(3):74-6. Review 

3133. Newman DK. Report of a mail survey of 

women with bladder control disorders. Urol 

Nurs 2004 Dec; 24(6):499-507. Not eligible 

outcomes 

3134. Newman DK, Gaines T, Snare E. Innovation 

in bladder assessment: use of technology in 

extended care. J Gerontol Nurs 2005 Dec; 

31(12):33-41; quiz 2-3. Case-series 

3135. Newman DK, Wallace J, Blackwood N, et al. 

Promoting healthy bladder habits for seniors. 

Ostomy Wound Manage 1996 Nov-Dec; 

42(10):18-22, 4-5, 8. No associative 

hypothesis tested 

3136. Ng C, Prott G, Rutkowski S, et al. 

Gastrointestinal symptoms in spinal cord 

injury: relationships with level of injury and 

psychologic factors. Dis Colon Rectum 2005 

Aug; 48(8):1562-8. Not eligible target 

population 

3137. Ng CC, Lee LC, Han WH. Use of threedimensional ultrasound scan to assess the 

clinical importance of midurethral placement 

of the tension-free vaginal tape (TVT) for 

treatment of incontinence. Int Urogynecol J 

Pelvic Floor Dysfunct 2005 May-Jun; 

16(3):220-5. Case-series 
B-140 

3138. Ng RK, Murray A. Can we afford to take short 

cuts in the management of stress urinary 

incontinence? Singapore Med J 1993 Apr; 

34(2):121-4. Case-series 

3139. Ngninkeu BN, van Heugen G, di Gregorio M, 

et al. Laparoscopic artificial urinary sphincter 

in women for type III incontinence: 

preliminary results. Eur Urol 2005 Jun; 

47(6):793-7; discussion 7. Case-series 

3140. Nguyen A, Mahoney S, Minor L, et al. A 

simple objective method of adjusting sling 

tension. J Urol 1999 Nov; 162(5):1674-6. 

Case-series 

3141. Nguyen JK, Bhatia NN. Risk of recurrent 

stress incontinence in women undergoing the 

combined modified pereyra procedure and 

transvaginal sacrospinous ligament vault 

suspension. Urology 2001 Dec; 58(6):947-52. 

Case-series 

3142. Nguyen JK, Bhatia NN. Resolution of motor 

urge incontinence after surgical repair of 

pelvic organ prolapse. J Urol 2001 Dec; 

166(6):2263-6. Case-series 

3143. Nguyen JK, Gunn GC, Bhatia NN. The effect 

of patient position on leak-point pressure 

measurements in women with genuine stress 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2002; 13(1):9-14. Not eligible 

exposure 

3144. Nguyen JN. Tape mobilization for urinary 

retention after tension-free vaginal tape 

procedures. Urology 2005 Sep; 66(3):523-6. 

Case-series 

3145. Nguyen JN, Yazdany T, Burchette RJ. 

Urodynamic evaluation of urethral 

competency in women with posterior vaginal 

support defects. Urology 2007 Jan; 69(1):87-

90. Not eligible outcomes 

3146. Nguyen TT, Maartens NF. Images in 

neuroscience: urge incontinence and an 

abnormal patch of skin. J Clin Neurosci 2005 

Apr; 12(3):271-2, 95. Case report 

3147. Nicholls RJ, Gilbert JM. Surgical correction 

of the efferent ileal limb for disordered 

defaecation following restorative 

proctocolectomy with the S ileal reservoir. Br 

J Surg 1990 Feb; 77(2):152-4. Case-series 

3148. Nichols CM, Lamb EH, Ramakrishnan V. 

Differences in outcomes after third- versus 

fourth-degree perineal laceration repair: a 

prospective study. Am J Obstet Gynecol 2005 

Aug; 193(2):530-4; discussion 4-6. Caseseries 

3149. Nicita G. A new operation for genitourinary 

prolapse. J Urol 1998 Sep; 160(3 Pt 1):741-5. 

Case-series 

3150. Nickless R, Burke N, Bolton T. Using 

ultrasound to assess bladder function in aged 

care rehabilitation. Aust Nurs J 2002 May; 

9(10):suppl 1-3. Secondary data analysis 

3151. Nielsen KK, Kromann-Andersen B, Jacobsen 

H, et al. The urethral plug: a new treatment 

modality for genuine urinary stress 

incontinence in women. J Urol 1990 Nov; 

144(5):1199-202. Case-series 

3152. Nielsen MB, Buron B, Christiansen J, et al. 

Defecographic findings in patients with anal 

incontinence and constipation and their 

relation to rectal emptying. Dis Colon Rectum 

1993 Sep; 36(9):806-9. Not associative 

hypothesis tested 

3153. Nielsen MB, Dammegaard L, Pedersen JF. 

Endosonographic assessment of the anal 

sphincter after surgical reconstruction. Dis 

Colon Rectum 1994 May; 37(5):434-8. Caseseries 

3154. Nielsen MB, Hauge C, Pedersen JF, et al. 

Endosonographic evaluation of patients with 

anal incontinence: findings and influence on 

surgical management. AJR Am J Roentgenol 

1993 Apr; 160(4):771-5. Not eligible 

outcomes 

3155. Nielsen MB, Hauge C, Rasmussen OO, et al. 

Anal endosonographic findings in the followup of primarily sutured sphincteric ruptures. 

Br J Surg 1992 Feb; 79(2):104-6. Case-series 

3156. Nielsen MB, Rasmussen OO, Pedersen JF, et 

al. Risk of sphincter damage and anal 

incontinence after anal dilatation for fissurein-ano. An endosonographic study. Dis Colon 

Rectum 1993 Jul; 36(7):677-80. Case-series 

3157. Niemczyk P, Klutke JJ, Carlin BI, et al. 

United States experience with tension-free 

vaginal tape procedure for urinary stress 

incontinence: assessment of safety and 

tolerability. Tech Urol 2001 Dec; 7(4):261-5. 

Case-series 

3158. Nieuwenhuijzen JA, Meinhardt W, Horenblas 

S. Clinical outcomes after sexuality preserving 

cystectomy and neobladder (prostate sparing 

cystectomy) in 44 patients. J Urol 2005 Apr; 

173(4):1314-7. Case-series 

3159. Niewijk AH, Weijts WB. Effects of a multimedia course on urinary incontinence. Patient 

Educ Couns 1997 Jan; 30(1):95-103. Not 

eligible level of evidence 

3160. Nikiteas N, Korsgen S, Kumar D, et al. Audit 

of sphincter repair. Factors associated with 

poor outcome. Dis Colon Rectum 1996 Oct; 

39(10):1164-70. Case-series 
B-141 

3161. Nill TG, Peller PA, Kropp KA. Management 

of urinary incontinence by bladder tube 

urethral lengthening and submucosal 

reimplantation. J Urol 1990 Aug; 144(2 Pt 

2):559-61; discussion 62-3. Case-series 

3162. Nilsson CG. Effectiveness of the conveen 

continence guard (a disposable vaginal device) 

in the treatment of complicated female stress 

incontinence. Acta Obstet Gynecol Scand 

2000 Dec; 79(12):1052-5. Not eligible target 

population 

3163. Nilsson CG, Kuuva N. The tension-free 

vaginal tape procedure is successful in the 

majority of women with indications for 

surgical treatment of urinary stress 

incontinence. Bjog 2001 Apr; 108(4):414-9. 

Case-series 

3164. Nilsson CG, Kuuva N, Falconer C, et al. 

Long-term results of the tension-free vaginal 

tape (TVT) procedure for surgical treatment of 

female stress urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 12 

Suppl 2:S5-8. Case-series 

3165. Nilsson CG, Lukkari E, Haarala M, et al. 

Comparison of a 10-mg controlled release 

oxybutynin tablet with a 5-mg oxybutynin 

tablet in urge incontinent patients. Neurourol 

Urodyn 1997; 16(6):533-42. Not eligible 

exposure 

3166. Nissenkorn I, Richter S, Slutzker D. A simple, 

self-retaining intraurethral catheter for 

treatment of prostatic obstruction. Eur Urol 

1990; 18(4):286-9. Case-series 

3167. Nitahara KS, Aboseif S, Tanagho EA. Longterm results of colpocystourethropexy for 

persistent or recurrent stress urinary 

incontinence. J Urol 1999 Jul; 162(1):138-41. 

Case-series 

3168. Nitti VW, Bregg KJ, Sussman EM, et al. The 

Raz bladder neck suspension in patients 65 

years old and older. J Urol 1993 Apr; 

149(4):802-7. Case-series 

3169. Nitti VW, Carlson KV, Blaivas JG, et al. 

Early results of pubovaginal sling lysis by 

midline sling incision. Urology 2002 Jan; 

59(1):47-51; discussion -2. Not eligible 

exposure 

3170. Nitti VW, Combs AJ. Correlation of Valsalva 

leak point pressure with subjective degree of 

stress urinary incontinence in women. J Urol 

1996 Jan; 155(1):281-5. Not eligible outcomes 

3171. Nitz NM, Jumadilova Z, Darkow T, et al. 

Medical costs after initiation of drug treatment 

for overactive bladder: effects of selection 

bias on cost estimates. Am J Manag Care 2005 

Jul; 11(4 Suppl):S130-9. Not eligible 

outcomes 

3172. Nixon E. Continence. Easing the social stress. 

Nurs Times 1995 Dec 13-19; 91(50):60. No 

associative hypothesis tested 

3173. Nobili F, Copello F, Buffoni F, et al. Regional 

cerebral blood flow and prognostic evaluation 

in Alzheimer's disease. Dement Geriatr Cogn 

Disord 2001 Mar-Apr; 12(2):89-97. Not 

eligible exposure 

3174. Nobili F, Copello F, Vitali P, et al. Timing of 

disease progression by quantitative EEG in 

Alzheimer' s patients. J Clin Neurophysiol 

1999 Nov; 16(6):566-73. Case-series 

3175. Noble JM, Canoll P, Honig LS. Brain tumorassociated dementia. Sci Aging Knowledge 

Environ 2005 Aug 24; 2005(34):dn2. CaseReports 

3176. Nochajski TH, Burns PA, Pranikoff K, et al. 

Dimensions of urine loss among older women 

with genuine stress incontinence. Neurourol 

Urodyn 1993; 12(3):223-33. Not eligible 

outcomes 

3177. Noguchi M, Eguchi Y, Ichiki J, et al. 

Therapeutic efficacy of clenbuterol for urinary 

incontinence after radical prostatectomy. Int J 

Urol 1997 Sep; 4(5):480-3. Case-series 

3178. Noguchi M, Noda S, Nakashima O, et al. 

Suspension technique improves rapid recovery 

of urinary continence following radical 

retropubic prostatectomy. Kurume Med J 

2004; 51(3-4):245-51. Not eligible exposure 

3179. Noguchi M, Shimada A, Nakashima O, et al. 

Urodynamic evaluation of a suspension 

technique for rapid recovery of continence 

after radical retropubic prostatectomy. Int J 

Urol 2006 Apr; 13(4):373-8. Case-series 

3180. Noh C, Kshirsagar A, Mohler JL. Outcomes 

after radical retropubic prostatectomy. 

Urology 2003 Feb; 61(2):412-6. Case series 

3181. Nomura S, Ishido T, Tanaka K, et al. 

Augmentation ileocystoplasty in patients with 

neurogenic bladder due to spinal cord injury 

or spina bifida. Spinal Cord 2002 Jan; 

40(1):30-3. Case-series 

3182. Norderval S, Oian P, Revhaug A, et al. Anal 

incontinence after obstetric sphincter tears: 

outcome of anatomic primary repairs. Dis 

Colon Rectum 2005 May; 48(5):1055-61. 

Case-series 
B-142 

3183. Nordstrom G, Nyman CR, Theorell T. 

Psychosocial adjustment and general state of 

health in patients with ileal conduit urinary 

diversion. Scand J Urol Nephrol 1992; 

26(2):139-47. Case-series 

3184. Nordstrom GM, Nyman CR. Male and female 

sexual function and activity following ileal 

conduit urinary diversion. Br J Urol 1992 Jul; 

70(1):33-9. Case-series 

3185. Norris A, Scerri A, Powell M. Quality of 

anaesthesia for insertion of tension-free 

vaginal tape using local analgesia and 

sedation. Eur J Anaesthesiol 2001 Nov; 

18(11):755-8. Not eligible exposure 

3186. Norton C. Continence. Continent's provision. 

Nurs Times 1992 Oct 28-Nov 3; 88(44):76-8. 

Comment 

3187. Norton C. Incontinence in old age. Nurs Elder 

1992 Jul-Aug; 4(4):17-8. 

3188. Norton C. Asking simple questions: 

promoting continence (repeat) (continuing 

education credit). Nurs Stand 1996 Jul 31; 

10(45 Suppl Nu):5-17; quiz 21-5. No 

associative hypothesis tested 

3189. Norton C. Providing appropriate services for 

continence: an overview. Nurs Stand 1996 Jun 

26; 10(40):41-5. Review 

3190. Norton C. Faecal incontinence in adults. Nurs 

Stand 1997 Aug 6; 11(46):49-54; quiz 5-6. 

Comment 

3191. Norton C, Brown J, Thomas E. Continence: a 

phone call away. Nurs Stand 1995 Mar 15-21; 

9(25):22-3. Comment 

3192. Norton C, Burch J, Kamm MA. Patients' 

views of a colostomy for fecal incontinence. 

Dis Colon Rectum 2005 May; 48(5):1062-9. 

Not eligible outcomes 

3193. Norton C, Chelvanayagam S. A nursing 

assessment tool for adults with fecal 

incontinence. J Wound Ostomy Continence 

Nurs 2000 Sep; 27(5):279-91. No associative 

hypothesis tested 

3194. Norton C, Fader M. Continence management. 

Elder Care 1994 Nov-Dec; 6(6):23-7. 

Comment 

3195. Norton C, Kamm MA. Outcome of 

biofeedback for faecal incontinence. Br J Surg 

1999 Sep; 86(9):1159-63. Case-series 

3196. Norton C, Kamm MA. Anal plug for faecal 

incontinence. Colorectal Dis 2001 Sep; 

3(5):323-7. No associative hypothesis tested 

3197. Norton P, Karram M, Wall LL, et al. 

Randomized double-blind trial of terodiline in 

the treatment of urge incontinence in women. 

Obstet Gynecol 1994 Sep; 84(3):386-91. Not 

eligible exposure 

3198. Nouira Y, Feki W, Rhouma SB, et al. 

Vesicouterine fistula as a complication of 

forceps delivery: a case report. Int Urogynecol 

J Pelvic Floor Dysfunct 2005 Nov-Dec; 

16(6):512-4. Case Reports 

3199. Novielli KD, Simpson Z, Hua G, et al. 

Urinary incontinence in primary care: a 

comparison of older African-American and 

Caucasian women. Int Urol Nephrol 2003; 

35(3):423-8. Not eligible level of evidence 

3200. Nuotio M, Jylha M, Luukkaala T, et al. Health 

problems associated with lower urinary tract 

symptoms in older women. A populationbased survey. Scand J Prim Health Care 2005 

Dec; 23(4):209-14. Not eligible outcomes 

3201. Nyaruhucha CN, Msuya JM, Matrida E. 

Nutritional status, functional ability and food 

habits of institutionalised and noninstitutionalised elderly people in Morogoro 

Region, Tanzania. East Afr Med J 2004 May; 

81(5):248-53. Case-series 

3202. Nyberg L, Gustafson Y. Fall prediction index 

for patients in stroke rehabilitation. Stroke 

1997 Apr; 28(4):716-21. Not eligible 

outcomes 

3203. Nygaard I, DeLancey JO, Arnsdorf L, et al. 

Exercise and incontinence. Obstet Gynecol 

1990 May; 75(5):848-51. Question 2 

3204. Nygaard I, Holcomb R. Reproducibility of the 

seven-day voiding diary in women with stress 

urinary incontinence. Int Urogynecol J Pelvic 

Floor Dysfunct 2000; 11(1):15-7. Not eligible 

outcomes 

3205. Nygaard I, Zmolek G. Exercise pad testing in 

continent exercisers: reproducibility and 

correlation with voided volume, pyridium 

staining, and type of exercise. Neurourol 

Urodyn 1995; 14(2):125-9. Not eligible 

outcomes 

3206. Nygaard IE. Does prolonged high-impact 

activity contribute to later urinary 

incontinence? A retrospective cohort study of 

female Olympians. Obstet Gynecol 1997 Nov; 

90(5):718-22. Not eligible level of evidence 

3207. Nygaard IE, Glowacki C, Saltzman CL. 

Relationship between foot flexibility and 

urinary incontinence in nulliparous varsity 

athletes. Obstet Gynecol 1996 Jun; 

87(6):1049-51. Case-series 

3208. Nygaard IE, Thompson FL, Svengalis SL, et 

al. Urinary incontinence in elite nulliparous 

athletes. Obstet Gynecol 1994 Aug; 

84(2):183-7. Not eligible level of evidence 
B-143 

3209. Oberwalder M, Dinnewitzer A, Baig MK, et 

al. The association between late-onset fecal 

incontinence and obstetric anal sphincter 

defects. Arch Surg 2004 Apr; 139(4):429-32. 

Not eligible exposure 

3210. Oberwalder M, Thaler K, Baig MK, et al. 

Anal ultrasound and endosonographic 

measurement of perineal body thickness: a 

new evaluation for fecal incontinence in 

females. Surg Endosc 2004 Apr; 18(4):650-4. 

Not eligible outcomes 

3211. O'Boyle AL, O'Boyle JD, Place RJ. An active 

duty woman with anal incontinence after 

vaginal delivery: an elusive diagnosis. Mil 

Med 2004 Dec; 169(12):966-7. Case-reports 

3212. O'Brien J. Evaluating primary care 

interventions for incontinence. Nurs Stand 

1996 Feb 28; 10(23):40-3. Case-series 

3213. O'Brien PE, Skinner S. Restoring control: the 

Acticon Neosphincter artificial bowel 

sphincter in the treatment of anal 

incontinence. Dis Colon Rectum 2000 Sep; 

43(9):1213-6. Case-series 

3214. O'Connell B, Hanna B, Bailey S, et al. The 

nature and severity of urinary incontinence in 

post-natal women. Contemp Nurse 2002 Oct; 

13(2-3):158-68. Not eligible level of evidence 

3215. O'Connell HE, McGuire EJ, Aboseif S, et al. 

Transurethral collagen therapy in women. J 

Urol 1995 Oct; 154(4):1463-5. Case-series 

3216. O'Connell-Gifford E. Contact dermatitis 

complicated by environment. Ostomy Wound 

Manage 2000 Sep; 46(9):16-7. Case- Reports 

3217. O'Connor JJ. Brief report: evaluation of fecal 

incontinence using rectal ultrasound. Md Med 

J 1996 Apr; 45(4):308-9. Comment 

3218. O'Connor RC, Stapp EC, Donnellan SM, et al. 

Long-term results of suprapubic bladder neck 

closure for treatment of the devastated outlet. 

Urology 2005 Aug; 66(2):311-5. Case-series 

3219. O'Donnell BF, Drachman DA, Barnes HJ, et 

al. Incontinence and troublesome behaviors 

predict institutionalization in dementia. J 

Geriatr Psychiatry Neurol 1992 Jan-Mar; 

5(1):45-52. Not eligible outcomes 

3220. O'Donnell M, Viktrup L, Hunskaar S. The role 

of general practitioners in the initial 

management of women with urinary 

incontinence in France, Germany, Spain and 

the UK. Eur J Gen Pract 2007; 13(1):20-6. Not 

eligible level of evidence 

3221. O'Donnell PD, Beck C. Urinary incontinence 

volume patterns in elderly inpatient men. 

Urology 1991 Aug; 38(2):128-31. Case-series 

3222. O'Donnell PD, Brookover T, Hewett M, et al. 

Continence level following radical 

prostatectomy. Urology 1990 Dec; 36(6):511-

2. Case-series 

3223. O'Donnell PD, Doyle R. Biofeedback therapy 

technique for treatment of urinary 

incontinence. Urology 1991 May; 37(5):432-

6. Comment 

3224. Oefelein MG. Prospective predictors of 

urinary continence after anatomical radical 

retropubic prostatectomy: a multivariate 

analysis. World J Urol 2004 Oct; 22(4):267-

71. Case-series 

3225. Oesterling JE, Gearhart JP. Utilization of ileal 

conduit in construction of continent urinary 

reservoir. Urology 1990 Jul; 36(1):15-9. Case 

Reports 

3226. Oettling G, Franz HB. Mapping of androgen, 

estrogen and progesterone receptors in the 

anal continence organ. Eur J Obstet Gynecol 

Reprod Biol 1998 Apr; 77(2):211-6. Not 

eligible outcomes 

3227. O'Flynn KJ, Murphy R, Thomas DG. 

Neurogenic bladder dysfunction in lumbar 

intervertebral disc prolapse. Br J Urol 1992 

Jan; 69(1):38-40. Case-series 

3228. O'Flynn KJ, Thomas DG. Artificial urinary 

sphincter insertion in congenital neuropathic 

bladder. Br J Urol 1991 Feb; 67(2):155-7. 

Case-series 

3229. Oge O, Tekgul S, Ergen A, et al. Urotheliumpreserving augmentation cystoplasty covered 

with a peritoneal flap. BJU Int 2000 May; 

85(7):802-5. Not eligible target population 

3230. Ogundipe A, Rosenzweig BA, Karram MM, et 

al. Modified suburethral sling procedure for 

treatment of recurrent or severe stress urinary 

incontinence. Surg Gynecol Obstet 1992 Aug; 

175(2):173-6. Case-series 

3231. Oh HS, Kim MK, Seo WS. Effectiveness of a 

behavioral intervention program for urinary 

incontinence in a community setting. Taehan 

Kanho Hakhoe Chi 2005 Dec; 35(8):1476-84. 

Not eligible target population 

3232. Oh SJ, Hong SK, Son H, et al. Quality of life 

and disease severity in Korean women with 

stress urinary incontinence. Urology 2005 Jul; 

66(1):69-73. Not eligible outcomes 

3233. Oh SJ, Ku JH. Comparison of three diseasespecific quality-of-life questionnaires (Bristol 

Female Lower Urinary Tract Symptoms, 

Incontinence Quality of Life and King's 

Health Questionnaire) in women with stress 

urinary incontinence. Scand J Urol Nephrol 

2007; 41(1):66-71. Not eligible exposure 
B-144 

3234. Oh SJ, Ku JH, Hong SK, et al. Factors 

influencing self-perceived disease severity in 

women with stress urinary incontinence 

combined with or without urge incontinence. 

Neurourol Urodyn 2005; 24(4):341-7. Not 

eligible outcomes 

3235. Ohkawa A, Kondo A, Takei M, et al. Tensionfree vaginal tape surgery for stress urinary 

incontinencne: a prospective multicentered 

study in Japan. Int J Urol 2006 Jun; 13(6):738-

42. Case-series 

3236. Ojanuga D. Preventing birth injury among 

women in Africa: case studies in northern 

Nigeria. Am J Orthopsychiatry 1991 Oct; 

61(4):533-9. Case-series 

3237. Ojdeby G, Claezon A, Brekkan E, et al. 

Urinary incontinence and sexual impotence 

after radical prostatectomy. Scand J Urol 

Nephrol 1996 Dec; 30(6):473-7. Case-series 

3238. Okada Y, Shichiri Y, Terai A, et al. 

Management of late complications of 

continent urinary diversion using the Kock 

pouch and the Indiana pouch procedures. Int J 

Urol 1996 Sep; 3(5):334-9. Case- series 

3239. O'Keefe EA, Talley NJ, Zinsmeister AR, et al. 

Bowel disorders impair functional status and 

quality of life in the elderly: a populationbased study. J Gerontol A Biol Sci Med Sci 

1995 Jul; 50(4):M184-9. Not eligible target 

population 

3240. Okonkwo JE, Obionu CO, Obiechina NJ. 

Factors contributing to urinary incontinence 

and pelvic prolapse in Nigeria. Int J Gynaecol 

Obstet 2001 Sep; 74(3):301-3. Not eligible 

level of evidence 

3241. Oladokun A, Babarinsa IA, Adewole IF. The 

deficient perineum: oblique presentation of a 

clinically obvious anomaly. Afr J Med Med 

Sci 2002 Sep; 31(3):267-9. Case-series 

3242. Olagne E, Baulieux J, de la Roche E, et al. 

Functional results of delayed coloanal 

anastomosis after preoperative radiotherapy 

for lower third rectal cancer. J Am Coll Surg 

2000 Dec; 191(6):643-9. Case-series 

3243. Olah KS. Vaginal colposuspension: a new 

approach to an established continence 

procedure. J Obstet Gynaecol 2003 Nov; 

23(6):687-8. Case Reports 

3244. Oldbury M. Continence. Hard won comfort. 

Nurs Times 1992 Mar 25-31; 88(13):86. Case 

Reports 

3245. O'Leary MP, Gee WF, Holtgrewe HL, et al. 

1999 American Urological Association Gallup 

Survey: changes in physician practice 

patterns, treatment of incontinence and 

bladder cancer, and impact of managed care. J 

Urol 2000 Oct; 164(4):1311-6. Not eligible 

outcomes 

3246. Oliveira L, Pfeifer J, Wexner SD. 

Physiological and clinical outcome of anterior 

sphincteroplasty. Br J Surg 1996 Apr; 

83(4):502-5. Case-series 

3247. Oliveira L, Reissman P, Nogueras J, et al. 

Laparoscopic creation of stomas. Surg Endosc 

1997 Jan; 11(1):19-23. Case-series 

3248. Oliver JR, Wheeless CR, Jr., Fakhoury G. 

Correction of incontinent ileocolic urostomy 

with Kock's nipple valve. Gynecol Oncol 1991 

Nov; 43(2):178-81. Case Reports 

3249. Olopade FA, Norman A, Blake P, et al. A 

modified Inflammatory Bowel Disease 

questionnaire and the Vaizey Incontinence 

questionnaire are simple ways to identify 

patients with significant gastrointestinal 

symptoms after pelvic radiotherapy. Br J 

Cancer 2005 May 9; 92(9):1663-70. Not 

eligible outcomes 

3250. Olson JK. Offsetting natural 'poisons'. 

Incontinent residents require vigilant, gentle 

skin care. Contemp Longterm Care 2001 Aug; 

24(8):17. Comment 

3251. O'Malley KJ, Hickey DP, Kapoor A, et al. 

Artificial urinary sphincter insertion in renal 

transplant recipients. Urology 1999 Nov; 

54(5):923. Case Reports 

3252. O'Meara B. Continence. Hidden dangers. Nurs 

Times 1999 Aug 4-10; 95(31):70, 3. News 

3253. Onaitis M, Ludwig K, Perez-Tamayo A, et al. 

The Kraske procedure: a critical analysis of a 

surgical approach for mid-rectal lesions. J 

Surg Oncol 2006 Sep 1; 94(3):194-202. Not 

eligible exposure 

3254. Ong NC, Dwyer PL. Labial fusion causing 

voiding difficulty and urinary incontinence. 

Aust N Z J Obstet Gynaecol 1999 Aug; 

39(3):391-3. Case-reports 

3255. Onishi J, Suzuki Y, Umegaki H, et al. 

Behavioral, psychological and physical 

symptoms in group homes for older adults 

with dementia. Int Psychogeriatr 2006 Mar; 

18(1):75-86. Question 1 

3256. Onishi J, Suzuki Y, Umegaki H, et al. 

Influence of behavioral and psychological 

symptoms of dementia (BPSD) and 

environment of care on caregivers' burden. 

Arch Gerontol Geriatr 2005 Sep-Oct; 

41(2):159-68. Not eligible outcomes 
B-145 

3257. Onur R, Singla A. Solvent-dehydrated 

cadaveric dermis: a new allograft for 

pubovaginal sling surgery. Int J Urol 2005 

Sep; 12(9):801-5. Not eligible target 

population 

3258. Ooi BS, Ho YH, Eu KW, et al. Management 

of anorectal foreign bodies: a cause of obscure 

anal pain. Aust N Z J Surg 1998 Dec; 

68(12):852-5. Case-series 

3259. Oom DM, Gosselink MP, Van Dijl VR, et al. 

Puborectal sling interposition for the treatment 

of rectovaginal fistulas. Tech Coloproctol 

2006 Jul; 10(2):125-30; discussion 30. Caseseries 

3260. Oostra K, Everaert K, Van Laere M. Urinary 

incontinence in brain injury. Brain Inj 1996 

Jun; 10(6):459-64. Case-series 

3261. Oot-Giromini BA. Pressure ulcer prevalence, 

incidence and associated risk factors in the 

community. Decubitus 1993 Sep; 6(5):24-32. 

Not eligible outcomes 

3262. Ordonez E, Zivkovic F, Moser F, et al. 

Inadvertent ureteral catheterizaion with a 

microtip catheter at cystometry. Int 

Urogynecol J Pelvic Floor Dysfunct 1998; 

9(3):184-5. Not eligible exposure 

3263. Ordorica R, Stein B. Incontinence: defining 

the problem. R I Med 1994 Aug; 77(8):262-3. 

Comment 

3264. Ordorica RC, Masel J, Seigne J, et al. 

Evaluation and management of mechanical 

dysfunction in continent colonic urinary 

reservoirs. J Urol 2000 Jun; 163(6):1679-84. 

Not eligible outcomes 

3265. Orkin BA, Soper NJ, Kelly KA, et al. 

Influence of sleep on anal sphincteric pressure 

in health and after ileal pouch-anal 

anastomosis. Dis Colon Rectum 1992 Feb; 

35(2):137-44. Not eligible outcomes 

3266. Orovan WL, Davis IR. Kock to urethra: 

continent functional bladder replacement. Can 

J Surg 1990 Apr; 33(2):91-4. Case-series 

3267. Orr A, McVean RJ, Webb AK, et al. 

Questionnaire survey of urinary incontinence 

in women with cystic fibrosis. Bmj 2001 Jun 

23; 322(7301):1521. Not eligible level of 

evidence 

3268. Orrom WJ, Miller R, Cornes H, et al. 

Comparison of anterior sphincteroplasty and 

postanal repair in the treatment of idiopathic 

fecal incontinence. Dis Colon Rectum 1991 

Apr; 34(4):305-10. Not eligible target 

population 

3269. Orrom WJ, Wong WD, Rothenberger DA, et 

al. Evaluation of an air-filled microballoon 

and mini-transducer in the clinical practice of 

anorectal manometry. Preliminary 

communication. Dis Colon Rectum 1990 Jul; 

33(7):594-7. Not eligible outcomes 

3270. Ortiz H, Armendariz P, DeMiguel M, et al. 

Complications and functional outcome 

following artificial anal sphincter 

implantation. Br J Surg 2002 Jul; 89(7):877-

81. Case-series 

3271. Ortiz H, Armendariz P, DeMiguel M, et al. 

Prospective study of artificial anal sphincter 

and dynamic graciloplasty for severe anal 

incontinence. Int J Colorectal Dis 2003 Jul; 

18(4):349-54. Not eligible target population 

3272. Ortiz H, Marzo J. Endorectal flap 

advancement repair and fistulectomy for high 

trans-sphincteric and suprasphincteric fistulas. 

Br J Surg 2000 Dec; 87(12):1680-3. Caseseries 

3273. Ortiz H, Marzo J, Armendariz P, et al. Quality 

of life assessment in patients with chronic anal 

fissure after lateral internal sphincterotomy. 

Br J Surg 2005 Jul; 92(7):881-5. Case-series 

3274. Osborne M. Iye Sowodie's "Gladdie, Gladdie" 

day. Mercy Ships treats women made 

incontinent by birth injuries. Midwifery Today 

Int Midwife 2006 Winter; (80):60-1. Comment 

3275. Osterberg A, Edebol Eeg-Olofsson K, Graf W. 

Results of surgical treatment for faecal 

incontinence. Br J Surg 2000 Nov; 

87(11):1546-52. Case-series 

3276. Osterberg A, Graf W, Edebol Eeg-Olofsson K, 

et al. Results of neurophysiologic evaluation 

in fecal incontinence. Dis Colon Rectum 2000 

Sep; 43(9):1256-61. Not eligible outcomes 

3277. Osterberg A, Graf W, Eeg-Olofsson K, et al. 

Is electrostimulation of the pelvic floor an 

effective treatment for neurogenic faecal 

incontinence? Scand J Gastroenterol 1999 

Mar; 34(3):319-24. Case-series 

3278. Osterberg A, Graf W, Holmberg A, et al. 

Long-term results of anterior levatorplasty for 

fecal incontinence. A retrospective study. Dis 

Colon Rectum 1996 Jun; 39(6):671-4; 

discussion 4-5. Case-series 

3279. Osterberg A, Graf W, Karlbom U, et al. 

Evaluation of a questionnaire in the 

assessment of patients with faecal 

incontinence and constipation. Scand J 

Gastroenterol 1996 Jun; 31(6):575-80. Not 

eligible outcomes 
B-146 

3280. Osterberg A, Graf W, Pahlman L. The 

longitudinal high-pressure zone profile in 

patients with fecal incontinence. Am J 

Gastroenterol 1999 Oct; 94(10):2966-71. Not 

eligible outcomes 

3281. Osterweil D, Martin M, Syndulko K. 

Predictors of skilled nursing placement in a 

multilevel long-term-care facility. J Am 

Geriatr Soc 1995 Feb; 43(2):108-12. Not 

eligible exposure 

3282. Ostrzenski A, Osborne NG, Ostrzenska K. 

Method for diagnosing paravaginal defects 

using contrast ultrasonographic technique. J 

Ultrasound Med 1997 Oct; 16(10):673-7. Not 

eligible outcomes 

3283. O'Sullivan R, Karantanis E, Stevermuer TL, et 

al. Definition of mild, moderate and severe 

incontinence on the 24-hour pad test. Bjog 

2004 Aug; 111(8):859-62. Not eligible 

outcomes 

3284. O'Sullivan R, Simons A, Prashar S, et al. Is 

objective cure of mild undifferentiated 

incontinence more readily achieved than that 

of moderate incontinence? Costs and 2-year 

outcome. Int Urogynecol J Pelvic Floor 

Dysfunct 2003 Aug; 14(3):193-8; discussion 

8. Case-series 

3285. Otero M, Boulvain M, BianchiDemicheli F, et 

al. Women's health 18 years after rupture of 

the anal sphincter during childbirth: II. 

Urinary incontinence, sexual function, and 

physical and mental health. American Journal 

of Obstetrics and Gynecology 2006 May; 

194(5):1260-5. Not eligible level of evidence 

3286. Otero M, Boulvain M, Bianchi-Demicheli F, 

et al. Women's health 18 years after rupture of 

the anal sphincter during childbirth: II. 

Urinary incontinence, sexual function, and 

physical and mental health. Am J Obstet 

Gynecol 2006 May; 194(5):1260-5. Not 

eligible level of evidence 

3287. Otto IC, Ito K, Ye C, et al. Causes of rectal 

incontinence after sphincter-preserving 

operations for rectal cancer. Dis Colon 

Rectum 1996 Dec; 39(12):1423-7. Case-series 

3288. Ottoway J. A patient's view. Elder Care 1999 

Dec-2000 Jan; 11(9):35. Comment 

3289. Ouslander J, Schnelle J, Simmons S, et al. The 

dark side of incontinence: nighttime 

incontinence in nursing home residents. J Am 

Geriatr Soc 1993 Apr; 41(4):371-6. Not 

eligible target population 

3290. Ouslander JG. Intractable incontinence in the 

elderly. BJU Int 2000 May; 85 Suppl 3:72-8; 

discussion 81-2. Review 

3291. Ouslander JG, Ai-Samarrai N, Schnelle JF. 

Prompted voiding for nighttime incontinence 

in nursing homes: is it effective? J Am Geriatr 

Soc 2001 Jun; 49(6):706-9. Case-series 

3292. Ouslander JG, Buxton WG, AlSamarrai NR, 

et al. Nighttime urinary incontinence and sleep 

disruption among nursing home residents. 

Journal of the American Geriatrics Society 

1998 Apr; 46(4):463-6. Not eligible outcomes 

3293. Ouslander JG, Buxton WG, Al-Samarrai NR, 

et al. Nighttime urinary incontinence and sleep 

disruption among nursing home residents. J 

Am Geriatr Soc 1998 Apr; 46(4):463-6. Not 

eligible target population 

3294. Ouslander JG, Cooper E, Godley D. Estrogen 

treatment for incontinence in frail older 

women. J Am Geriatr Soc 1999 Nov; 

47(11):1383-4. Letter 

3295. Ouslander JG, Griffiths P, McConnell E, et al. 

Functional Incidental Training: applicability 

and feasibility in the Veterans Affairs nursing 

home patient population. J Am Med Dir Assoc 

2005 Mar-Apr; 6(2):121-7. Not eligible 

outcomes 

3296. Ouslander JG, Schapira M, Fingold S, et al. 

Accuracy of rapid urine screening tests among 

incontinent nursing home residents with 

asymptomatic bacteriuria. J Am Geriatr Soc 

1995 Jul; 43(7):772-5. Not eligible outcomes 

3297. Ouslander JG, Schapira M, Schnelle JF. Urine 

specimen collection from incontinent female 

nursing home residents. J Am Geriatr Soc 

1995 Mar; 43(3):279-81. Not eligible 

outcomes 

3298. Ouslander JG, Schapira M, Schnelle JF, et al. 

Pyuria among chronically incontinent but 

otherwise asymptomatic nursing home 

residents. J Am Geriatr Soc 1996 Apr; 

44(4):420-3. Not eligible outcomes 

3299. Ouslander JG, Schapira M, Schnelle JF, et al. 

Does eradicating bacteriuria affect the severity 

of chronic urinary incontinence in nursing 

home residents? Ann Intern Med 1995 May 

15; 122(10):749-54. Not eligible exposure 

3300. Ouslander JG, Schnelle JF, Uman G, et al. 

Does oxybutynin add to the effectiveness of 

prompted voiding for urinary incontinence 

among nursing home residents? A placebocontrolled trial. J Am Geriatr Soc 1995 Jun; 

43(6):610-7. Not eligible exposure 

3301. Ouslander JG, Simmons S, Schnelle J, et al. 

Effects of prompted voiding on fecal 

continence among nursing home residents. J 

Am Geriatr Soc 1996 Apr; 44(4):424-8. Not 

eligible target population 
B-147 

3302. Ouslander JG, Zarit SH, Orr NK, et al. 

Incontinence among elderly communitydwelling dementia patients. Characteristics, 

management, and impact on caregivers. J Am 

Geriatr Soc 1990 Apr; 38(4):440-5. Not 

eligible outcomes 

3303. Owan T, Kohra T, Miyara Y, et al. Urination 

assessment after the removal of bladder 

catheter using a novel urination chart. Nurs 

Health Sci 2003 Sep; 5(3):189-97. Not eligible 

target population 

3304. Owen CM, Yell JA. Genital lichen sclerosus 

associated with incontinence. J Obstet 

Gynaecol 2002 Mar; 22(2):209-10. CaseReports 

3305. Ozel B, Ballard C. Urethral and paraurethral 

leiomyomas in the female patient. Int 

Urogynecol J Pelvic Floor Dysfunct 2006 Jan; 

17(1):93-5. Case Reports 

3306. Ozel B, Minaglia S, Hurtado E, et al. 

Treatment of voiding dysfunction after 

transobturator tape procedure. Urology 2004 

Nov; 64(5):1030. Case Reports 

3307. Ozel B, White T, Urwitz-Lane R, et al. The 

impact of pelvic organ prolapse on sexual 

function in women with urinary incontinence. 

Int Urogynecol J Pelvic Floor Dysfunct 2006 

Jan; 17(1):14-7. Not eligible outcomes 

3308. Ozkan B, Demirkesen O, Durak H, et al. 

Which factors predict upper urinary tract 

deterioration in overactive neurogenic bladder 

dysfunction? Urology 2005 Jul; 66(1):99-104. 

Case-series 

3309. Ozkan-Seyhan T, Sungur MO, Senturk E, et 

al. BIS guided sedation with propofol during 

spinal anaesthesia: influence of anaesthetic 

level on sedation requirement. Br J Anaesth 

2006 May; 96(5):645-9. Case-series 

3310. Ozturk R, Niazi S, Stessman M, et al. Longterm outcome and objective changes of 

anorectal function after biofeedback therapy 

for faecal incontinence. Aliment Pharmacol 

Ther 2004 Sep 15; 20(6):667-74. Case-series 

3311. Ozuner G, Strong SA, Fazio VW. Effect of 

rectosigmoid stump length on restorative 

proctocolectomy after subtotal colectomy. Dis 

Colon Rectum 1995 Oct; 38(10):1039-42. 

Case-series 

3312. Pagano G, Biondo G, Armaleo F, et al. 

Complex anal fistula surgery: personal 

experience. Chir Ital 2004 Jul-Aug; 56(4):523-

7. Not eligible exposure 

3313. Pagliacci MC, Franceschini M, Di Clemente 

B, et al. A multicentre follow-up of clinical 

aspects of traumatic spinal cord injury. Spinal 

Cord 2007 Jun; 45(6):404-10. Not eligible 

outcomes 

3314. Paick JS, Kim SW, Ku JH, et al. Preoperative 

maximal flow rate may be a predictive factor 

for the outcome of tension-free vaginal tape 

procedure for stress urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2004 

Nov-Dec; 15(6):413-7; discussion 7. Caseseries 

3315. Paick JS, Ku JH, Shin JW, et al. 

Complications associated with the tension-free 

vaginal tape procedure: the Korean 

experience. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 May-Jun; 16(3):215-9. Not 

eligible target population 

3316. Paick JS, Ku JH, Shin JW, et al. Significance 

of pad test loss for the evaluation of women 

with urinary incontinence. Neurourol Urodyn 

2005; 24(1):39-43. Not eligible outcomes 

3317. Paick JS, Ku JH, Shin JW, et al. Shortening of 

tension-free vaginal tape for the treatment of 

recurrent incontinence. J Urol 2004 Apr; 

171(4):1634. Case Reports 

3318. Pajoncini C, Costantini E, Guercini F, et al. 

Clinical and urodynamic features of intrinsic 

sphincter deficiency. Neurourol Urodyn 2003; 

22(4):264-8. Case-series 

3319. Pajoncini C, Costantini E, Guercini F, et al. 

Intrinsic sphincter deficiency: do the 

maximum urethral closure pressure and the 

Valsalva leak-point pressure identify different 

pathogenic mechanisms? Int Urogynecol J 

Pelvic Floor Dysfunct 2002; 13(1):30-5. Caseseries 

3320. Palleschi G, Pastore AL, Stocchi F, et al. 

Correlation between the Overactive Bladder 

questionnaire (OAB-q) and urodynamic data 

of Parkinson disease patients affected by 

neurogenic detrusor overactivity during 

antimuscarinic treatment. Clin 

Neuropharmacol 2006 Jul-Aug; 29(4):220-9. 

Not eligible outcomes 

3321. Palma L, Rizzo G, Lio R, et al. Aspecific 

inflammatory lesion (histiocytosis?) 

simulating intramedullary astrocytoma. Case 

report. J Neurosurg Sci 1999 Mar; 43(1):69-

72. Case report 

3322. Palma P, Riccetto C, Herrmann V, et al. 

Transobturator SAFYRE sling is as effective 

as the transvaginal procedure. Int Urogynecol 

J Pelvic Floor Dysfunct 2005 Nov-Dec; 

16(6):487-91. Not eligible target population 
B-148 

3323. Palma PC, Dambros M, Riccetto CZ, et al. 

The Ibero-American experience with a readjustable minimally invasive sling. BJU Int 

2005 Feb; 95(3):341-5. Not eligible target 

population 

3324. Palma PC, Dambros M, Thiel M, et al. 

Readjustable transobturator sling: a novel 

sling procedure for male urinary incontinence. 

Urol Int 2004; 73(4):354-6. Case Reports 

3325. Palma PC, Riccetto CL, Herrmann V, et al. 

Repeated lipoinjections for stress urinary 

incontinence. J Endourol 1997 Feb; 11(1):67-

70. Not eligible exposure 

3326. Palma PC, Thiel M, Riccetto CL, et al. 

Resiniferatoxin for detrusor instability 

refractory to anticholinergics. Int Braz J Urol 

2004 Jan-Feb; 30(1):53-8. Not eligible target 

population 

3327. Palmer MH. Level 1: basic assessment and 

management of urinary incontinence in 

nursing homes. Nurse Pract Forum 1994 Sep; 

5(3):152-7. No associative hypothesis tested 

3328. Palmer MH. A health-promotion perspective 

of urinary continence. Nurs Outlook 1994 JulAug; 42(4):163-9. Review 

3329. Palmer MH. Nurses' knowledge and beliefs 

about continence interventions in long-term 

care. J Adv Nurs 1995 Jun; 21(6):1065-72. 

Not eligible target population 

3330. Palmer MH, Baumgarten M, Langenberg P, et 

al. Risk factors for hospital-acquired 

incontinence in elderly female hip fracture 

patients. J Gerontol A Biol Sci Med Sci 2002 

Oct; 57(10):M672-7. Not eligible target 

population 

3331. Palmer MH, Bennett RG, Marks J, et al. 

Urinary incontinence: a program that works. J 

Long Term Care Adm 1994 Summer; 

22(2):19-25. No association hypothesis tested 

3332. Palmer MH, Fitzgerald S, Berry SJ, et al. 

Urinary incontinence in working women: an 

exploratory study. Women Health 1999; 

29(3):67-82. Not eligible level of evidence 

3333. Palmer MH, McCormick KA, Langford A, et 

al. Continence outcomes: documentation on 

medical records in the nursing home 

environment. J Nurs Care Qual 1992 Apr; 

6(3):36-43. 

3334. Palmer MH, Myers AH, Fedenko KM. 

Urinary continence changes after hip-fracture 

repair. Clin Nurs Res 1997 Feb; 6(1):8-21; 

discussion -4. Case-series 

3335. Palmer MH, Newman DK. Bladder matters: 

urinary incontinence in nursing homes. Am J 

Nurs 2004 Nov; 104(11):57-9. Comment 

3336. Palmer MH, Newman DK. Bladder control 

educational needs of older adults. J Gerontol 

Nurs 2006 Jan; 32(1):28-32. Not eligible 

outcomes 

3337. Palmieri B, Benuzzi G, Bellini N. The anal 

bag: a modern approach to fecal incontinence 

management. Ostomy Wound Manage 2005 

Dec; 51(12):44-52. Not eligible exposure 

3338. Palomba S, Russo T, Iuzzolino D, et al. 

Comparison between two laparoscopic 

retropubic urethropexy. Minerva Chir 2002 

Jun; 57(3):323-9. Not available publication 

3339. Pang D. Sacral agenesis and caudal spinal 

cord malformations. Neurosurgery 1993 May; 

32(5):755-78; discussion 78-9. Not eligible 

target population 

3340. Pang MW, Chan LW, Yip SK. One-year 

urodynamic outcome and quality of life in 

patients with concomitant tension-free vaginal 

tape during pelvic floor reconstruction surgery 

for genitourinary prolapse and urodynamic 

stress incontinence. Int Urogynecol J Pelvic 

Floor Dysfunct 2003 Oct; 14(4):256-60; 

discussion 9-60. Case-series 

3341. Pannek J. Vesicostomy in adult 

meningomyelocele patients. Reappraisal of an 

old technique. Int Urol Nephrol 1999; 

31(5):643-5. Case Reports 

3342. Pannek J, Haupt G, Sommerfeld HJ, et al. 

Urodynamic and rectomanometric findings in 

urinary incontinence. Scand J Urol Nephrol 

1996 Dec; 30(6):457-60. Not eligible 

outcomes 

3343. Pannek J, Muller M, Haupt G. An unexpected 

complicationof the remote-controlled 

intraurethral valve pump for urinary 

incontinence. Urol Int 1998; 61(4):235-6. 

Case- Reports 

3344. Pannek J, Sommerfeld HJ. Ovarian cystoid 

causing Kock pouch incontinence. Urol Int 

1998; 60(1):59-61. Case Reports 

3345. Panugthong P, Chulyamitporn T, Tanapat Y. 

Prevalence and risk factors of urinary 

incontinence in Thai menopausal women at 

Phramongkutklao Hospital. J Med Assoc Thai 

2005 Nov; 88 Suppl 3:S25-30. Not eligible 

level of evidence 

3346. Paolucci S, Antonucci G, Grasso MG, et al. 

The role of unilateral spatial neglect in 

rehabilitation of right brain-damaged ischemic 

stroke patients: a matched comparison. Arch 

Phys Med Rehabil 2001 Jun; 82(6):743-9. Not 

eligible level of evidence 
B-149 

3347. Paolucci S, Matano A, Bragoni M, et al. 

Rehabilitation of left brain-damaged ischemic 

stroke patients: the role of comprehension 

language deficits. A matched comparison. 

Cerebrovasc Dis 2005; 20(5):400-6. Not 

eligible level of evidence 

3348. Papa Petros PE. A cystocele may compensate 

for latent stress incontinence by stretching the 

vaginal hammock. Gynecol Obstet Invest 

1998; 46(3):206-9. Case-series 

3349. Papa Petros PE. Cure of urinary and fecal 

incontinence by pelvic ligament 

reconstruction suggests a connective tissue 

etiology for both. Int Urogynecol J Pelvic 

Floor Dysfunct 1999; 10(6):356-60. Caseseries 

3350. Papa Petros PE, Bush MB. A mathematical 

model for micturition gives new insights into 

pressure measurement and function. Int 

Urogynecol J Pelvic Floor Dysfunct 1998; 

9(2):103-7. Not eligible outcomes 

3351. Papa Petros PE, Ulmsten U. An analysis of 

rapid pad testing and the history for the 

diagnosis of stress incontinence. Acta Obstet 

Gynecol Scand 1992 Oct; 71(7):529-36. Caseseries 

3352. Papachrysostomou M, Pye SD, Wild SR, et al. 

Anal endosonography in asymptomatic 

subjects. Scand J Gastroenterol 1993 Jun; 

28(6):551-6. Not eligible outcomes 

3353. Papachrysostomou M, Pye SD, Wild SR, et al. 

Significance of the thickness of the anal 

sphincters with age and its relevance in faecal 

incontinence. Scand J Gastroenterol 1994 

Aug; 29(8):710-4. Not eligible outcomes 

3354. Papanicolaou S, Hunskaar S, Lose G, et al. 

Assessment of bothersomeness and impact on 

quality of life of urinary incontinence in 

women in France, Germany, Spain and the 

UK. BJU Int 2005 Oct; 96(6):831-8. Not 

eligible outcomes 

3355. Papanicolaou S, Pons ME, Hampel C, et al. 

Medical resource utilisation and cost of care 

for women seeking treatment for urinary 

incontinence in an outpatient setting. 

Examples from three countries participating in 

the PURE study. Maturitas 2005 Nov 30; 52 

Suppl 2:S35-47. Not eligible exposure 

3356. Paparella P, Ercoli A, Groutz A, et al. Clinical 

and urodynamic effects of anterior 

colporraphy and approximation of 

pubococcygeus muscles in patients with 

severe cystocele. Arch Gynecol Obstet 2005 

Mar; 271(3):195-9. Case-series 

3357. Papasakelariou C, Papasakelariou B. 

Laparoscopic bladder neck suspension. J Am 

Assoc Gynecol Laparosc 1997 Feb; 4(2):185-

9. Case-series 

3358. Paraiso MF, Walters MD, Rackley RR, et al. 

Laparoscopic and abdominal sacral 

colpopexies: a comparative cohort study. Am 

J Obstet Gynecol 2005 May; 192(5):1752-8. 

Case-series 

3359. Parazzini F, Lavezzari M, Arbitani W. 

Prevalence of overactive bladder and urinary 

incontinence. J Fam Pract 2002 Dec; 

51(12):1072-5. Not eligible level of evidence 

3360. Pardi DS, Ramnath VR, Loftus EV, Jr., et al. 

Lymphocytic colitis: clinical features, 

treatment, and outcomes. Am J Gastroenterol 

2002 Nov; 97(11):2829-33. Not eligible target 

population 

3361. Parellada CM, Miller AS, Williamson ME, et 

al. Paradoxical high anal resting pressures in 

men with idiopathic fecal seepage. Dis Colon 

Rectum 1998 May; 41(5):593-7. Case-series 

3362. Park JJ, Cintron JR, Orsay CP, et al. Repair of 

chronic anorectal fistulae using commercial 

fibrin sealant. Arch Surg 2000 Feb; 

135(2):166-9. Not eligible outcomes 

3363. Park JM, Montie JE. Mechanisms of 

incontinence and retention after orthotopic 

neobladder diversion. Urology 1998 Apr; 

51(4):601-9. Case-series 

3364. Park R, Martin S, Goldberg JD, et al. 

Anastomotic strictures following radical 

prostatectomy: insights into incidence, 

effectiveness of intervention, effect on 

continence, and factors predisposing to 

occurrence. Urology 2001 Apr; 57(4):742-6. 

Case-series 

3365. Park S, Hong B, Lee KS, et al. Risk factors of 

voiding dysfunction and patient satisfaction 

after tension-free vaginal tape procedure. J 

Korean Med Sci 2005 Dec; 20(6):1006-10. 

Case-series 

3366. Park SW, Sung DJ, Choi EJ, et al. 

Comparison of cystographic findings of 

intrinsic sphincteric deficiency with urethral 

hypermobility causing urinary incontinence. 

Urol Int 2007; 78(2):116-20. Case-series 

3367. Park T, Lee SY. A test of missing completely 

at random for longitudinal data with missing 

observations. Stat Med 1997 Aug 30; 

16(16):1859-71. No associative hypothesis 

tested 
B-150 

3368. Park T, Lee SY. Simple pattern-mixture 

models for longitudinal data with missing 

observations: analysis of urinary incontinence 

data. Stat Med 1999 Nov 15; 18(21):2933-41. 

No associative hypothesis tested 

3369. Parker SC, Spencer MP, Madoff RD, et al. 

Artificial bowel sphincter: long-term 

experience at a single institution. Dis Colon 

Rectum 2003 Jun; 46(6):722-9. Case-series 

3370. Parkhouse HF, Woodhouse CR. Long-term 

status of patients with posterior urethral 

valves. Urol Clin North Am 1990 May; 

17(2):373-8. Review 

3371. Parkkinen A, Karjalainen E, Vartiainen M, et 

al. Physiotherapy for female stress urinary 

incontinence: individual therapy at the 

outpatient clinic versus home-based pelvic 

floor training: a 5-year follow-up study. 

Neurourol Urodyn 2004; 23(7):643-8. Caseseries 

3372. Parra RO, Shaker L. Experience with a 

simplified technique for the treatment of 

female stress urinary incontinence. Br J Urol 

1990 Dec; 66(6):615-7. Case-series 

3373. Parres JA, Kropp KA. Urodynamic evaluation 

of the continence mechanism following 

urethral lengthening--reimplantation and 

enterocystoplasty. J Urol 1991 Aug; 146(2 ( Pt 

2)):535-8. Not eligible target population 

3374. Partoll LM. Efficacy of tension-free vaginal 

tape with other pelvic reconstructive surgery. 

Am J Obstet Gynecol 2002 Jun; 186(6):1292-

5; discussion 5-8. Case-series 

3375. Parys BT, Woolfenden KA, Parsons KF. 

Bladder dysfunction after simple 

hysterectomy: urodynamic and neurological 

evaluation. Eur Urol 1990; 17(2):129-33. Not 

eligible outcomes 

3376. Pasaoglu E, Tokoglu F, Boyacigil S, et al. A 

case of bladder agenesis. Australas Radiol 

1997 May; 41(2):201-3. Case Reports 

3377. Pasceri P. Utilizing a prevention and treatment 

protocol for skin breakdown secondary to 

urinary incontinence. Ostomy Wound Manage 

1991 Sep-Oct; 36:66-9. Case Reports 

3378. Patankar SK, Ferrara A, Larach SW, et al. 

Electromyographic assessment of biofeedback 

training for fecal incontinence and chronic 

constipation. Dis Colon Rectum 1997 Aug; 

40(8):907-11. Case-series 

3379. Patankar SK, Ferrara A, Levy JR, et al. 

Biofeedback in colorectal practice: a 

multicenter, statewide, three-year experience. 

Dis Colon Rectum 1997 Jul; 40(7):827-31. 

Case-series 

3380. Patel AS, O'Leary ML, Stein RJ, et al. The 

relationship between overactive bladder and 

sexual activity in women. Int Braz J Urol 2006 

Jan-Feb; 32(1):77-87. Not eligible outcomes 

3381. Patel H, Peddada AV, Zimmern PE, et al. Risk 

of incontinence with transurethral resection of 

the prostate after radiation therapy for prostate 

cancer. J Surg Oncol 1997 Feb; 64(2):127-9. 

Case- Reports 

3382. Patel MD, Coshall C, Rudd AG, et al. 

Cognitive impairment after stroke: clinical 

determinants and its associations with longterm stroke outcomes. J Am Geriatr Soc 2002 

Apr; 50(4):700-6. Not eligible exposure 

3383. Paterson J. Stigma associated with 

postprostatectomy urinary incontinence. J 

Wound Ostomy Continence Nurs 2000 May; 

27(3):168-73. Case-series 

3384. Patki P, Hamid R, Shah PJ, et al. Long-term 

efficacy of AMS 800 artificial urinary 

sphincter in male patients with urodynamic 

stress incontinence due to spinal cord lesion. 

Spinal Cord 2006 May; 44(5):297-300. Caseseries 

3385. Patki PS, Hamid R, Arumugam K, et al. 

Botulinum toxin-type A in the treatment of 

drug-resistant neurogenic detrusor overactivity 

secondary to traumatic spinal cord injury. BJU 

Int 2006 Jul; 98(1):77-82. Case-series 

3386. Patrick DL, Martin ML, Bushnell DM, et al. 

Cultural adaptation of a quality-of-life 

measure for urinary incontinence. Eur Urol 

1999 Nov; 36(5):427-35. Not eligible 

outcomes 

3387. Patry G, Bolduc S, Martineau G, et al. 

Colovaginal fistula: an unusual complication 

of the tension-free vaginal tape procedure. J 

Urol 2004 Sep; 172(3):972-3. Case Reports 

3388. Patten J. A case study in evidence-based 

wound management. Br J Nurs 2000 Jun 

suppl; 9(12):S38-40, S2, S4 passim. Case 

Reports 

3389. Paty PB, Enker WE, Cohen AM, et al. Longterm functional results of coloanal 

anastomosis for rectal cancer. Am J Surg 1994 

Jan; 167(1):90-4; discussion 4-5. Case-series 

3390. Pauliina A, Jorma P, Paula I, et al. 

Intravaginal surface EMG probe design test 

for urinary incontinence patients. Acupunct 

Electrother Res 2002; 27(1):37-44. Caseseries 
B-151 

3391. Pauwels E, De Wachter S, Wyndaele JJ. A 

normal flow pattern in women does not 

exclude voiding pathology. Int Urogynecol J 

Pelvic Floor Dysfunct 2005 Mar-Apr; 

16(2):104-8; discussion 8. Not eligible 

exposure 

3392. Peake S, Manderson L. The constraints of a 

normal life: the management of urinary 

incontinence by middle aged women. Women 

Health 2003; 37(3):37-51. Not eligible 

outcomes 

3393. Pearl RK, Prasad ML, Nelson RL, et al. 

Bilateral gluteus maximus transposition for 

anal incontinence. Dis Colon Rectum 1991 

Jun; 34(6):478-81. Case-reports 

3394. Pearman JW, Bailey M, Riley LP. Bladder 

instillations of trisdine compared with catheter 

introducer for reduction of bacteriuria during 

intermittent catheterisation of patients with 

acute spinal cord trauma. Br J Urol 1991 May; 

67(5):483-90. Not eligible outcomes 

3395. Pearson BD. Liquidate a myth: reducing liquid 

intake is not advisable for elderly with urine 

control problems. Urol Nurs 1993 Sep; 

13(3):86-7. Comment 

3396. Pearson BD, Larson J. Improving elders' 

continence state. Clin Nurs Res 1992 Nov; 

1(4):430-9. Case-series 

3397. Peeker R, Damber JE, Hjalmas K, et al. The 

urological fate of young adults with 

myelomeningocele: a three decade follow-up 

study. Eur Urol 1997; 32(2):213-7. Caseseries 

3398. Peet SM, Castleden CM, McGrother CW, et 

al. The management of urinary incontinence in 

residential and nursing homes for older 

people. Age Ageing 1996 Mar; 25(2):139-43. 

Not eligible exposure 

3399. Peeters ST, Hoogeman MS, Heemsbergen 

WD, et al. Rectal bleeding, fecal incontinence, 

and high stool frequency after conformal 

radiotherapy for prostate cancer: normal tissue 

complication probability modeling. Int J 

Radiat Oncol Biol Phys 2006 Sep 1; 66(1):11-

9. Secondary data analysis 

3400. Peguero E, Abou-Khalil B, Fakhoury T, et al. 

Self-injury and incontinence in psychogenic 

seizures. Epilepsia 1995 Jun; 36(6):586-91. 

Not eligible target population 

3401. Pelissier EP, Blum D, Bachour A, et al. 

Functional results of coloanal anastomosis 

with reservoir. Dis Colon Rectum 1992 Sep; 

35(9):843-6. Case-series 

3402. Pelliccioni G, Scarpino O, Piloni V. Motor 

evoked potentials recorded from external anal 

sphincter by cortical and lumbo-sacral 

magnetic stimulation: normative data. J 

Neurol Sci 1997 Jul; 149(1):69-72. Caseseries 

3403. Pelosi MA, 3rd, Pelosi MA. Transvaginal 

needle suspension with LeFort colpocleisis for 

stress incontinence and advanced uterovaginal 

prolapse in a high-risk patient. J Am Assoc 

Gynecol Laparosc 1998 May; 5(2):207-11. 

Case report 

3404. Pelosi MA, 3rd, Pelosi MA. Pubic bone 

suburethral stabilization sling: laparoscopic 

assessment of a transvaginal operation for the 

treatment of stress urinary incontinence. J 

Laparoendosc Adv Surg Tech A 1999 Feb; 

9(1):45-50. Case-series 

3405. Pelsang RE, Rao SS, Welcher K. FECOM: a 

new artificial stool for evaluating defecation. 

Am J Gastroenterol 1999 Jan; 94(1):183-6. 

Not eligible exposure 

3406. Pelzer AE, Akkad T, Schwentner C, et al. 

Treatment of adult female epispadias without 

exstrophy in the presence of rhabdosphincter 

function. Int J Urol 2006 Mar; 13(3):321-2. 

Not eligible exposure 

3407. Pemberton P, Brooks A, Eriksen CM, et al. A 

comparative study of two types of urinary 

sheath. Nurs Times 2006 Feb 14-20; 

102(7):36-41. Not eligible outcomes 

3408. Pena A, Grasshoff S, Levitt M. Reoperations 

in anorectal malformations. J Pediatr Surg 

2007 Feb; 42(2):318-25. Not eligible target 

population 

3409. Penna C, Daude F, Parc R, et al. Previous 

subtotal colectomy with ileostomy and 

sigmoidostomy improves the morbidity and 

early functional results after ileal pouch-anal 

anastomosis in ulcerative colitis. Dis Colon 

Rectum 1993 Apr; 36(4):343-8. Not eligible 

target population 

3410. Penninckx F. Belgian experience with 

dynamic graciloplasty for faecal incontinence. 

Br J Surg 2004 Jul; 91(7):872-8. Case-series 

3411. Penninckx F, Lestar B, Kerremans R. 

Manometric evaluation of incontinent patients. 

Acta Gastroenterol Belg 1995 Jan-Feb; 

58(1):51-9. Not eligible outcomes 

3412. Pereira CE, Lynch JC. Spinal epidural 

abscess: an analysis of 24 cases. Surg Neurol 

2005; 63 Suppl 1:S26-9. Case-series 
B-152 

3413. Perez F, Arroyo A, Serrano P, et al. 

Fistulotomy with primary sphincter 

reconstruction in the management of complex 

fistula-in-ano: prospective study of clinical 

and manometric results. J Am Coll Surg 2005 

Jun; 200(6):897-903. Case-series 

3414. Perez LM, Webster GD. Successful outcome 

of artificial urinary sphincters in men with 

post-prostatectomy urinary incontinence 

despite adverse implantation features. J Urol 

1992 Oct; 148(4):1166-70. Case-series 

3415. Perez M, Lemelle JL, Barthelme H, et al. 

Bowel management with antegrade colonic 

enema using a Malone or a Monti conduit--

clinical results. Eur J Pediatr Surg 2001 Oct; 

11(5):315-8. Not eligible target population 

3416. Perez MA, Meyerowitz BE, Lieskovsky G, et 

al. Quality of life and sexuality following 

radical prostatectomy in patients with prostate 

cancer who use or do not use erectile aids. 

Urology 1997 Nov; 50(5):740-6. Case-series 

3417. Perez N, Garcier JM, Pin-Leveugle J, et al. 

Dynamic magnetic resonance imaging of the 

female pelvis: radio-anatomy and pathologic 

applications. Preliminary results. Surg Radiol 

Anat 1999; 21(2):133-8. Not eligible outcomes 

3418. Perfetto EM, Subedi P, Jumadilova Z. 

Treatment of overactive bladder: a model 

comparing extended-release formulations of 

tolterodine and oxybutynin. Am J Manag Care 

2005 Jul; 11(4 Suppl):S150-7. Not eligible 

outcomes 

3419. Perk H, Oral B, Yesildag A, et al. Magnetic 

resonance imaging for stress incontinence: 

evaluation of patients before and after surgical 

correction. Eur J Radiol 2002 Oct; 44(1):44-7. 

Case-series 

3420. Perlmutter AD, Weinstein MD, Reitelman C. 

Vesical neck reconstruction in patients with 

epispadias-exstrophy complex. J Urol 1991 

Aug; 146(2 ( Pt 2)):613-5. Not eligible target 

population 

3421. Perneger TV, Gaspoz JM, Rae AC, et al. 

Contribution of individual items to the 

performance of the Norton pressure ulcer 

prediction scale. J Am Geriatr Soc 1998 Oct; 

46(10):1282-6. Not eligible target population 

3422. Perrotte P, Litwin MS, McGuire EJ, et al. 

Quality of life after salvage cryotherapy: the 

impact of treatment parameters. J Urol 1999 

Aug; 162(2):398-402. Not eligible level of 

evidence 

3423. Perrouin-Verbe B, Labat JJ, Richard I, et al. 

Clean intermittent catheterisation from the 

acute period in spinal cord injury patients. 

Long term evaluation of urethral and genital 

tolerance. Paraplegia 1995 Nov; 33(11):619-

24. Case-series 

3424. Perry RE, Blatchford GJ, Christensen MA, et 

al. Manometric diagnosis of anal sphincter 

injuries. Am J Surg 1990 Jan; 159(1):112-6; 

discussion 6-7. Question 4 

3425. Persson G, Barlow L, Karlsson A, et al. 

Chapter 3. Major health problems. Health in 

Sweden: The National Public Health Report 

2001. Scand J Public Health Suppl 2001; 

58:37-102. Secondary data presentation 

3426. Persson J, Bossmar T, Wolner-Hanssen P. 

Laparoscopic colposuspension: a short term 

urodynamic follow-up and a three-year 

questionnaire-study. Acta Obstet Gynecol 

Scand 2000 May; 79(5):414-20. Case-series 

3427. Pescatori M, Anastasio G, Bottini C, et al. 

New grading and scoring for anal 

incontinence. Evaluation of 335 patients. Dis 

Colon Rectum 1992 May; 35(5):482-7. Not 

eligible target population 

3428. Pescatori M, Ayabaca S, Caputo D. Can anal 

manometry predict anal incontinence after 

fistulectomy in males? Colorectal Dis 2004 

Mar; 6(2):97-102. Case-series 

3429. Pescatori M, Brusciano L, Binda GA, et al. A 

novel approach for perirectal tumours: the 

perianal intersphincteric excision. Int J 

Colorectal Dis 2005 Jan; 20(1):72-5. Case 

Reports 

3430. Pescatori M, Interisano A, Stolfi VM, et al. 

Delorme's operation and sphincteroplasty for 

rectal prolapse and fecal incontinence. Int J 

Colorectal Dis 1998; 13(5-6):223-7. Caseseries 

3431. Pescatori M, Pavesio R, Anastasio G, et al. 

Transanal electrostimulation for fecal 

incontinence: clinical, psychologic, and 

manometric prospective study. Dis Colon 

Rectum 1991 Jul; 34(7):540-5. Case-series 

3432. Peschers UM, DeLancey JO, Schaer GN, et al. 

Exoanal ultrasound of the anal sphincter: 

normal anatomy and sphincter defects. Br J 

Obstet Gynaecol 1997 Sep; 104(9):999-1003. 

Not eligible outcomes 

3433. Peschers UM, Fanger G, Schaer GN, et al. 

Bladder neck mobility in continent nulliparous 

women. Bjog 2001 Mar; 108(3):320-4. Not 

eligible exposure 
B-153 

3434. Peschers UM, Jundt K, Dimpfl T. Differences 

between cough and Valsalva leak-point 

pressure in stress incontinent women. 

Neurourol Urodyn 2000; 19(6):677-81. Caseseries 

3435. Peters S. Treating fecal incontinence. 

Restoring self-esteem in your elderly patients. 

Adv Nurse Pract 1998 Apr; 6(4):63-6. Case 

report 

3436. Peters WA, 3rd, Christenson ML. Fixation of 

the vaginal apex to the coccygeus fascia 

during repair of vaginal vault eversion with 

enterocele. Am J Obstet Gynecol 1995 Jun; 

172(6):1894-900; discussion 900-2. Caseseries 

3437. Peterson MD, Matlaga BR, Kim SC, et al. 

Holmium laser enucleation of the prostate for 

men with urinary retention. J Urol 2005 Sep; 

174(3):998-1001; discussion Case Series 

3438. Petrelli NJ, Nagel S, Rodriguez-Bigas M, et 

al. Morbidity and mortality following 

abdominoperineal resection for rectal 

adenocarcinoma. Am Surg 1993 Jul; 

59(7):400-4. Case-series 

3439. Petros JA, Catalona WJ. Antegrade approach 

to radical retropubic prostatectomy in patients 

with difficult apical dissection. J Urol 1991 

May; 145(5):994-7. Case-series 

3440. Petros P. Changes in bladder neck geometry 

and closure pressure after midurethral 

anchoring suggest a musculoelastic 

mechanism activates closure. Neurourol 

Urodyn 2003; 22(3):191-7. Not eligible 

outcomes 

3441. Petros P, Anderson J. Role of internal anal 

sphincter damage in the causation of 

idiopathic faecal incontinence: a prospective 

study. Aust N Z J Obstet Gynaecol 2005 Feb; 

45(1):77-8. Case-series 

3442. Petros PE. The pubourethral ligaments--an 

anatomical and histological study in the live 

patient. Int Urogynecol J Pelvic Floor 

Dysfunct 1998; 9(3):154-7. Case-series 

3443. Petros PE. Symptoms of defective emptying 

and raised residual urine may arise from 

ligamentous laxity in the posterior vaginal 

fornix. Gynecol Obstet Invest 1998; 

45(2):105-8. Not eligible outcomes 

3444. Petros PE, Richardson PA. Midurethral Tissue 

Fixation System sling -- a 'micromethod' for 

cure of stress incontinence -- preliminary 

report. Aust N Z J Obstet Gynaecol 2005 Oct; 

45(5):372-5. Case-series 

3445. Petros PE, Ulmsten U. Tests for 'detrusor 

instability' in women. These mainly measure 

the urethral resistance created by pelvic floor 

contraction acting against a premature 

activation of the micturition reflex. Acta 

Obstet Gynecol Scand 1993 Nov; 72(8):661-7. 

Not eligible outcomes 

3446. Petros PE, Ulmsten U. Natural volume 

handwashing urethrocystometry: a 

physiological technique for the objective 

diagnosis of the unstable detrusor. Gynecol 

Obstet Invest 1993; 36(1):42-6. Not eligible 

outcomes 

3447. Petros PE, Ulmsten U. Urethral pressure 

increase on effort originates from within the 

urethra, and continence from musculovaginal 

closure. Neurourol Urodyn 1995; 14(4):337-

46; discussion 46-50. Case-series 

3448. Petros PE, Ulmsten UI. Non stress non urge 

female urinary incontinence--diagnosis and 

cure: a preliminary report. Acta Obstet 

Gynecol Scand Suppl 1990; 153:69-70. Caseseries 

3449. Petros PE, Ulmsten UI. The tuck procedure: a 

simplified vaginal repair for treatment of 

female urinary incontinence. Acta Obstet 

Gynecol Scand Suppl 1990; 153:41-2. Caseseries 

3450. Petros PE, Ulmsten UI. Cough transmission 

ratio: an indicator of suburethral vaginal wall 

tension rather than urethral closure? Acta 

Obstet Gynecol Scand Suppl 1990; 153:37-9. 

Not eligible exposure 

3451. Petros PE, Ulmsten UI. Pregnancy effects on 

the intravaginal sling operation. Acta Obstet 

Gynecol Scand Suppl 1990; 153:77-8. Casereports 

3452. Petros PP. The intravaginal slingplasty 

operation, a minimally invasive technique for 

cure of urinary incontinence in the female. 

Aust N Z J Obstet Gynaecol 1996 Nov; 

36(4):453-61. Case-series 

3453. Petros PP, Skilling PM. Pelvic floor 

rehabilitation in the female according to the 

integral theory of female urinary incontinence. 

First report. Eur J Obstet Gynecol Reprod Biol 

2001 Feb; 94(2):264-9. Case-series 

3454. Petrou SP. Does Valsalva leak point pressure 

predict outcome after the distal urethral 

polypropylene sling? Role of urodynamics in 

the sling era. Int Braz J Urol 2004 Jul-Aug; 

30(4):355-6. Comment 
B-154 

3455. Petrou SP, Broderick GA. Valsalva leak-point 

pressure changes after successful and failed 

suburethral sling. Int Urogynecol J Pelvic 

Floor Dysfunct 2002; 13(5):299-302. Caseseries 

3456. Petrou SP, Brown JA, Blaivas JG. 

Suprameatal transvaginal urethrolysis. J Urol 

1999 Apr; 161(4):1268-71. Case-series 

3457. Petrou SP, Frank I. Complications and initial 

continence rates after a repeat pubovaginal 

sling procedure for recurrent stress urinary 

incontinence. J Urol 2001 Jun; 165(6 Pt 

1):1979-81. Case-series 

3458. Petrou SP, Kollmorgen TA. Valsalva leak 

point pressure and bladder volume. Neurourol 

Urodyn 1998; 17(1):3-7. Case-series 

3459. Petrou SP, Young PR. Rate of recurrent stress 

urinary incontinence after retropubic 

urethrolysis. J Urol 2002 Feb; 167(2 Pt 

1):613-5. Case-series 

3460. Petrovich Z, Lieskovsky G, Langholz B, et al. 

Radical prostatectomy and postoperative 

irradiation in patients with pathological stage 

C (T3) carcinoma of the prostate. Int J Radiat 

Oncol Biol Phys 1998 Jan 1; 40(1):139-47. 

Case series 

3461. Petry H, Berry DL, Spichiger E, et al. 

Responses and experiences after radical 

prostatectomy: perceptions of married couples 

in Switzerland. Int J Nurs Stud 2004 Jul; 

41(5):507-13. Not eligible outcomes 

3462. Pettersen R, Dahl T, Wyller TB. Prediction of 

long-term functional outcome after stroke 

rehabilitation. Clin Rehabil 2002 Mar; 

16(2):149-59. Not eligible outcomes 

3463. Pettersen R, Wyller TB. Prognostic 

significance of micturition disturbances after 

acute stroke. J Am Geriatr Soc 2006 Dec; 

54(12):1878-84. Not eligible level of evidence 

3464. Peyrat L, Boutin JM, Bruyere F, et al. 

Intestinal perforation as a complication of 

tension-free vaginal tape procedure for urinary 

incontinence. Eur Urol 2001 May; 39(5):603-

5. Case Reports 

3465. Peyromaure M, Dayma T, Zerbib M. 

Development of a bladder stone following a 

tension-free vaginal tape intervention. J Urol 

2004 Jan; 171(1):337. Case Reports 

3466. Pezim ME. Successful treatment of horseshoe 

fistula requires deroofing of deep postanal 

space. Am J Surg 1994 May; 167(5):513-5. 

Case-series 

3467. Pfeifer J. Quality of life after sphincteroplasty. 

Acta Chir Iugosl 2004; 51(2):73-5. Caseseries 

3468. Pfeifer J, Salanga VD, Agachan F, et al. 

Variation in pudendal nerve terminal motor 

latency according to disease. Dis Colon 

Rectum 1997 Jan; 40(1):79-83. Not eligible 

outcomes 

3469. Pfenninger JL, Zainea GG. Common anorectal 

conditions: Part I. Symptoms and complaints. 

Am Fam Physician 2001 Jun 15; 63(12):2391-

8. Not eligible exposure 

3470. Pfister C, Cappele O, Dunet F, et al. 

Assessment of the intrinsic urethral sphincter 

component function in postprostatectomy 

urinary incontinence. Neurourol Urodyn 2002; 

21(3):194-7. Case-series 

3471. Pfister SM. Bladder diaries and voiding 

patterns in older adults. J Gerontol Nurs 1999 

Mar; 25(3):36-41. Not eligible outcomes 

3472. Pfister SM, Dougherty MC. Behavioral 

management for bladder control: response in 

selected rural residential care homes. J 

Community Health Nurs 1994; 11(3):155-64. 

No associative hypothesis tested 

3473. Pfisterer MH, Griffiths DJ, Schaefer W, et al. 

The effect of age on lower urinary tract 

function: a study in women. J Am Geriatr Soc 

2006 Mar; 54(3):405-12. Not eligible 

outcomes 

3474. Pfrommer W, Holschneider AM, Loffler N, et 

al. A new polyurethane anal plug in the 

treatment of incontinence after anal atresia 

repair. Eur J Pediatr Surg 2000 Jun; 

10(3):186-90. Not eligible target population 

3475. Phelan MW, Franks M, Somogyi GT, et al. 

Botulinum toxin urethral sphincter injection to 

restore bladder emptying in men and women 

with voiding dysfunction. J Urol 2001 Apr; 

165(4):1107-10. Case-series 

3476. Phelps JY, Lin L, Liu CY. Laparoscopic 

suburethral sling procedure. J Am Assoc 

Gynecol Laparosc 2003 Nov; 10(4):496-500. 

Case-series 

3477. Philip J, Willmott S, Irwin P. Interstitial 

cystitis versus detrusor overactivity: a 

comparative, randomized, controlled study of 

cystometry using saline and 0.3 M potassium 

chloride. J Urol 2006 Feb; 175(2):566-70; 

discussion 70-1. Not eligible exposure 

3478. Philippe HJ, Perdu M, Dompeyre P, et al. 

Transvaginal colpo-urethropexy with fibrin 

sealant: 4 years-follow up in 23 cases. Eur J 

Obstet Gynecol Reprod Biol 1996 Dec 27; 

70(2):157-8. Case Reports 
B-155 

3479. Phillips C, Hacking N, Monga A. Superselective angiographic embolisation of a 

branch of the anterior pudendal artery for the 

treatment of intractable post-operative 

bleeding. Int Urogynecol J Pelvic Floor 

Dysfunct 2006 May; 17(3):299-301. CaseReports 

3480. Phillips CD, Morris JN, Hawes C, et al. 

Association of the Resident Assessment 

Instrument (RAI) with changes in function, 

cognition, and psychosocial status. J Am 

Geriatr Soc 1997 Aug; 45(8):986-93. Not 

eligible outcomes 

3481. Phillips SF. The diverse spectrum of irritable 

bowel syndrome. Hosp Pract (Off Ed) 1995 

Feb 15; 30(2):69-74, 7; discussion 8. CaseReports 

3482. Phillips TH, Ritchey ML, Dunn CD, et al. 

Complications of the Heitz-Boyer urinary 

diversion: case report of late development of 

malignancy. J Urol 1991 Jul; 146(1):159-61. 

Case Reports 

3483. Philp J, Cottenden A, Ledger D. Continence. 

The reuser's guide. Nurs Times 1992 Oct 28-

Nov 3; 88(44):66-72. Not eligible target 

population 

3484. Piccini C, Bracco L, Falcini M, et al. Natural 

history of Alzheimer's disease: prognostic 

value of plateaux. J Neurol Sci 1995 Aug; 

131(2):177-82. Not eligible level of evidence 

3485. Pieper B, Cleland V. An external urinecollection device for women: a clinical trial. J 

ET Nurs 1993 Mar-Apr; 20(2):51-5. Not 

eligible outcomes 

3486. Pikarsky AJ, Belin B, Efron J, et al. 

Complications following formalin installation 

in the treatment of radiation induced proctitis. 

Int J Colorectal Dis 2000 Apr; 15(2):96-9. 

Case-series 

3487. Pike JG, Berardinucci G, Hamburger B, et al. 

The surgical management of urinary 

incontinence in myelodysplastic children. J 

Pediatr Surg 1991 Apr; 26(4):466-70; 

discussion 70-1. Not eligible target population 

3488. Piloni V, Fioravanti P, Spazzafumo L, et al. 

Measurement of the anorectal angle by 

defecography for the diagnosis of fecal 

incontinence. Int J Colorectal Dis 1999 Apr; 

14(2):131-5. Not eligible outcomes 

3489. Pils K, Neumann F, Meisner W, et al. 

Predictors of falls in elderly people during 

rehabilitation after hip fracture--who is at risk 

of a second one? Z Gerontol Geriatr 2003 Feb; 

36(1):16-22. Not eligible level of evidence 

3490. Pinedo G, Vaizey CJ, Nicholls RJ, et al. 

Results of repeat anal sphincter repair. Br J 

Surg 1999 Jan; 86(1):66-9. Case-series 

3491. Pinho M, Ortiz J, Oya M, et al. Total pelvic 

floor repair for the treatment of neuropathic 

fecal incontinence. Am J Surg 1992 Mar; 

163(3):340-3. Case-series 

3492. Pinho M, Yoshioka K, Keighley MR. Are 

pelvic floor movements abnormal in 

disordered defecation? Dis Colon Rectum 

1991 Dec; 34(12):1117-9. Not eligible 

outcomes 

3493. Pinna Pintor M, Zara GP, Falletto E, et al. 

Pudendal neuropathy in diabetic patients with 

faecal incontinence. Int J Colorectal Dis 1994 

May; 9(2):105-9. Not eligible outcomes 

3494. Pinta T, Kylanpaa ML, Luukkonen P, et al. 

Anal incontinence: diagnosis by endoanal US 

or endovaginal MRI. Eur Radiol 2004 Aug; 

14(8):1472-7. Case-series 

3495. Pinta T, Kylanpaa-Back ML, Salmi T, et al. 

Delayed sphincter repair for obstetric ruptures: 

analysis of failure. Colorectal Dis 2003 Jan; 

5(1):73-8. Case-series 

3496. Pinta TM, Kylanpaa ML, Teramo KA, et al. 

Sphincter rupture and anal incontinence after 

first vaginal delivery. Acta Obstet Gynecol 

Scand 2004 Oct; 83(10):917-22. Case-series 

3497. Pisarska M, Sajdak S. Lower urinary tract 

function after postoperative radiotherapy in 

the treatment of cervical cancer. Eur J 

Gynaecol Oncol 2003; 24(6):490-4. Caseseries 

3498. Pit MJ. Rare complications of tension-free 

vaginal tape procedure: late intraurethral 

displacement and early misplacement of tape. 

J Urol 2002 Feb; 167(2 Pt 1):647. Case 

Reports 

3499. Pit MJ, De Ruiter MC, Lycklama ANAA, et 

al. Anatomy of the arcus tendineus fasciae 

pelvis in females. Clin Anat 2003 Mar; 

16(2):131-7. Not eligible target population 

3500. Pittman JS, Benson JT, Sumners JE. 

Physiologic evaluation of the anorectum. A 

new ultrasound technique. Dis Colon Rectum 

1990 Jun; 33(6):476-8. Not eligible outcomes 

3501. Pla-Marti V, Moro-Valdezate D, AlosCompany R, et al. The effect of surgery on 

quality of life in patients with faecal 

incontinence of obstetric origin. Colorectal 

Dis 2007 Jan; 9(1):90-5. Case-series 

3502. Plancke HR, Delaere KP, Pons C. Indiana 

pouch in female patients with spinal cord 

injury. Spinal Cord 1999 Mar; 37(3):208-10. 

Case-series 
B-156 

3503. Planells Roig M, Sanahuja Santafe A, Garcia 

Miranda de Larra JL, et al. Prospective 

analysis of marlex mesh repair for 

symptomatic rectocele with obstructive 

defecation. Rev Esp Enferm Dig 2002 Feb; 

94(2):67-77. Case-series 

3504. Poca MA, Sahuquillo J, Busto M, et al. 

Agreement between CSF flow dynamics in 

MRI and ICP monitoring in the diagnosis of 

normal pressure hydrocephalus. Sensitivity 

and specificity of CSF dynamics to predict 

outcome. Acta Neurochir Suppl 2002; 81:7-

10. Not eligible exposure 

3505. Podnar S, Mrkaic M, Vodusek DB. 

Standardization of anal sphincter 

electromyography: quantification of 

continuous activity during relaxation. 

Neurourol Urodyn 2002; 21(6):540-5. Not 

eligible outcomes 

3506. Podnar S, Trsinar B, Vodusek DB. Bladder 

dysfunction in patients with cauda equina 

lesions. Neurourol Urodyn 2006; 25(1):23-31. 

Not eligible exposure 

3507. Poen AC, de Brauw M, Felt-Bersma RJ, et al. 

Laparoscopic rectopexy for complete rectal 

prolapse. Clinical outcome and anorectal 

function tests. Surg Endosc 1996 Sep; 

10(9):904-8. Case-series 

3508. Poen AC, Felt-Bersma RJ, Cuesta MA, et al. 

Vaginal endosonography of the anal sphincter 

complex is important in the assessment of 

faecal incontinence and perianal sepsis. Br J 

Surg 1998 Mar; 85(3):359-63. Not eligible 

outcomes 

3509. Poen AC, Felt-Bersma RJ, Dekker GA, et al. 

Third degree obstetric perineal tears: risk 

factors and the preventive role of mediolateral 

episiotomy. Br J Obstet Gynaecol 1997 May; 

104(5):563-6. Not eligible outcomes 

3510. Pohjasvaara T, Erkinjuntti T, Ylikoski R, et al. 

Clinical determinants of poststroke dementia. 

Stroke 1998 Jan; 29(1):75-81. Not eligible 

outcomes 

3511. Pohl HG, Bauer SB, Borer JG, et al. The 

outcome of voiding dysfunction managed with 

clean intermittent catheterization in 

neurologically and anatomically normal 

children. BJU Int 2002 Jun; 89(9):923-7. Not 

eligible target population 

3512. Polimeni G, Salvo F, Cutroneo P, et al. 

Venlafaxine-induced urinary incontinence 

resolved after switching to sertraline. Clin 

Neuropharmacol 2005 Sep-Oct; 28(5):247-8. 

Case- Reports 

3513. Pollack J, Holm T, Cedermark B, et al. Longterm effect of preoperative radiation therapy 

on anorectal function. Dis Colon Rectum 2006 

Mar; 49(3):345-52. Not eligible level of 

evidence 

3514. Pollack J, Nordenstam J, Brismar S, et al. 

Anal incontinence after vaginal delivery: a 

five-year prospective cohort study. Obstet 

Gynecol 2004 Dec; 104(6):1397-402. Not 

eligible level of evidence 

3515. Pollak JT, Jenkins P, Kopka SL, et al. Effect 

of genital prolapse on assessment of bladder 

neck mobility by the Q-tip test. Obstet 

Gynecol 2003 Apr; 101(4):662-5. Case-series 

3516. Polt CA. Taking the pressure off for women 

with stress incontinence. Nursing 2006 Feb; 

36(2):49-51. Case Reports 

3517. Pomfret I. Continence. Comprehensive care to 

order. Nurs Times 1996 Apr 10-16; 92(15):62-

4. Comment 

3518. Pontes JE, Montie J, Klein E, et al. Salvage 

surgery for radiation failure in prostate cancer. 

Cancer 1993 Feb 1; 71(3 Suppl):976-80. 

Case-series 

3519. Ponticelli A, Iacobelli BD, Silveri M, et al. 

Colorectal dysfunction and faecal 

incontinence in children with spina bifida. Br 

J Urol 1998 May; 81 Suppl 3:117-9. Not 

eligible target population 

3520. Pool-Goudzwaard AL, Slieker ten Hove MC, 

Vierhout ME, et al. Relations between 

pregnancy-related low back pain, pelvic floor 

activity and pelvic floor dysfunction. Int 

Urogynecol J Pelvic Floor Dysfunct 2005 

Nov-Dec; 16(6):468-74. Not eligible target 

population 

3521. Poore RE, McCullough DL, Jarow JP. 

Puboprostatic ligament sparing improves 

urinary continence after radical retropubic 

prostatectomy. Urology 1998 Jan; 51(1):67-

72. Case-series 

3522. Popat R, Apostolidis A, Kalsi V, et al. A 

comparison between the response of patients 

with idiopathic detrusor overactivity and 

neurogenic detrusor overactivity to the first 

intradetrusor injection of botulinum-A toxin. J 

Urol 2005 Sep; 174(3):984-9. Case-series 

3523. Poppen B, Svenberg T, Bark T, et al. 

Colectomy-proctomucosectomy with S-pouch: 

operative procedures, complications, and 

functional outcome in 69 consecutive patients. 

Dis Colon Rectum 1992 Jan; 35(1):40-7. 

Case-series 
B-157 

3524. Porru D, Tinelli C, Gerardini M, et al. 

Evaluation of urinary and general symptoms 

and correlation with other clinical parameters 

in interstitial cystitis patients. Neurourol 

Urodyn 2005; 24(1):69-73. Not eligible level 

of evidence 

3525. Porru D, Usai E. Orthotopic ileal bladder 

substitute after radical cystectomy: 

urodynamic features. Neurourol Urodyn 1994; 

13(3):255-60. Case-series 

3526. Porru D, Usai E. Standard and extramural 

ambulatory urodynamic investigation for the 

diagnosis of detrusor instability-correlated 

incontinence and micturition disorders. 

Neurourol Urodyn 1994; 13(3):237-42. Caseseries 

3527. Portier G, Bonhomme N, Platonoff I, et al. 

Use of Malone antegrade continence enema in 

patients with perineal colostomy after rectal 

resection. Dis Colon Rectum 2005 Mar; 

48(3):499-503. Not eligible target population 

3528. Portier G, Iovino F, Lazorthes F. Surgery for 

rectal prolapse: Orr-Loygue ventral rectopexy 

with limited dissection prevents postoperativeinduced constipation without increasing 

recurrence. Dis Colon Rectum 2006 Aug; 

49(8):1136-40. Case-series 

3529. Portier G, Platonoff I, Lazorthes F. Long-term 

functional results after straight or colonic Jpouch coloanal anastomosis. Recent Results 

Cancer Res 2005; 165:191-5. Case-series 

3530. Poryazov K. The therapeutic effect of 

treatment of urinary stress incontinence with 

estriol. Folia Med (Plovdiv) 1990; 32(4):16-9. 

Case-series 

3531. Potosky AL, Davis WW, Hoffman RM, et al. 

Five-year outcomes after prostatectomy or 

radiotherapy for prostate cancer: the prostate 

cancer outcomes study. J Natl Cancer Inst 

2004 Sep 15; 96(18):1358-67. Not eligible 

level of evidence 

3532. Potosky AL, Legler J, Albertsen PC, et al. 

Health outcomes after prostatectomy or 

radiotherapy for prostate cancer: results from 

the Prostate Cancer Outcomes Study. J Natl 

Cancer Inst 2000 Oct 4; 92(19):1582-92. Not 

eligible level of evidence 

3533. Potter J. Bowel care in older people. Clin Med 

2003 Jan-Feb; 3(1):48-51. Comment 

3534. Potter J, Peel P, Mian S, et al. National audit 

of continence care for older people: 

management of faecal incontinence. Age 

Ageing 2007 May; 36(3):268-73. Not eligible 

outcomes 

3535. Powel LL. Commentary on Abstracts from the 

literature. Continence. Patient-reported 

symptoms after primary therapy for early 

prostate cancer: results of a prospective cohort 

study original article by Talcott JA, Rieker P, 

Clark JA, Propert KJ, Weeks JC, Beard CJ et 

al appears in J CLINICAL ONCOL 

1998;16:275-283. Journal of WOCN 2000 

Jan; 27(1):14A-5A. Comment 

3536. Powel LL, Clark JA. The value of the 

marginalia as an adjunct to structured 

questionnaires: experiences of men after 

prostate cancer surgery. Qual Life Res 2005 

Apr; 14(3):827-35. Case-series 

3537. Prasher VP, Filer A. Behavioural disturbance 

in people with Down's syndrome and 

dementia. J Intellect Disabil Res 1995 Oct; 39 

( Pt 5):432-6. Not eligible exposure 

3538. Pregazzi R, Sartore A, Bortoli P, et al. 

Immediate postpartum perineal examination 

as a predictor of puerperal pelvic floor 

dysfunction. Obstet Gynecol 2002 Apr; 

99(4):581-4. Not eligible level of evidence 

3539. Pregazzi R, Sartore A, Bortoli P, et al. 

Perineal ultrasound evaluation of urethral 

angle and bladder neck mobility in women 

with stress urinary incontinence. Bjog 2002 

Jul; 109(7):821-7. Not eligible outcomes 

3540. Preik M, Albrecht D, O'Connell M, et al. 

Effect of controlled-release delivery on the 

pharmacokinetics of oxybutynin at different 

dosages: severity-dependent treatment of the 

overactive bladder. BJU Int 2004 Oct; 

94(6):821-7. Not eligible exposure 

3541. Preisser JS, Qaqish BF. Robust regression for 

clustered data with application to binary 

responses. Biometrics 1999 Jun; 55(2):574-9. 

Not eligible exposure 

3542. Presti JC, Jr., Schmidt RA, Narayan PA, et al. 

Pathophysiology of urinary incontinence after 

radical prostatectomy. J Urol 1990 May; 

143(5):975-8. Case-series 

3543. Prestwood KM, Besdine RW. Geriatric 

medicine. Jama 1992 Jul 15; 268(3):360-2. 

Review 

3544. Prete F, Prete FP, De Luca R, et al. 

Restorative proctectomy with colon pouchanal anastomosis by laparoscopic transanal 

pull-through: an available option for low 

rectal cancer? Surg Endosc 2007 Jan; 

21(1):91-6. Case-series 

3545. Pretlove S, Thompson PJ, Toozs-Hobson PM, 

et al. The first 18 months of a new perineal 

trauma clinic. J Obstet Gynaecol 2004 Jun; 

24(4):399-402. Case Reports 
B-158 

3546. Price N, Jackson SR. Clinical audit of the use 

of tension-free vaginal tape as a surgical 

treatment for urinary stress incontinence, set 

against NICE guidelines. J Obstet Gynaecol 

2004 Aug; 24(5):534-8. Case-series 

3547. Pricolo VE. Ileal pouch-anal anastomosis: the 

"ideal" operation for ulcerative colitis and 

adenomatous polyposis coli? R I Med 1994 

Nov; 77(11):382-4. Comment 

3548. Pricolo VE, Potenti FM, Luks FI. Selective 

preservation of the anal transition zone in 

ileoanal pouch procedures. Dis Colon Rectum 

1996 Aug; 39(8):871-7. Case-series 

3549. Primus G. One year follow-up on the SPARC 

sling system for the treatment of female 

urodynamic stress incontinence. Int J Urol 

2006 Nov; 13(11):1410-4. Case-series 

3550. Primus G, Kramer G. Maximal external 

electrical stimulation for treatment of 

neurogenic or non-neurogenic urgency and/or 

urge incontinence. Neurourol Urodyn 1996; 

15(3):187-94. Case-series 

3551. Probert CS, Jayanthi V, Mayberry JF. Quality 

of life after colectomy. A comparison of 

conventional ileostomy and sphincter saving 

continent procedures. Arq Gastroenterol 1996 

Apr-Jun; 33(2):48-51. Question 2 

3552. Prosser S, Dobbs F. Case-finding incontinence 

in the over-75s. Br J Gen Pract 1997 Aug; 

47(421):498-500. Not eligible outcomes 

3553. Protogerou V, Moschou M, Antoniou N, et al. 

Modified S-pouch neobladder vs ileal conduit 

and a matched control population: a qualityof-life survey. BJU Int 2004 Aug; 94(3):350-

4. Not eligible level of evidence 

3554. Prott G, Hansen R, Badcock C, et al. What is 

the optimum methodology for the clinical 

measurement of resting anal sphincter 

pressure? Neurogastroenterol Motil 2005 Aug; 

17(4):595-9. Case-series 

3555. Proudfoot LM, Farmer ES, McIntosh JB. 

Testing incontinence pads using single-case 

research designs. Br J Nurs 1994 Apr 14-27; 

3(7):316, 8-20, 22 passim. Not eligible 

outcomes 

3556. Pruthi RS, Petrus CD, Bundrick WJ. New 

onset vesicovaginal fistula after transurethral 

collagen injection in women who underwent 

cystectomy and orthotopic neobladder 

creation: presentation and definitive treatment. 

J Urol 2000 Nov; 164(5):1638-9. CaseReports 

3557. Publicover C, Bear M. The effect of bladder 

training on urinary incontinence in 

community-dwelling older women. J Wound 

Ostomy Continence Nurs 1997 Nov; 

24(6):319-24. Not eligible target population 

3558. Pucciani F, Boni D, Perna F, et al. Descending 

perineum syndrome: are abdominal 

hysterectomy and bowel habits linked? Dis 

Colon Rectum 2005 Nov; 48(11):2094-9. Not 

eligible target population 

3559. Pucciani F, Iozzi L, Masi A, et al. Multimodal 

rehabilitation for faecal incontinence: 

experience of an Italian centre devoted to 

faecal disorder rehabilitation. Tech 

Coloproctol 2003 Oct; 7(3):139-47; discussion 

47. Case-series 

3560. Puet TA, Jackson H, Amy S. Use of pulsed 

irrigation evacuation in the management of the 

neuropathic bowel. Spinal Cord 1997 Oct; 

35(10):694-9. Case Reports 

3561. Pugsley H, Barbrook C, Mayne CJ, et al. 

Morbidity of incontinence surgery in women 

over 70 years old: a retrospective cohort 

study. BJOG 2005 Jun; 112(6):786-90. Not 

eligible outcomes 

3562. Puppo P, Introini C, Calvi P, et al. Pelvic floor 

reconstruction before orthotopic bladder 

replacement after radical cystectomy for 

bladder cancer. Urology 2005 Jan; 65(1):174. 

Case Reports 

3563. Pycha A, Klingler CH, Haitel A, et al. 

Implantable microballoons: an attractive 

alternative in the management of intrinsic 

sphincter deficiency. Eur Urol 1998; 

33(5):469-75. Case-series 

3564. Pyne K, Stott M. Continence. Delivering the 

best service. Nurs Times 1996 Apr 10-16; 

92(15):60-2. No associative hypothesis tested 

3565. Qian LX, Wu HF, Shui YG, et al. Pressure 

assessment in intercavernous embedding of 

bulboperineal urethra for treatment of urinary 

incontinence after prostatic operation. Asian J 

Androl 2001 Sep; 3(3):235-7. Case-series 

3566. Quadri G, Magatti F, Belloni C, et al. 

Transabdominal repair of cystocele by wedge 

colpectomy during combined abdominalvaginal surgery. Int Urogynecol J Pelvic Floor 

Dysfunct 1997; 8(5):278-83. Not eligible 

target population 

3567. Qualey TL, Jr. An approach to elderly 

incontinence. Nurs Manage 1995 Apr; 

26(4):48Q, S-T. Comment 

3568. Quallich SA, Ohl DA. Artificial urinary 

sphincter case study. Urol Nurs 2003 Aug; 

23(4):274-6. Case Reports 
B-159 

3569. Quek ML, Ginsberg DA. Long-term 

urodynamics followup of bladder 

augmentation for neurogenic bladder. J Urol 

2003 Jan; 169(1):195-8. Case-series 

3570. Quek ML, Ginsberg DA, Wilson S, et al. 

Pubovaginal slings for stress urinary 

incontinence following radical cystectomy and 

orthotopic neobladder reconstruction in 

women. J Urol 2004 Jul; 172(1):219-21. Casereports 

3571. Quinlan DM, Leonard MP, Brendler CB, et al. 

Use of the Benchekroun hydraulic valve as a 

catheterizable continence mechanism. J Urol 

1991 Jun; 145(6):1151-5. Case-series 

3572. Quinn P, Goka J, Richardson H. Assessment 

of an electronic daily diary in patients with 

overactive bladder. BJU Int 2003 May; 

91(7):647-52. Not eligible outcomes 

3573. Quint EH, Smith YR, Bowerman RA, et al. 

Spasticity of the pelvic floor mimicking an 

obstructive anomaly. J Pediatr Adolesc 

Gynecol 2003 Apr; 16(2):83-5. Not eligible 

exposure 

3574. Raboy A, Hakim LS, Ferzli G, et al. 

Extraperitoneal endoscopic vesicourethral 

suspension. J Laparoendosc Surg 1993 Oct; 

3(5):505-8. Comment 

3575. Rachagan SP, Mathews A. Urinary 

incontinence caused by prazosin. Singapore 

Med J 1992 Jun; 33(3):308-9. Case Reports 

3576. Rackley R, Weiss JP, Rovner ES, et al. 

Nighttime dosing with tolterodine reduces 

overactive bladder-related nocturnal 

micturitions in patients with overactive 

bladder and nocturia. Urology 2006 Apr; 

67(4):731-6; discussion 6. Not eligible 

exposure 

3577. Radley SC, Chapple CR, Bryan NP, et al. 

Effect of methoxamine on maximum urethral 

pressure in women with genuine stress 

incontinence: a placebo-controlled, doubleblind crossover study. Neurourol Urodyn 

2001; 20(1):43-52. Not eligible outcomes 

3578. Radley SC, Chapple CR, Mitsogiannis IC, et 

al. Transurethral implantation of 

macroplastique for the treatment of female 

stress urinary incontinence secondary to 

urethral sphincter deficiency. Eur Urol 2001 

Apr; 39(4):383-9. Case-series 

3579. Radomski SB, Caley B, Reiz JL, et al. 

Preliminary evaluation of a new controlledrelease oxybutynin in urinary incontinence. 

Curr Med Res Opin 2004; 20(2):249-53. Not 

eligible target population 

3580. Radomski SB, Herschorn S. Laparoscopic 

Burch bladder neck suspension: early results. J 

Urol 1996 Feb; 155(2):515-8. Case-series 

3581. Radziszewski P, Borkowski A, Torz C, et al. 

Distribution of collagen type VII in 

connective tissues of postmenopausal stressincontinent women. Gynecol Endocrinol 2005 

Mar; 20(3):121-6. Not eligible outcomes 

3582. Rafii A, Darai E, Haab F, et al. Body mass 

index and outcome of tension-free vaginal 

tape. Eur Urol 2003 Mar; 43(3):288-92. Caseseries 

3583. Rafii A, Jacob D, Deval B. Obturator abscess 

after transobturator tape for stress urinary 

incontinence. Obstet Gynecol 2006 Sep; 108(3 

Pt 2):720-3. Case Reports 

3584. Rafique M, Arif MH. Management of 

iatrogenic ureteric injuries associated with 

gynecological surgery. Int Urol Nephrol 2002; 

34(1):31-5. Case-series 

3585. Raghavan P, Raza WA, Ahmed YS, et al. 

Prevalence of pressure sores in a community 

sample of spinal injury patients. Clin Rehabil 

2003 Dec; 17(8):879-84. Not eligible 

outcomes 

3586. Rahman NU, Minor TX, Deng D, et al. 

Combined external urethral bulking and 

artificial urinary sphincter for urethral atrophy 

and stress urinary incontinence. BJU Int 2005 

Apr; 95(6):824-6. Case-series 

3587. Rahn DD, Marinis SI, Schaffer JI, et al. 

Anatomical path of the tension-free vaginal 

tape: reassessing current teachings. Am J 

Obstet Gynecol 2006 Dec; 195(6):1809-13. 

Not eligible target population 

3588. Rainey JB, Donaldson DR, Thomson JP. 

Postanal repair: which patients derive most 

benefit? J R Coll Surg Edinb 1990 Apr; 

35(2):101-5. Case-series 

3589. Rait G, Fletcher A, Smeeth L, et al. 

Prevalence of cognitive impairment: results 

from the MRC trial of assessment and 

management of older people in the 

community. Age Ageing 2005 May; 

34(3):242-8. Not eligible level of evidence 

3590. Raiwet C, Phillips D. A regional approach to 

continence management. Can Nurse 2001 

Apr; 97(4):16-20. Comment 

3591. Raj GV, Peterson AC, Toh KL, et al. 

Outcomes following revisions and secondary 

implantation of the artificial urinary sphincter. 

J Urol 2005 Apr; 173(4):1242-5. Case-series 

3592. Raj GV, Peterson AC, Webster GD. Outcomes 

following erosions of the artificial urinary 

sphincter. J Urol 2006 Jun; 175(6):2186-90; 

discussion 90. Case-series 
B-160 

3593. Rajkumar GN, Small DR, Mustafa AW, et al. 

A prospective study to evaluate the safety, 

tolerability, efficacy and durability of 

response of intravesical injection of botulinum 

toxin type A into detrusor muscle in patients 

with refractory idiopathic detrusor 

overactivity. BJU Int 2005 Oct; 96(6):848-52. 

Not eligible target population 

3594. Rajpurkar AD, Onur R, Singla A. Patient 

satisfaction and clinical efficacy of the new 

perineal bone-anchored male sling. Eur Urol 

2005 Feb; 47(2):237-42; discussion 42. Caseseries 

3595. Ramakrishnan V, Southern S, Hart NB, et al. 

Endoscopically assisted gracilis harvest for 

use as a free and pedicled flap. Br J Plast Surg 

1998 Dec; 51(8):580-3. Case Reports 

3596. Ramanujam PS, Venkatesh KS, Fietz MJ. 

Perineal excision of rectal procidentia in 

elderly high-risk patients. A ten-year 

experience. Dis Colon Rectum 1994 Oct; 

37(10):1027-30. Case-series 

3597. Ramchandani P, Banner MP, Berlin JW, et al. 

Vesicourethral anastomotic strictures after 

radical prostatectomy: efficacy of 

transurethral balloon dilation. Radiology 1994 

Nov; 193(2):345-9. Case-series 

3598. Ramirez JM, Aguilella V, Martinez M, et al. 

The utility of endovaginal sonography in the 

evaluation of fecal incontinence. Rev Esp 

Enferm Dig 2005 May; 97(5):317-22. Caseseries 

3599. Ramon J, Leandri P, Rossignol G, et al. 

Preservation of urinary continence and 

potency after cystoprostatectomy. Prog Clin 

Biol Res 1992; 378:125-32. Case series 

3600. Ramon J, Mekras JA, Webster GD. The 

outcome of transvaginal cystourethropexy in 

patients with anatomical stress urinary 

incontinence and outlet weakness. J Urol 1990 

Jul; 144(1):106-8; discussion 8-9. Case-series 

3601. Ramon J, Rossignol G, Leandri P, et al. 

Morbidity of radical retropubic prostatectomy 

following previous prostate resection. J Surg 

Oncol 1994 Jan; 55(1):14-9. Not eligible level 

of evidence 

3602. Ramoso-Jalbuena J. Climacteric Filipino 

women: a preliminary survey in the 

Philippines. Maturitas 1994 Oct; 19(3):183-

90. Not eligible level of evidence 

3603. Ramsay IN, Ali HM, Hunter M, et al. A 

prospective, randomized controlled trial of 

inpatient versus outpatient continence 

programs in the treatment of urinary 

incontinence in the female. Int Urogynecol J 

Pelvic Floor Dysfunct 1996; 7(5):260-3. Not 

eligible exposure 

3604. Rannestad T, Eikeland OJ, Helland H, et al. 

Are the physiologically and psychosocially 

based symptoms in women suffering from 

gynecological disorders alleviated by means 

of hysterectomy? J Womens Health Gend 

Based Med 2001 Jul-Aug; 10(6):579-87. Not 

eligible level of evidence 

3605. Rantz MJ. Examining MDS (Minimum Data 

Set) resident assessments for the impact on 

public policy. J Long Term Care Adm 1995 

Fall-Winter; 23(3):18-21. Not eligible 

exposure 

3606. Rao GN, Drew PJ, Lee PW, et al. Anterior 

resection syndrome is secondary to 

sympathetic denervation. Int J Colorectal Dis 

1996; 11(5):250-8. Case-series 

3607. Rao J, Koay SK, Lau WK, et al. Patientreported urinary continence (third-party 

interview): results of post-radical retropubic 

prostatectomy in Singaporeans. Asian J Surg 

2005 Jul; 28(3):207-10. Case-series 

3608. Rao KA, Yazaki E, Evans DF, et al. Objective 

evaluation of small bowel and colonic transit 

time using pH telemetry in athletes with 

gastrointestinal symptoms. Br J Sports Med 

2004 Aug; 38(4):482-7. Case-series 

3609. Rao SS, Ozturk R, Stessman M. Investigation 

of the pathophysiology of fecal seepage. Am J 

Gastroenterol 2004 Nov; 99(11):2204-9. Not 

eligible outcomes 

3610. Rao SS, Patel RS. How useful are manometric 

tests of anorectal function in the management 

of defecation disorders? Am J Gastroenterol 

1997 Mar; 92(3):469-75. Not eligible 

outcomes 

3611. Rao SS, Welcher KD, Happel J. Can 

biofeedback therapy improve anorectal 

function in fecal incontinence? Am J 

Gastroenterol 1996 Nov; 91(11):2360-6. 

Case-series 

3612. Rapp DE, Lucioni A, Katz EE, et al. Use of 

botulinum-A toxin for the treatment of 

refractory overactive bladder symptoms: an 

initial experience. Urology 2004 Jun; 

63(6):1071-5. Not eligible target population 
B-161 

3613. Rapp DE, O'Connor R C, Katz EE, et al. 

Neobladder-vaginal fistula after cystectomy 

and orthotopic neobladder construction. BJU 

Int 2004 Nov; 94(7):1092-5; discussion 5. 

Case-series 

3614. Rardin CR, Kohli N, Rosenblatt PL, et al. 

Tension-free vaginal tape: outcomes among 

women with primary versus recurrent stress 

urinary incontinence. Obstet Gynecol 2002 

Nov; 100(5 Pt 1):893-7. Case-series 

3615. Rasmussen A, Mouritsen L, Dalgaard A, et al. 

Twenty-four hour pad weighing test: 

reproducibility and dependency of activity 

level and fluid intake. Neurourol Urodyn 

1994; 13(3):261-5. Case-series 

3616. Rasmussen KL, Krue S, Johansson LE, et al. 

Obesity as a predictor of postpartum urinary 

symptoms. Acta Obstet Gynecol Scand 1997 

Apr; 76(4):359-62. Not eligible level of 

evidence 

3617. Rasmussen O, Christensen B, Sorensen M, et 

al. Rectal compliance in the assessment of 

patients with fecal incontinence. Dis Colon 

Rectum 1990 Aug; 33(8):650-3. Not eligible 

outcomes 

3618. Rasmussen OO, Buntzen S, Sorensen M, et al. 

Sacral nerve stimulation in fecal incontinence. 

Dis Colon Rectum 2004 Jul; 47(7):1158-62; 

discussion 62-3. Case-series 

3619. Rasmussen OO, Christiansen J, Tetzschner T, 

et al. Pudendal nerve function in idiopathic 

fecal incontinence. Dis Colon Rectum 2000 

May; 43(5):633-6; discussion 6-7. Not eligible 

target population 

3620. Rasmussen OO, Colstrup H, Lose G, et al. A 

technique for the dynamic assessment of anal 

sphincter function. Int J Colorectal Dis 1990 

Aug; 5(3):135-41. Not eligible exposure 

3621. Rasmussen OO, Petersen IK, Christiansen J. 

Anorectal function following low anterior 

resection. Colorectal Dis 2003 May; 5(3):258-

61. Case-series 

3622. Rasmussen OO, Puggaard L, Christiansen J. 

Anal sphincter repair in patients with obstetric 

trauma: age affects outcome. Dis Colon 

Rectum 1999 Feb; 42(2):193-5. Case-series 

3623. Rasmussen OO, Ronholt C, Alstrup N, et al. 

Anorectal pressure gradient and rectal 

compliance in fecal incontinence. Int J 

Colorectal Dis 1998; 13(4):157-9. Not eligible 

outcomes 

3624. Rasmussen OO, Sorensen M, Tetzschner T, et 

al. Anorectal pressure gradient in patients with 

anal incontinence. Dis Colon Rectum 1992 

Jan; 35(1):8-11. Not eligible level of evidence 

3625. Rasmussen OO, Sorensen M, Tetzschner T, et 

al. Dynamic anal manometry: physiological 

variations and pathophysiological findings in 

fecal incontinence. Gastroenterology 1992 Jul; 

103(1):103-13. Question 4 

3626. Ratto C, Grillo E, Parello A, et al. Endoanal 

ultrasound-guided surgery for anal fistula. 

Endoscopy 2005 Aug; 37(8):722-8. Caseseries 

3627. Ratto C, Grillo E, Parello A, et al. Sacral 

neuromodulation in treatment of fecal 

incontinence following anterior resection and 

chemoradiation for rectal cancer. Dis Colon 

Rectum 2005 May; 48(5):1027-36. Caseseries 

3628. Ratto C, Morelli U, Paparo S, et al. Minimally 

invasive sacral neuromodulation implant 

technique: modifications to the conventional 

procedure. Dis Colon Rectum 2003 Mar; 

46(3):414-7. Case-series 

3629. Ravetz RS. Psychiatric disorders associated 

with Alzheimer's disease. J Am Osteopath 

Assoc 1999 Sep; 99(9 Suppl):S13-6. No 

associative hypothesis tested 

3630. Ravid A, Richard CS, Spencer LM, et al. 

Pregnancy, delivery, and pouch function after 

ileal pouch-anal anastomosis for ulcerative 

colitis. Dis Colon Rectum 2002 Oct; 

45(10):1283-8. Case-series 

3631. Rayome RG, Johnson V, Gray M. Stress 

urinary incontinence after radical 

prostatectomy. J Wound Ostomy Continence 

Nurs 1994 Nov; 21(6):264-9. Case Reports 

3632. Rayome RG, King C, King T. Patient with 

nocturnal enuresis and stress incontinence 

after previous hysterectomy and radiation 

therapy for cervical cancer. J Wound Ostomy 

Continence Nurs 1995 Jan; 22(1):64-7. CaseReports 

3633. Raz R, Gennesin Y, Wasser J, et al. Recurrent 

urinary tract infections in postmenopausal 

women. Clin Infect Dis 2000 Jan; 30(1):152-

6. Not eligible outcomes 

3634. Raz S. Vaginal surgery for stress 

incontinence. J Am Geriatr Soc 1990 Mar; 

38(3):345-7. Comment 

3635. Raz S, Little NA, Juma S, et al. Repair of 

severe anterior vaginal wall prolapse (grade 

IV cystourethrocele). J Urol 1991 Oct; 

146(4):988-92. Case-series 

3636. Raz S, Nitti VW, Bregg KJ. Transvaginal 

repair of enterocele. J Urol 1993 Apr; 

149(4):724-30. Case-series 
B-162 

3637. Raz S, Stothers L, Young GP, et al. Vaginal 

wall sling for anatomical incontinence and 

intrinsic sphincter dysfunction: efficacy and 

outcome analysis. J Urol 1996 Jul; 

156(1):166-70. Case-series 

3638. Razdan S, Vlachiotis JD, Edelstein RA, et al. 

Schistosomal myelopathy as a cause of 

neurogenic bladder dysfunction. Urology 1997 

May; 49(5):777-80. Case Reports 

3639. Read NW, Sun WM. Reflex anal dilatation: 

effect of parting the buttocks on anal function 

in normal subjects and patients with anorectal 

and spinal disease. Gut 1991 Jun; 32(6):670-3. 

Not eligible exposure 

3640. Rechberger T, Donica H, Baranowski W, et al. 

Female urinary stress incontinence in terms of 

connective tissue biochemistry. Eur J Obstet 

Gynecol Reprod Biol 1993 May; 49(3):187-

91. Not eligible outcomes 

3641. Rechberger T, Postawski K, Jakowicki JA, et 

al. Role of fascial collagen in stress urinary 

incontinence. Am J Obstet Gynecol 1998 Dec; 

179(6 Pt 1):1511-4. Not eligible outcomes 

3642. Reddy AP, DeLancey JO, Zwica LM, et al. 

On-screen vector-based ultrasound assessment 

of vesical neck movement. Am J Obstet 

Gynecol 2001 Jul; 185(1):65-70. Not eligible 

outcomes 

3643. Reddy SM, Ruby J, Wallace M, et al. Patient 

self-assessment of complications and quality 

of life after conformal neutron and photon 

irradiation for localized prostate cancer. 

Radiat Oncol Investig 1997; 5(5):252-6. Caseseries 

3644. Reed RL, Hepburn K, Adelson R, et al. Low 

serum albumin levels, confusion, and fecal 

incontinence: are these risk factors for 

pressure ulcers in mobility-impaired 

hospitalized adults? Gerontology 2003 JulAug; 49(4):255-9. Not eligible outcomes 

3645. Regensberg D. Objective social continence: 

understanding continence. Nurs RSA 1994 

May; 9(5):23-6. Comment 

3646. Reichelt O, Weirich T, Wunderlich H, et al. 

Pubovaginal cutaneous fascial sling procedure 

for stress urinary incontinence: 10 years' 

experience. Urol Int 2004; 72(4):318-23; 

discussion 23-4. Case-series 

3647. Reid SV, Parys BT. Long-term 5-year 

followup of the results of the vesica 

procedure. J Urol 2005 Apr; 173(4):1234-6. 

Case-series 

3648. Reilly WT, Talley NJ, Pemberton JH, et al. 

Validation of a questionnaire to assess fecal 

incontinence and associated risk factors: Fecal 

Incontinence Questionnaire. Dis Colon 

Rectum 2000 Feb; 43(2):146-53; discussion 

53-4. Not eligible outcomes 

3649. Reis F, Netto NR, Jr., Reinato JA, et al. The 

impact of prostatectomy and brachytherapy in 

patients with localized prostate cancer. Int 

Urol Nephrol 2004; 36(2):187-90. Case series 

3650. Reisinger E, Stummvoll W. Visualization of 

the endopelvic fascia by transrectal threedimensional ultrasound. Int Urogynecol J 

Pelvic Floor Dysfunct 2006 Feb; 17(2):165-9. 

Not eligible outcomes 

3651. Reissman P, Agachan F, Wexner SD. 

Outcome of laparoscopic colorectal surgery in 

older patients. Am Surg 1996 Dec; 

62(12):1060-3. Case-series 

3652. Reitz A, Schmid DM, Curt A, et al. Afferent 

fibers of the pudendal nerve modulate 

sympathetic neurons controlling the bladder 

neck. Neurourol Urodyn 2003; 22(6):597-601. 

Case-series 

3653. Remsburg RE, Palmer MH, Langford AM, et 

al. Staff compliance with and ratings of 

effectiveness of a prompted voiding program 

in a long-term care facility. J Wound Ostomy 

Continence Nurs 1999 Sep; 26(5):261-9. Not 

eligible outcomes 

3654. Remzi FH, Gorgun E, Bast J, et al. Vaginal 

delivery after ileal pouch-anal anastomosis: a 

word of caution. Dis Colon Rectum 2005 Sep; 

48(9):1691-9. Case-series 

3655. Renner K, Rosen HR, Novi G, et al. Quality of 

life after surgery for rectal cancer: do we still 

need a permanent colostomy? Dis Colon 

Rectum 1999 Sep; 42(9):1160-7. Case-series 

3656. Renschler TD, Middleton RG. 30 years of 

experience with York-Mason repair of rectourinary fistulas. J Urol 2003 Oct; 170(4 Pt 

1):1222-5; discussion 5. Case-series 

3657. Rentsch M, Paetzel C, Lenhart M, et al. 

Dynamic magnetic resonance imaging 

defecography: a diagnostic alternative in the 

assessment of pelvic floor disorders in 

proctology. Dis Colon Rectum 2001 Jul; 

44(7):999-1007. Not eligible outcomes 

3658. Renzi A, Brusciano L, Pescatori M, et al. 

Pneumatic balloon dilatation for chronic anal 

fissure: a prospective, clinical, 

endosonographic, and manometric study. Dis 

Colon Rectum 2005 Jan; 48(1):121-6. Not 

eligible target population 
B-163 

3659. Resnick B. A bladder scan trial in geriatric 

rehabilitation. Rehabil Nurs 1995 Jul-Aug; 

20(4):194-6, 203. Not eligible outcomes 

3660. Resnick N, Fenner D. Toward optimal health: 

the experts respond to urinary incontinence. J 

Womens Health 1998 May; 7(4):419-24. 

Interview 

3661. Resnick NM. Noninvasive diagnosis of the 

patient with complex incontinence. 

Gerontology 1990; 36 Suppl 2:8-18. 

3662. Resnick NM. Urinary incontinence in older 

adults. Hosp Pract (Off Ed) 1992 Oct 15; 

27(10):139-42, 47, 50 passim. Comment 

3663. Resnick NM. An 89-year-old woman with 

urinary incontinence. Jama 1996 Dec 11; 

276(22):1832-40. Case- Reports 

3664. Rett MT, Simoes JA, Herrmann V, et al. 

Management of stress urinary incontinence 

with surface electromyography-assisted 

biofeedback in women of reproductive age. 

Phys Ther 2007 Feb; 87(2):136-42. Caseseries 

3665. Retzky SS, Rogers RM, Jr. Urinary 

incontinence in women. Clin Symp 1995; 

47(3):2-32. Review 

3666. Reuben DB, Frank JC, Hirsch SH, et al. A 

randomized clinical trial of outpatient 

comprehensive geriatric assessment coupled 

with an intervention to increase adherence to 

recommendations. J Am Geriatr Soc 1999 

Mar; 47(3):269-76. Not eligible outcomes 

3667. Reuben DB, Maly RC, Hirsch SH, et al. 

Physician implementation of and patient 

adherence to recommendations from 

comprehensive geriatric assessment. Am J 

Med 1996 Apr; 100(4):444-51. Not eligible 

outcomes 

3668. Reuben DB, Roth C, Kamberg C, et al. 

Restructuring primary care practices to 

manage geriatric syndromes: the ACOVE-2 

intervention. J Am Geriatr Soc 2003 Dec; 

51(12):1787-93. Not eligible outcomes 

3669. Rex DK, Lappas JC. Combined anorectal 

manometry and defecography in 50 

consecutive adults with fecal incontinence. 

Dis Colon Rectum 1992 Nov; 35(11):1040-5. 

Case-series 

3670. Rex DK, Lappas JC, Goulet RC, et al. 

Selection of constipated patients as subtotal 

colectomy candidates. J Clin Gastroenterol 

1992 Oct; 15(3):212-7. Not eligible exposure 

3671. Reyes-Ortiz CA, Al Snih S, Markides KS. 

Falls among elderly persons in Latin America 

and the Caribbean and among elderly 

Mexican-Americans. Rev Panam Salud 

Publica 2005 May-Jun; 17(5-6):362-9. Not 

eligible outcomes 

3672. Reymert J, Hunskaar S. Why do only a 

minority of perimenopausal women with 

urinary incontinence consult a doctor? Scand J 

Prim Health Care 1994 Sep; 12(3):180-3. Not 

eligible outcomes 

3673. Rezapour M, Falconer C, Ulmsten U. 

Tension-Free vaginal tape (TVT) in stress 

incontinent women with intrinsic sphincter 

deficiency (ISD)--a long-term follow-up. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 12 

Suppl 2:S12-4. Case-series 

3674. Rezapour M, Ulmsten U. Tension-Free 

vaginal tape (TVT) in women with recurrent 

stress urinary incontinence--a long-term 

follow up. Int Urogynecol J Pelvic Floor 

Dysfunct 2001; 12 Suppl 2:S9-11. Case-series 

3675. Rezapour M, Ulmsten U. Tension-Free 

vaginal tape (TVT) in women with mixed 

urinary incontinence--a long-term follow-up. 

Int Urogynecol J Pelvic Floor Dysfunct 2001; 

12 Suppl 2:S15-8. Case-series 

3676. Reznicek SB. Common urologic problems in 

the elderly. Prostate cancer, outlet obstruction, 

and incontinence require special management. 

Postgrad Med 2000 Jan; 107(1):163-4, 7-70, 

77-8. Review 

3677. Rhee EY. Technique for concomitant 

implantation of the penile prosthesis with the 

male sling. J Urol 2005 Mar; 173(3):925-7. 

Case-series 

3678. Rhodes P. The sound of silence. Health Serv J 

1993 Oct 21; 103(5375):28-9. Comment 

3679. Rhodes P, Parker G. Continence. Profile of an 

adviser. Nurs Times 1994 Jan 26-Feb 1; 

90(4):75-8. Comment 

3680. Ribera MC, Pascual R, Orozco D, et al. 

Incidence and risk factors associated with 

urinary tract infection in diabetic patients with 

and without asymptomatic bacteriuria. Eur J 

Clin Microbiol Infect Dis 2006 Jun; 

25(6):389-93. Not eligible outcomes 

3681. Ricciardi R, Mellgren AF, Madoff RD, et al. 

The utility of pudendal nerve terminal motor 

latencies in idiopathic incontinence. Dis Colon 

Rectum 2006 Jun; 49(6):852-7. Not eligible 

outcomes 
B-164 

3682. Richards KC, Beck C, Shue VM, et al. 

Demographic and sleep characteristics in 

cognitively impaired nursing home residents 

with and without severe sleep/wake pattern 

inefficiency. Issues Ment Health Nurs 2005 

Aug-Sep; 26(7):751-69. Not eligible exposure 

3683. Richardson DA, Ramahi A. Reproducibility of 

pressure transmission ratios in stress 

incontinent women. Neurourol Urodyn 1993; 

12(2):123-30. Not eligible outcomes 

3684. Richardson TD, Kennelly MJ, Faerber GJ. 

Endoscopic injection of glutaraldehyde crosslinked collagen for the treatment of intrinsic 

sphincter deficiency in women. Urology 1995 

Sep; 46(3):378-81. Not eligible target 

population 

3685. Richman M, McLaughlin S, Maygarden S, et 

al. Initial incision of lateral pelvic fascia and 

early ligation of vascular pedicles during 

radical prostatectomy: potential to reduce 

positive margin rates. BJU Int 2005 Jan; 

95(1):40-5. Case-series 

3686. Richmond D. The incontinent woman: 1. Br J 

Hosp Med 1993 Oct 6-19; 50(7):418-23. 

Comment 

3687. Richter HE, Burgio KL, Brubaker L, et al. 

Factors associated with incontinence 

frequency in a surgical cohort of stress 

incontinent women. Am J Obstet Gynecol 

2005 Dec; 193(6):2088-93. Not eligible target 

population 

3688. Richter HE, Burgio KL, Holley RL, et al. 

Cadaveric fascia lata sling for stress urinary 

incontinence: a prospective quality-of-life 

analysis. Am J Obstet Gynecol 2003 Dec; 

189(6):1590-5; discussion 5-6. Not eligible 

outcomes 

3689. Richter HE, Fielding JR, Bradley CS, et al. 

Endoanal ultrasound findings and fecal 

incontinence symptoms in women with and 

without recognized anal sphincter tears. 

Obstet Gynecol 2006 Dec; 108(6):1394-401. 

Not eligible level of evidence 

3690. Richter HE, Norman AM, Burgio KL, et al. 

Tension-free vaginal tape: a prospective 

subjective and objective outcome analysis. Int 

Urogynecol J Pelvic Floor Dysfunct 2005 

Mar-Apr; 16(2):109-13. Case-series 

3691. Richter HE, Varner RE, Sanders E, et al. 

Effects of pubovaginal sling procedure on 

patients with urethral hypermobility and 

intrinsic sphincteric deficiency: would they do 

it again? Am J Obstet Gynecol 2001 Jan; 

184(2):14-9. Case-series 

3692. Riedler I, Primus G, Trummer H, et al. 

Fournier's gangrene after tension-free vaginal 

tape (TVT) procedure. Int Urogynecol J Pelvic 

Floor Dysfunct 2004 Mar-Apr; 15(2):145-6. 

Case- Reports 

3693. Riedy LW, Chintam R, Walter JS. Use of a 

neuromuscular stimulator to increase anal 

sphincter pressure. Spinal Cord 2000 Dec; 

38(12):724-7. Case-series 

3694. Rieger N, Schloithe A, Saccone G, et al. A 

prospective study of anal sphincter injury due 

to childbirth. Scand J Gastroenterol 1998 Sep; 

33(9):950-5. Not eligible outcomes 

3695. Rieger NA, Downey PR, Wattchow DA. Short 

communication: endoanal ultrasound during 

contraction of the anal sphincter--improved 

definition and diagnostic accuracy. Br J 

Radiol 1996 Jul; 69(823):665-7. Not eligible 

outcomes 

3696. Rieger NA, Sarre RG, Saccone GT, et al. 

Correlation of pudendal nerve terminal motor 

latency with the results of anal manometry. Int 

J Colorectal Dis 1997; 12(5):303-7. Not 

eligible outcomes 

3697. Rieger NA, Sweeney JL, Hoffmann DC, et al. 

Investigation of fecal incontinence with 

endoanal ultrasound. Dis Colon Rectum 1996 

Aug; 39(8):860-4. Case-series 

3698. Rieger NA, Wattchow DA, Sarre RG, et al. 

Prospective trial of pelvic floor retraining in 

patients with fecal incontinence. Dis Colon 

Rectum 1997 Jul; 40(7):821-6. Not eligible 

target population 

3699. Rigby D, Whelan L. Parkinson's disease--

continence management. Nurs Times 2001 Jul 

26-Aug 1; 97(30):65-6. Not eligible exposure 

3700. Rigby M. Call for early diagnosis in 

continence care. Elder Care 1996 Feb-Mar; 

8(1):33. 

3701. Riley DE, Lang AE. The spectrum of 

levodopa-related fluctuations in Parkinson's 

disease. Neurology 1993 Aug; 43(8):1459-64. 

Case- Reports 

3702. Ring H, Tshuva M, Ronen R, et al. Quality of 

care on a stroke rehabilitation ward: the use of 

urinary incontinence as tracer. Int J Rehabil 

Res 1998 Jun; 21(2):241-5. Not eligible 

outcomes 

3703. Rintala R, Lahdenne P, Lindahl H, et al. 

Anorectal function in adults operated for a 

benign sacrococcygeal teratoma. J Pediatr 

Surg 1993 Sep; 28(9):1165-7. Not eligible 

exposure 
B-165 

3704. Rintala RJ, Lindahl HG. Fecal continence in 

patients having undergone posterior sagittal 

anorectoplasty procedure for a high anorectal 

malformation improves at adolescence, as 

constipation disappears. J Pediatr Surg 2001 

Aug; 36(8):1218-21. Not eligible target 

population 

3705. Ripetti V, Caputo D, Ausania F, et al. Sacral 

nerve neuromodulation improves physical, 

psychological and social quality of life in 

patients with fecal incontinence. Tech 

Coloproctol 2002 Dec; 6(3):147-52. Not 

eligible target population 

3706. Rivas DA, Karasick S, Chancellor MB. 

Cutaneous ileocystostomy (a bladder 

chimney) for the treatment of severe 

neurogenic vesical dysfunction. Paraplegia 

1995 Sep; 33(9):530-5. Case-series 

3707. Rizk DE, Abadir MN, Thomas LB, et al. 

Determinants of the length of episiotomy or 

spontaneous posterior perineal lacerations 

during vaginal birth. Int Urogynecol J Pelvic 

Floor Dysfunct 2005 Sep-Oct; 16(5):395-400. 

Not eligible outcomes 

3708. Rizk DE, Helal TE, Mason N, et al. Nonevidence of estrogen receptors in the rectal 

mucosa. Int Urogynecol J Pelvic Floor 

Dysfunct 1998; 9(3):136-9. Not eligible 

outcomes 

3709. Rizk DE, Raaschou T, Mason N, et al. 

Evidence of progesterone receptors in the 

mucosa of the urinary bladder. Scand J Urol 

Nephrol 2001 Sep; 35(4):305-9. Not eligible 

outcomes 

3710. Rizk DE, Shaheen H, Thomas L, et al. The 

prevalence and determinants of health careseeking behavior for urinary incontinence in 

United Arab Emirates women. Int Urogynecol 

J Pelvic Floor Dysfunct 1999; 10(3):160-5. 

Not eligible outcomes 

3711. Rizvi RM, Nazim MH. The frequency of 

urinary symptoms in women attending 

gynaecology clinics at the Aga Khan 

University Hospital Karachi, Pakistan. J Pak 

Med Assoc 2005 Nov; 55(11):489-92. Not 

eligible target population 

3712. Roberts PL, Coller JA, Schoetz DJ, Jr., et al. 

Manometric assessment of patients with 

obstetric injuries and fecal incontinence. Dis 

Colon Rectum 1990 Jan; 33(1):16-20. Caseseries 

3713. Robinson BE, Barry PP, Renick N, et al. 

Physician confidence and interest in learning 

more about common geriatric topics: a needs 

assessment. J Am Geriatr Soc 2001 Jul; 

49(7):963-7. Not eligible outcomes 

3714. Robinson D, Bidmead J, Cardozo L, et al. An 

unusual cause of voiding dysfunction 

following colposuspension. J Obstet Gynaecol 

2003 Mar; 23(2):210-1. Case Reports 

3715. Robinson D, Cardozo L, Akeson M, et al. 

Antidiuresis: a new concept in managing 

female daytime urinary incontinence. BJU Int 

2004 May; 93(7):996-1000. Not eligible 

exposure 

3716. Robinson D, Savvas M, Cardozo L. An 

unusual cause of 'incontinence' after 

hysterectomy. BJU Int 2003 May; 91(7):727-

8. Case report 

3717. Robinson JP. Phases of the qualitative 

research interview with institutionalized 

elderly individuals. J Gerontol Nurs 2000 

Nov; 26(11):17-23. Not eligible outcomes 

3718. Robinson JP, Shea JA. Development and 

testing of a measure of health-related quality 

of life for men with urinary incontinence. J 

Am Geriatr Soc 2002 May; 50(5):935-45. Not 

eligible outcomes 

3719. Robinson JW, Donnelly BJ, Coupland K, et al. 

Quality of life 2 years after salvage 

cryosurgery for the treatment of local 

recurrence of prostate cancer after 

radiotherapy. Urol Oncol 2006 Nov-Dec; 

24(6):472-86. Case-series 

3720. Rocco F, Carmignani L, Acquati P, et al. 

Restoration of posterior aspect of 

rhabdosphincter shortens continence time after 

radical retropubic prostatectomy. J Urol 2006 

Jun; 175(6):2201-6. Case series 

3721. Rociu E, Stoker J, Eijkemans MJ, et al. Fecal 

incontinence: endoanal US versus endoanal 

MR imaging. Radiology 1999 Aug; 

212(2):453-8. Case-series 

3722. Rockner G. Urinary incontinence after 

perineal trauma at childbirth. Scand J Caring 

Sci 1990; 4(4):169-72. Question 2 

3723. Rockwood TH, Church JM, Fleshman JW, et 

al. Patient and surgeon ranking of the severity 

of symptoms associated with fecal 

incontinence: the fecal incontinence severity 

index. Dis Colon Rectum 1999 Dec; 

42(12):1525-32. Not eligible outcomes 

3724. Rodrigues P, Hering F, Meler A, et al. Pubofascial versus vaginal sling operation for the 

treatment of stress urinary incontinence: a 

prospective study. Neurourol Urodyn 2004; 

23(7):627-31. Case-series 

3725. Rodriguez LV, Blander DS, Dorey F, et al. 

Discrepancy in patient and physician 

perception of patient's quality of life related to 

urinary symptoms. Urology 2003 Jul; 

62(1):49-53. Case-series 
B-166 

3726. Rodriguez LV, Bukkapatnam R, Shah SM, et 

al. Transvaginal paravaginal repair of highgrade cystocele central and lateral defects with 

concomitant suburethral sling: report of early 

results, outcomes, and patient satisfaction with 

a new technique. Urology 2005 Nov; 66(5 

Suppl):57-65. Case-series 

3727. Rodriguez LV, Raz S. Prospective analysis of 

patients treated with a distal urethral 

polypropylene sling for symptoms of stress 

urinary incontinence: surgical outcome and 

satisfaction determined by patient driven 

questionnaires. J Urol 2003 Sep; 170(3):857-

63; discussion 63. Case-series 

3728. Rodriguez-Tellez M, Herrerias JM, Jr., 

Arguelles F, et al. Accidental intrarectal 

administration of alcohol enema induces 

proctocolitis and fecal incontinence. 

Endoscopy 2001 Jul; 33(7):641. Case Reports 

3729. Roe B. Effective and ineffective management 

of incontinence: issues around illness 

trajectory and health care. Qual Health Res 

2000 Sep; 10(5):677-90. Comment 

3730. Roe B, Doll H, Wilson K. Help seeking 

behaviour and health and social services 

utilisation by people suffering from urinary 

incontinence. Int J Nurs Stud 1999 Jun; 

36(3):245-53. Not eligible level of evidence 

3731. Roe B, May C. Incontinence and sexuality: 

findings from a qualitative perspective. J Adv 

Nurs 1999 Sep; 30(3):573-9. Not eligible 

outcomes 

3732. Roe B, Wilson K, Doll H. Public awareness 

and health education: findings from an 

evaluation of health services for incontinence 

in England. Int J Nurs Stud 2001 Feb; 

38(1):79-89. Not eligible level of evidence 

3733. Roe BH. Development of Continence 

Advisory Services in the United Kingdom. 

Scand J Caring Sci 1990; 4(2):51-4. Review 

3734. Roe BH. What choices in care for the 

incontinent? World Health Forum 1992; 

13(1):81-3. Review 

3735. Roehl B, Buchanan EM. Urinary incontinence 

evaluation and the utility of pessaries in older 

women. Care Manag J 2006 Winter; 7(4):213-

7. Review 

3736. Roehrborn CG, Abrams P, Rovner ES, et al. 

Efficacy and tolerability of tolterodine 

extended-release in men with overactive 

bladder and urgency urinary incontinence. 

BJU Int 2006 May; 97(5):1003-6. Not eligible 

exposure 

3737. Roenneburg ML, Wheeless CR, Jr. Traumatic 

absence of the proximal urethra. Am J Obstet 

Gynecol 2005 Dec; 193(6):2169-72. Caseseries 

3738. Rogers E, Ohori M, Kassabian VS, et al. 

Salvage radical prostatectomy: outcome 

measured by serum prostate specific antigen 

levels. J Urol 1995 Jan; 153(1):104-10. Caseseries 

3739. Rogers GR, Villarreal A, Kammerer-Doak D, 

et al. Sexual function in women with and 

without urinary incontinence and/or pelvic 

organ prolapse. Int Urogynecol J Pelvic Floor 

Dysfunct 2001; 12(6):361-5. Not eligible 

outcomes 

3740. Rogers RG, Coates KW, Kammerer-Doak D, 

et al. A short form of the Pelvic Organ 

Prolapse/Urinary Incontinence Sexual 

Questionnaire (PISQ-12). Int Urogynecol J 

Pelvic Floor Dysfunct 2003 Aug; 14(3):164-8; 

discussion 8. Not eligible outcomes 

3741. Rogers RG, Kammerer-Doak D, Darrow A, et 

al. Sexual function after surgery for stress 

urinary incontinence and/or pelvic organ 

prolapse: a multicenter prospective study. Am 

J Obstet Gynecol 2004 Jul; 191(1):206-10. 

Not eligible outcomes 

3742. Rogers RG, Kammerer-Doak D, Darrow A, et 

al. Does sexual function change after surgery 

for stress urinary incontinence and/or pelvic 

organ prolapse? A multicenter prospective 

study. Am J Obstet Gynecol 2006 Nov; 

195(5):e1-4. Case-series 

3743. Rogers RG, Kammerer-Doak D, Olsen A, et 

al. A randomized, double-blind, placebocontrolled comparison of the effect of 

nitrofurantoin monohydrate macrocrystals on 

the development of urinary tract infections 

after surgery for pelvic organ prolapse and/or 

stress urinary incontinence with suprapubic 

catheterization. Am J Obstet Gynecol 2004 

Jul; 191(1):182-7. Not eligible outcomes 

3744. Rogers RG, Lebkuchner U, Kammerer-Doak 

DN, et al. Obesity and retropubic surgery for 

stress incontinence: is there really an 

increased risk of intraoperative complications? 

Am J Obstet Gynecol 2006 Dec; 195(6):1794-

8. Not eligible outcomes 

3745. Roghmann MC, Wallin MT, Gorman PH, et 

al. Prevalence and natural history of 

colonization with fluoroquinolone-resistant 

gram-negative bacilli in community-dwelling 

people with spinal cord dysfunction. Arch 

Phys Med Rehabil 2006 Oct; 87(10):1305-9. 

Not eligible outcomes 
B-167 

3746. Rohr G, Kragstrup J, Gaist D, et al. Genetic 

and environmental influences on urinary 

incontinence: a Danish population-based twin 

study of middle-aged and elderly women. 

Acta Obstet Gynecol Scand 2004 Oct; 

83(10):978-82. Not eligible level of evidence 

3747. Roig JV, Buch E, Alos R, et al. Anorectal 

function in patients with complete rectal 

prolapse. Differences between continent and 

incontinent individuals. Rev Esp Enferm Dig 

1998 Nov; 90(11):794-805. Not eligible 

outcomes 

3748. Roig JV, Villoslada C, Lledo S, et al. 

Prevalence of pudendal neuropathy in fecal 

incontinence. Results of a prospective study. 

Dis Colon Rectum 1995 Sep; 38(9):952-8. Not 

eligible exposure 

3749. Rollins G. Behavior management improves 

urinary incontinence in older women living at 

home. Rep Med Guidel Outcomes Res 2002 

Mar 8; 13(5):7-9. News 

3750. Romano G, La Torre F, Cutini G, et al. Total 

anorectal reconstruction with the artificial 

bowel sphincter: report of eight cases. A 

quality-of-life assessment. Dis Colon Rectum 

2003 Jun; 46(6):730-4. Case-series 

3751. Romano G, Rotondano G, Esposito P, et al. 

External anal sphincter defects: correlation 

between pre-operative anal endosonography 

and intraoperative findings. Br J Radiol 1996 

Jan; 69(817):6-9. Case-series 

3752. Romano SV, Metrebian SE, Vaz F, et al. An 

adjustable male sling for treating urinary 

incontinence after prostatectomy: a phase III 

multicentre trial. BJU Int 2006 Mar; 

97(3):533-9. Case-series 

3753. Romanzi LJ. Urinary incontinence: a family 

affair. J Gend Specif Med 1998 Oct-Nov; 

1(2):52-3. Comment 

3754. Romanzi LJ, Groutz A, Blaivas JG. Urethral 

diverticulum in women: diverse presentations 

resulting in diagnostic delay and 

mismanagement. J Urol 2000 Aug; 

164(2):428-33. Case-series 

3755. Rondorf-Klym LM, Colling J. Quality of life 

after radical prostatectomy. Oncol Nurs 

Forum 2003 Mar-Apr; 30(2):E24-32. Not 

eligible outcomes 

3756. Rondorf-Klym LM, Colling J, Simonson W. 

Medication use by community-dwelling 

elderly with urinary incontinence. Urol Nurs 

1998 Sep; 18(3):201-6. Not eligible outcomes 

3757. Rongen MJ, Uludag O, El Naggar K, et al. 

Long-term follow-up of dynamic graciloplasty 

for fecal incontinence. Dis Colon Rectum 

2003 Jun; 46(6):716-21. Case-series 

3758. Ronnblom A, Forsberg H, Danielsson A. 

Gastrointestinal symptoms in myotonic 

dystrophy. Scand J Gastroenterol 1996 Jul; 

31(7):654-7. Case-series 

3759. Roovers JP, van der Bom JG, van der Vaart 

CH, et al. Abdominal versus vaginal approach 

for the management of genital prolapse and 

coexisting stress incontinence. Int Urogynecol 

J Pelvic Floor Dysfunct 2002; 13(4):224-31. 

Case-series 

3760. Rose MA, Baigis-Smith J, Smith D, et al. 

Behavioral management of urinary 

incontinence in homebound older adults. 

Home Healthc Nurse 1990 Sep-Oct; 8(5):10-

5. Comment 

3761. Rosen HR, Novi G, Zoech G, et al. 

Restoration of anal sphincter function by 

single-stage dynamic graciloplasty with a 

modified (split sling) technique. Am J Surg 

1998 Mar; 175(3):187-93. Case-series 

3762. Rosen HR, Urbarz C, Holzer B, et al. Sacral 

nerve stimulation as a treatment for fecal 

incontinence. Gastroenterology 2001 Sep; 

121(3):536-41. Not eligible target population 

3763. Rosenberg J, Kehlet H. Early discharge after 

external anal sphincter repair. Dis Colon 

Rectum 1999 Apr; 42(4):457-9. Case-series 

3764. Rosenberg LJ, Griffiths DJ, Resnick NM. 

Factors that distinguish continent from 

incontinent older adults with detrusor 

overactivity. J Urol 2005 Nov; 174(5):1868-

72. Not eligible outcomes 

3765. Rosenblum N, Scarpero HM, Nitti VW. 

Voiding dysfunction in young, nulliparous 

women: symptoms and urodynamic findings. 

Int Urogynecol J Pelvic Floor Dysfunct 2004 

Nov-Dec; 15(6):373-7; discussion 7. Not 

eligible outcomes 

3766. Rosenzweig BA, Hischke D, Thomas S, et al. 

Stress incontinence in women. Psychological 

status before and after treatment. J Reprod 

Med 1991 Dec; 36(12):835-8. Not eligible 

exposure 

3767. Rosenzweig BA, Pushkin S, Blumenfeld D, et 

al. Prevalence of abnormal urodynamic test 

results in continent women with severe 

genitourinary prolapse. Obstet Gynecol 1992 

Apr; 79(4):539-42. Not eligible outcomes 

3768. Roshkow JE, Ng CC. Pelvic mucocele 

following colostomy: CT and ultrasound 

findings. J Comput Assist Tomogr 1990 NovDec; 14(6):1022-3. Case Reports 
B-168 

3769. Ross JW. Multichannel urodynamic 

evaluation of laparoscopic Burch 

colposuspension for genuine stress 

incontinence. Obstet Gynecol 1998 Jan; 

91(1):55-9. Case-series 

3770. Ross JW. Numerous indications for office 

flexible minihysteroscopy. J Am Assoc 

Gynecol Laparosc 2000 May; 7(2):221-6. Not 

eligible outcomes 

3771. Ross JW. Laparoscopic Burch 

colposuspension and overlapping 

sphincteroplasty for double incontinence. Jsls 

2001 Jul-Sep; 5(3):203-9. Case-series 

3772. Ross JW, Galen DI, Abbott K, et al. A 

prospective multisite study of radiofrequency 

bipolar energy for treatment of genuine stress 

incontinence. J Am Assoc Gynecol Laparosc 

2002 Nov; 9(4):493-9. Not eligible exposure 

3773. Rossignol G, Leandri P, Gautier JR, et al. 

Radical retropubic prostatectomy: 

complications and quality of life (429 cases, 

1983-1989). Eur Urol 1991; 19(3):186-91. 

Case series 

3774. Rossignol G, Leandri P, Ramon J, et al. 

Radical prostatectomy in the management of 

stage-A carcinoma of the prostate. Eur Urol 

1991; 20(3):179-83. Not eligible level of 

evidence 

3775. Rothbarth J, Bemelman WA, Meijerink WJ, et 

al. Long-term results of anterior anal sphincter 

repair for fecal incontinence due to obstetric 

injury / with invited commentaries. Dig Surg 

2000; 17(4):390-3; discussion 4. Case-series 

3776. Rothbarth J, Bemelman WA, Meijerink WJ, et 

al. What is the impact of fecal incontinence on 

quality of life? Dis Colon Rectum 2001 Jan; 

44(1):67-71. Case-series 

3777. Rouanet P, Senesse P, Bouamrirene D, et al. 

Anal sphincter reconstruction by dynamic 

graciloplasty after abdominoperineal resection 

for cancer. Dis Colon Rectum 1999 Apr; 

42(4):451-6. Case-series 

3778. Roumeguere T, Quackels T, Bollens R, et al. 

Trans-obturator vaginal tape (TOT) for female 

stress incontinence: one year follow-up in 120 

patients. Eur Urol 2005 Nov; 48(5):805-9. 

Case-series 

3779. Rousseau P, Fuentevilla-Clifton A. 

Acetazolamide and salicylate interaction in the 

elderly: a case report. J Am Geriatr Soc 1993 

Aug; 41(8):868-9. Case- Reports 

3780. Routh JC, Crimmins CR, Leibovich BC, et al. 

Impact of Parkinson's disease on continence 

after radical prostatectomy. Urology 2006 

Sep; 68(3):575-7. Case-series 

3781. Rovner ES, Gomes CM, Banner MP, et al. 

Ventral hernia of the urinary bladder with 

mixed urinary incontinence: treatment with 

herniorrhaphy and allograft fascial sling. 

Urology 2000 Jan; 55(1):145. Case Reports 

3782. Rovner ES, Wein AJ. Modern 

pharmacotherapy of urge urinary incontinence 

in the USA: tolterodine and oxybutynin. BJU 

Int 2000 Oct; 86 Suppl 2:44-53; discussion -4. 

Review 

3783. Roy S. The cost of continence. Elder Care 

1997 Dec-1998 Jan; 9(6 Suppl):3-4. Comment 

3784. Roy S. Continence. Services for a new 

century. Nurs Times 1999 Oct 20-26; 

95(42):65-7. Comment 

3785. Rozet F, Mandron E, Arroyo C, et al. 

Laparoscopic sacral colpopexy approach for 

genito-urinary prolapse: experience with 363 

cases. Eur Urol 2005 Feb; 47(2):230-6. Not 

eligible level of evidence 

3786. Rozmovits L, Ziebland S. Expressions of loss 

of adulthood in the narratives of people with 

colorectal cancer. Qual Health Res 2004 Feb; 

14(2):187-203. No associative hypothesis 

tested 

3787. Rubens DJ, Strang JG, Bogineni-Misra S, et 

al. Transperineal sonography of the rectum: 

anatomy and pathology revealed by 

sonography compared with CT and MR 

imaging. AJR Am J Roentgenol 1998 Mar; 

170(3):637-42. Not eligible exposure 

3788. Rubenstein JN, Hairston JC, Eggener SE, et 

al. Irritative voiding symptoms and 

microscopic hematuria caused by 

intraperitoneal calcified fat necrosis. Urology 

2002 Mar; 59(3):444. Case report 

3789. Rubenstein LZ, Alessi CA, Josephson KR, et 

al. A randomized trial of a screening, case 

finding, and referral system for older veterans 

in primary care. J Am Geriatr Soc 2007 Feb; 

55(2):166-74. Case Reports 

3790. Ruby CM, Hanlon JT, Fillenbaum GG, et al. 

Medication use and control of urination 

among community-dwelling older adults. J 

Aging Health 2005 Oct; 17(5):661-74. Not 

eligible level of evidence 

3791. Rudy D, Cline K, Harris R, et al. Time to 

onset of improvement in symptoms of 

overactive bladder using antimuscarinic 

treatment. BJU Int 2006 Mar; 97(3):540-6. 

Not eligible exposure 

3792. Rudy D, Cline K, Harris R, et al. Multicenter 

phase III trial studying trospium chloride in 

patients with overactive bladder. Urology 

2006 Feb; 67(2):275-80. Not eligible exposure 
B-169 

3793. Ruff CC, van Rijswijk L, Okoli A. The impact 

of urinary incontinence in African American 

women. Ostomy Wound Manage 2002 Dec; 

48(12):52-8. Not eligible target population 

3794. Ruiz-Deya G, Davis R, Srivastav SK, et al. 

Outpatient radical prostatectomy: impact of 

standard perineal approach on patient 

outcome. J Urol 2001 Aug; 166(2):581-6. Not 

eligible level of evidence 

3795. Rullier E, McBride T, Zerbib F, et al. Total 

anorectal and partial vaginal reconstruction 

with dynamic graciloplasty and colonic 

vaginoplasty after extended abdominoperineal 

resection: report of a case. Dis Colon Rectum 

1999 Aug; 42(8):1097-101. Case Reports 

3796. Rullier E, Zerbib F, Marrel A, et al. Validation 

of the French version of the Fecal 

Incontinence Quality-of-Life (FIQL) scale. 

Gastroenterol Clin Biol 2004 Jun-Jul; 28(6-7 

Pt 1):562-8. Not eligible exposure 

3797. Ruseler-van Embden JG, van Lieshout LM, 

Smits SA, et al. Potato tuber proteins 

efficiently inhibit human faecal proteolytic 

activity: implications for treatment of perianal dermatitis. Eur J Clin Invest 2004 Apr; 

34(4):303-11. Not eligible target population 

3798. Russell AL, Grigo HM, Joseph NS, et al. 

Evaluating the performance of pelvic floor 

exercises in women with urinary incontinence. 

J Reprod Med 2005 Jul; 50(7):529-32. Not 

eligible target population 

3799. Russo A, Botten R, Kong MF, et al. Effects of 

acute hyperglycaemia on anorectal motor and 

sensory function in diabetes mellitus. Diabet 

Med 2004 Feb; 21(2):176-82. Not eligible 

exposure 

3800. Rutman MP, Deng DY, Shah SM, et al. Spiral 

sling salvage anti-incontinence surgery in 

female patients with a nonfunctional urethra: 

technique and initial results. J Urol 2006 May; 

175(5):1794-8; discussion 8-9. Not eligible 

target population 

3801. Rutner AB, Levine SR, Schmaelzle JF. 

Processed porcine small intestine submucosa 

as a graft material for pubovaginal slings: 

durability and results. Urology 2003 Nov; 

62(5):805-9. Case-series 

3802. Ruud Bosch JL, Groen J. Treatment of 

refractory urge urinary incontinence with 

sacral spinal nerve stimulation in multiple 

sclerosis patients. Lancet 1996 Sep 14; 

348(9029):717-9. Case-series 

3803. Ryan PD, Harisinghani M, Lerwill MF, et al. 

Case records of the Massachusetts General 

Hospital. Case 6-2006. A 71-year-old woman 

with urinary incontinence and a mass in the 

bladder. N Engl J Med 2006 Feb 23; 

354(8):850-6. Case Reports 

3804. Ryhammer AM, Bek KM, Laurberg S. 

Multiple vaginal deliveries increase the risk of 

permanent incontinence of flatus urine in 

normal premenopausal women. Dis Colon 

Rectum 1995 Nov; 38(11):1206-9. Not 

eligible outcomes 

3805. Ryhammer AM, Laurberg S, Bek KM. Age 

and anorectal sensibility in normal women. 

Scand J Gastroenterol 1997 Mar; 32(3):278-

84. Not eligible exposure 

3806. Ryhammer AM, Laurberg S, Djurhuus JC, et 

al. No relationship between subjective 

assessment of urinary incontinence and pad 

test weight gain in a random population 

sample of menopausal women. J Urol 1998 

Mar; 159(3):800-3. Not eligible outcomes 

3807. Ryhammer AM, Laurberg S, Hermann AP. 

Long-term effect of vaginal deliveries on 

anorectal function in normal perimenopausal 

women. Dis Colon Rectum 1996 Aug; 

39(8):852-9. Not eligible outcomes 

3808. Ryhammer AM, Laurberg S, Hermann AP. No 

correlation between perineal position and 

pudendal nerve terminal motor latency in 

healthy perimenopausal women. Dis Colon 

Rectum 1998 Mar; 41(3):350-3. Not eligible 

outcomes 

3809. Ryhammer AM, Laurberg S, Sorensen FH. 

Effects of age on anal function in normal 

women. Int J Colorectal Dis 1997; 12(4):225-

9. Case-series 

3810. Ryn AK, Morren GL, Hallbook O, et al. 

Long-term results of electromyographic 

biofeedback training for fecal incontinence. 

Dis Colon Rectum 2000 Sep; 43(9):1262-6. 

Not eligible target population 

3811. Sabnis RB, Bapat SD, Desai RM, et al. 

Experience of continent urinary diversion with 

modified Koff's technique. Arch Esp Urol 

1992 May; 45(4):383-6. Case Reports 

3812. Sackier JM, Berci G, Hiatt JR, et al. 

Laparoscopic abdominoperineal resection of 

the rectum. Br J Surg 1992 Nov; 79(11):1207-

8. Case Reports 

3813. Safarinejad MR, Hosseini SY. Safety and 

efficacy of tramadol in the treatment of 

idiopathic detrusor overactivity: a doubleblind, placebo-controlled, randomized study. 

Br J Clin Pharmacol 2006 Apr; 61(4):456-63. 

Not eligible exposure 
B-170 

3814. Safir MH, Gousse AE, Rovner ES, et al. 4-

Defect repair of grade 4 cystocele. J Urol 1999 

Feb; 161(2):587-94. Case-series 

3815. Sagar PM, Holdsworth PJ, Johnston D. 

Correlation between laboratory findings and 

clinical outcome after restorative 

proctocolectomy: serial studies in 20 patients 

with end-to-end pouch-anal anastomosis. Br J 

Surg 1991 Jan; 78(1):67-70. Case-series 

3816. Sahadevan S, Lim PP, Choo PW. Dementia in 

the hospitalized elderly--a study of 100 

consecutive cases in Singapore. Int J Geriatr 

Psychiatry 1999 Apr; 14(4):266-71. Caseseries 

3817. Saigal CS, Gornbein J, Reid K, et al. Stability 

of time trade-off utilities for health states 

associated with the treatment of prostate 

cancer. Qual Life Res 2002 Aug; 11(5):405-

14. Not eligible level of evidence 

3818. Saigusa N, Belin BM, Choi HJ, et al. 

Recovery of the rectoanal inhibitory reflex 

after restorative proctocolectomy: does it 

correlate with nocturnal continence? Dis 

Colon Rectum 2003 Feb; 46(2):168-72. Caseseries 

3819. Sailer M, Bussen D, Debus ES, et al. Quality 

of life in patients with benign anorectal 

disorders. Br J Surg 1998 Dec; 85(12):1716-9. 

Not eligible outcomes 

3820. Saini J, Axelrod FB, Maayan C, et al. Urinary 

incontinence in familial dysautonomia. Int 

Urogynecol J Pelvic Floor Dysfunct 2003 

Aug; 14(3):209-13; discussion 13. Case-series 

3821. Sainio AP, Halme LE, Husa AI. Anal 

encirclement with polypropylene mesh for 

rectal prolapse and incontinence. Dis Colon 

Rectum 1991 Oct; 34(10):905-8. Case-series 

3822. Sainio AP, Voutilainen PE, Husa AI. 

Recovery of anal sphincter function following 

transabdominal repair of rectal prolapse: cause 

of improved continence? Dis Colon Rectum 

1991 Sep; 34(9):816-21. Case-series 

3823. Saint S, Kaufman SR, Rogers MA, et al. 

Condom versus indwelling urinary catheters: a 

randomized trial. J Am Geriatr Soc 2006 Jul; 

54(7):1055-61. Not eligible outcomes 

3824. Saito M, Kawatani M, Kinoshita Y, et al. 

Effectiveness of an anti-inflammatory drug, 

loxoprofen, for patients with nocturia. Int J 

Urol 2005 Aug; 12(8):779-82. Not eligible 

target population 

3825. Saito M, Watanabe T, Tabuchi F, et al. 

Urodynamic effects and safety of modified 

intravesical oxybutynin chloride in patients 

with neurogenic detrusor overactivity: 3 years 

experience. Int J Urol 2004 Aug; 11(8):592-6. 

Not eligible target population 

3826. Saito S, Murakami G. Radical perineal 

prostatectomy: a novel approach for 

lymphadenectomy from perineal incision. J 

Urol 2003 Oct; 170(4 Pt 1):1298-300. Caseseries 

3827. Sakai I, Harada K, Hara I, et al. 

Intussusception of the bladder neck does not 

promote early restoration to urinary 

continence after non-nerve-sparing radical 

retropubic prostatectomy. Int J Urol 2005 

Mar; 12(3):275-9. Case-series 

3828. Sakakibara R, Hattori T, Boku K, et al. 

Micturitional disturbance in neuro-Behcet's 

syndrome. Auton Neurosci 2000 Sep 1; 83(1-

2):86-9. Case-series 

3829. Sakakibara R, Hattori T, Fukutake T, et al. 

Micturitional disturbance in a patient with 

adrenomyeloneuropathy (AMN). Neurourol 

Urodyn 1998; 17(3):207-12. Case Reports 

3830. Sakakibara R, Hattori T, Kita K, et al. Stress 

induced urinary incontinence in patients with 

spinocerebellar degeneration. J Neurol 

Neurosurg Psychiatry 1998 Mar; 64(3):389-

91. Not eligible level of evidence 

3831. Sakakibara R, Hattori T, Tojo M, et al. 

Micturitional disturbance in progressive 

supranuclear palsy. J Auton Nerv Syst 1993 

Nov; 45(2):101-6. Case-series 

3832. Sakakibara R, Hattori T, Tojo M, et al. 

Micturitional disturbance in multiple system 

atrophy. Jpn J Psychiatry Neurol 1993 Sep; 

47(3):591-8. Not eligible exposure 

3833. Sakakibara R, Hattori T, Tojo M, et al. 

Micturitional disturbance in radiation 

myelopathy. J Spinal Disord 1993 Oct; 

6(5):402-5. Case-series 

3834. Sakakibara R, Hattori T, Tojo M, et al. The 

location of the paths subserving micturition: 

studies in patients with cervical myelopathy. J 

Auton Nerv Syst 1995 Nov 6; 55(3):165-8. 

Not eligible level of evidence 

3835. Sakakibara R, Hattori T, Uchiyama T, et al. 

Micturitional disturbance in pure autonomic 

failure. Neurology 2000 Jan 25; 54(2):499-

501. Case-series 

3836. Sakakibara R, Hattori T, Uchiyama T, et al. 

Uroneurological assessment of spina bifida 

cystica and occulta. Neurourol Urodyn 2003; 

22(4):328-34. Not eligible target population 
B-171 

3837. Sakakibara R, Hattori T, Uchiyama T, et al. 

Urinary function in elderly people with and 

without leukoaraiosis: relation to cognitive 

and gait function. J Neurol Neurosurg 

Psychiatry 1999 Nov; 67(5):658-60. Caseseries 

3838. Sakakibara R, Hattori T, Uchiyama T, et al. 

Micturitional disturbance in a patient with 

neurosarcoidosis. Neurourol Urodyn 2000; 

19(3):273-7. Case Reports 

3839. Sakakibara R, Hattori T, Uchiyama T, et al. 

Videourodynamic and sphincter motor unit 

potential analyses in Parkinson's disease and 

multiple system atrophy. J Neurol Neurosurg 

Psychiatry 2001 Nov; 71(5):600-6. Not 

eligible exposure 

3840. Sakakibara R, Hattori T, Uchiyama T, et al. 

Micturitional disturbance in subacute myelooptico-neuropathy (SMON). Auton Neurosci 

2001 Mar 23; 87(2-3):282-5. Case-series 

3841. Sakakibara R, Hattori T, Yasuda K, et al. 

Micturitional disturbance after acute 

hemispheric stroke: analysis of the lesion site 

by CT and MRI. J Neurol Sci 1996 Apr; 

137(1):47-56. Case-series 

3842. Sakakibara R, Hattori T, Yasuda K, et al. 

Micturitional disturbance in acute 

disseminated encephalomyelitis (ADEM). J 

Auton Nerv Syst 1996 Sep 12; 60(3):200-5. 

Case-series 

3843. Sakakibara R, Hattori T, Yasuda K, et al. 

Micturitional disturbance in Wernicke's 

encephalopathy. Neurourol Urodyn 1997; 

16(2):111-5. Case Reports 

3844. Sakakibara R, Ito T, Uchiyama T, et al. Lower 

urinary tract function in dementia of Lewy 

body type. J Neurol Neurosurg Psychiatry 

2005 May; 76(5):729-32. Not eligible 

exposure 

3845. Sakakibara R, Odaka T, Uchiyama T, et al. 

Colonic transit time, sphincter EMG, and 

rectoanal videomanometry in multiple system 

atrophy. Mov Disord 2004 Aug; 19(8):924-9. 

Not eligible exposure 

3846. Sakakibara R, Uchiyama T, Yamanishi T, et 

al. Urinary function in patients with 

corticobasal degeneration; comparison with 

normal subjects. Neurourol Urodyn 2004; 

23(2):154-8. Not eligible level of evidence 

3847. Sakakibara R, Uchiyama T, Yoshiyama M, et 

al. Micturitional disturbance in a patient with 

a spinal cavernous angioma. Neurourol 

Urodyn 2003; 22(6):606-10. Case- Reports 

3848. Sakakibara R, Uchiyama T, Yoshiyama M, et 

al. Preliminary communication: urodynamic 

assessment of donepezil hydrochloride in 

patients with Alzheimer's disease. Neurourol 

Urodyn 2005; 24(3):273-5. Case-series 

3849. Sakuragi N, Todo Y, Kudo M, et al. A 

systematic nerve-sparing radical hysterectomy 

technique in invasive cervical cancer for 

preserving postsurgical bladder function. Int J 

Gynecol Cancer 2005 Mar-Apr; 15(2):389-97. 

Case-series 

3850. Sale PG, Wyman JF. Achievement of goals 

associated with bladder training by older 

incontinent women. Appl Nurs Res 1994 May; 

7(2):93-6. Comment 

3851. Salemans JM, Nagengast FM, Lubbers EJ, et 

al. Postoperative and long-term results of ileal 

pouch-anal anastomosis for ulcerative colitis 

and familial polyposis coli. Dig Dis Sci 1992 

Dec; 37(12):1882-9. Case-series 

3852. Saliba D, Solomon D, Rubenstein L, et al. 

Feasibility of quality indicators for the 

management of geriatric syndromes in nursing 

home residents. J Am Med Dir Assoc 2005 

May-Jun; 6(3 Suppl):S50-9. Not eligible 

target population 

3853. Saliken JC, Donnelly BJ, Brasher P, et al. 

Outcome and safety of transrectal US-guided 

percutaneous cryotherapy for localized 

prostate cancer. J Vasc Interv Radiol 1999 

Feb; 10(2 Pt 1):199-208. Case-series 

3854. Salomon CG, Dudiak CM, Pyle JM, et al. 

Transrectal ultrasound of the prostate bed after 

collagen injection. J Comput Assist Tomogr 

1996 Mar-Apr; 20(2):279-82. Case-series 

3855. Salonia A, Zanni G, Nappi RE, et al. Sexual 

dysfunction is common in women with lower 

urinary tract symptoms and urinary 

incontinence: results of a cross-sectional 

study. Eur Urol 2004 May; 45(5):642-8; 

discussion 8. Not eligible outcomes 

3856. Saltzstein L. Management of overactive 

bladder in a difficult-to-treat patient with a 

transdermal formulation of oxybutynin. Urol 

Nurs 2005 Aug; 25(4):260-2. Case- Reports 

3857. Saltzstein RJ, Romano J. The efficacy of 

colostomy as a bowel management alternative 

in selected spinal cord injury patients. J Am 

Paraplegia Soc 1990 Apr; 13(2):9-13. CaseReports 

3858. Salvage D. Order out of chaos. Nurs Stand 

2000 Jun 14-20; 14(39):20-1. Case Reports 
B-172 

3859. Salvatore S, Khullar V, Cardozo L, et al. 

Long-term prospective randomized study 

comparing two different regimens of 

oxybutynin as a treatment for detrusor 

overactivity. Eur J Obstet Gynecol Reprod 

Biol 2005 Apr 1; 119(2):237-41. Not eligible 

exposure 

3860. Salvioli B, Bharucha AE, Rath-Harvey D, et 

al. Rectal compliance, capacity, and rectoanal 

sensation in fecal incontinence. Am J 

Gastroenterol 2001 Jul; 96(7):2158-68. Not 

eligible outcomes 

3861. Samanci N, Dora B, Kizilay F, et al. Factors 

affecting one year mortality and functional 

outcome after first ever ischemic stroke in the 

region of Antalya, Turkey (a hospital-based 

study). Acta Neurol Belg 2004 Dec; 

104(4):154-60. Not eligible outcomes 

3862. Samandari T, Smith BD, Morgan HJ. 

Progressive somnolence and confusion in a 

patient with hereditary hemorrhagic 

telangiectasias. Tenn Med 1996 Nov; 

89(11):417-8. Case Reports 

3863. Samil RS, Wishnuwardhani SD. Health of 

Indonesian women city-dwellers of 

perimenopausal age. Maturitas 1994 Oct; 

19(3):191-7. Not eligible outcomes 

3864. Samli M, Singla AK. Absorbable versus 

nonabsorbable graft: outcome of bone 

anchored male sling for post-radical 

prostatectomy incontinence. J Urol 2005 Feb; 

173(2):499-502. Case-series 

3865. Sammour ZM, Gomes CM, Duarte RJ, et al. 

Voiding dysfunction and the Williams-Beuren 

syndrome: a clinical and urodynamic 

investigation. J Urol 2006 Apr; 175(4):1472-6. 

Not eligible target population 

3866. Sampselle CM. Changes in pelvic muscle 

strength and stress urinary incontinence 

associated with childbirth. J Obstet Gynecol 

Neonatal Nurs 1990 Sep-Oct; 19(5):371-7. 

Case-series 

3867. Sampselle CM, Messer KL, Seng JS, et al. 

Learning outcomes of a group behavioral 

modification program to prevent urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Nov-Dec; 16(6):441-6. Not 

eligible outcomes 

3868. Sampselle CM, Miller JM, Herzog AR, et al. 

Behavioral modification: group teaching 

outcomes. Urol Nurs 1996 Jun; 16(2):59-63. 

Comment 

3869. Sampselle CM, Wyman JF, Thomas KK, et al. 

Continence for women: a test of AWHONN's 

evidence-based protocol in clinical practice. 

Association of Women's Health Obstetric and 

Neonatal Nurses. J Obstet Gynecol Neonatal 

Nurs 2000 Jan-Feb; 29(1):18-26. Not eligible 

level of evidence 

3870. Sampselle CM, Wyman JF, Thomas KK, et al. 

Continence for women: evaluation of 

AWHONN's third research utilization project. 

Association of Women's Health Obstetric and 

Neonatal Nurses. J Obstet Gynecol Neonatal 

Nurs 2000 Jan-Feb; 29(1):9-17. Not eligible 

outcomes 

3871. Samsioe G, Heraib F, Lidfeldt J, et al. 

Urogenital symptoms in women aged 50-59 

years. Women's Health in Lund Area 

(WHILSA) Study Group. Gynecol Endocrinol 

1999 Apr; 13(2):113-7. Not eligible level of 

evidence 

3872. Samuelsson E, Mansson L, Milsom I. 

Incontinence aids in Sweden: users and costs. 

BJU Int 2001 Dec; 88(9):893-8. Not eligible 

outcomes 

3873. Sanchez de Badajoz E, Diaz Ramirez F, Vara 

Thorbeck C. Stress incontinence: a new 

endoscopic approach. Urology 1990 Nov; 

36(5):403-5. Case-series 

3874. Sanchez-Ortiz RF, Broderick GA, Chaikin 

DC, et al. Collagen injection therapy for postradical retropubic prostatectomy incontinence: 

role of Valsalva leak point pressure. J Urol 

1997 Dec; 158(6):2132-6. 

3875. Sand P, Zinner N, Newman D, et al. 

Oxybutynin transdermal system improves the 

quality of life in adults with overactive 

bladder: a multicentre, community-based, 

randomized study. BJU Int 2007 Apr; 

99(4):836-44. Not eligible exposure 

3876. Sand PK, Appell R. Disruptive effects of 

overactive bladder and urge urinary 

incontinence in younger women. Am J Med 

2006 Mar; 119(3 Suppl 1):16-23. Review 

3877. Sand PK, Goldberg RP, Dmochowski RR, et 

al. The impact of the overactive bladder 

syndrome on sexual function: a preliminary 

report from the Multicenter Assessment of 

Transdermal Therapy in Overactive Bladder 

with Oxybutynin trial. Am J Obstet Gynecol 

2006 Dec; 195(6):1730-5. Not eligible 

outcomes 
B-173 

3878. Sand PK, Miklos J, Ritter H, et al. A 

comparison of extended-release oxybutynin 

and tolterodine for treatment of overactive 

bladder in women. Int Urogynecol J Pelvic 

Floor Dysfunct 2004 Jul-Aug; 15(4):243-8. 

Not eligible exposure 

3879. Sand PK, Staskin D, Miller J, et al. Effect of a 

urinary control insert on quality of life in 

incontinent women. Int Urogynecol J Pelvic 

Floor Dysfunct 1999; 10(2):100-5. Not 

eligible target population 

3880. Sander P, Bjarnesen J, Mouritsen L, et al. 

Anal incontinence after obstetric third- 

/fourth-degree laceration. One-year follow-up 

after pelvic floor exercises. Int Urogynecol J 

Pelvic Floor Dysfunct 1999; 10(3):177-81. 

Case-series 

3881. Sander P, Mouritsen L, Andersen JT, et al. 

Should measurement of maximum urinary 

flow rate and residual urine volume be a part 

of a "minimal care" assessment programme in 

female incontinence? Scand J Urol Nephrol 

2002; 36(2):124-7. Not eligible outcomes 

3882. Sander P, Thyssen H, Lose G, et al. Effect of a 

vaginal device on quality of life with urinary 

stress incontinence. Obstet Gynecol 1999 

Mar; 93(3):407-11. Not eligible target 

population 

3883. Sandvik H. Criterion validity of responses to 

patient vignettes: an analysis based on 

management of female urinary incontinence. 

Fam Med 1995 Jun; 27(6):388-92. Not eligible 

target population 

3884. Sandvik H. Health information and interaction 

on the internet: a survey of female urinary 

incontinence. BMJ 1999 Jul 3; 319(7201):29-

32. Not eligible target population 

3885. Sandvik H, Hunskaar S. Incontinence pads--

prevalence of use and individual consumption. 

Scand J Soc Med 1993 Jun; 21(2):120-1. Not 

eligible outcomes 

3886. Sandvik H, Hunskaar S. Incontinence in 

women: different response rates may 

introduce bias in community studies of pad 

consumption. J Epidemiol Community Health 

1994 Aug; 48(4):419. Comment 

3887. Sandvik H, Hunskaar S. General practitioners' 

management of female urinary incontinence. 

Medical records do not reflect patients' recall. 

Scand J Prim Health Care 1995 Sep; 

13(3):168-74. Not eligible outcomes 

3888. Sandvik H, Hunskaar S, Eriksen BC. 

Management of urinary incontinence in 

women in general practice: actions taken at 

the first consultation. Scand J Prim Health 

Care 1990 Mar; 8(1):3-8. Case- Reports 

3889. Sandvik H, Seim A, Vanvik A, et al. A 

severity index for epidemiological surveys of 

female urinary incontinence: comparison with 

48-hour pad-weighing tests. Neurourol 

Urodyn 2000; 19(2):137-45. Not eligible 

outcomes 

3890. Sangalli MR, Marti MC. Results of sphincter 

repair in postobstetric fecal incontinence. J 

Am Coll Surg 1994 Nov; 179(5):583-6. Caseseries 

3891. Sangwan YP, Coller JA, Barrett RC, et al. 

Distal rectoanal excitatory reflex: a reliable 

index of pudendal neuropathy? Dis Colon 

Rectum 1995 Sep; 38(9):916-20. Not eligible 

exposure 

3892. Sangwan YP, Coller JA, Barrett RC, et al. 

Unilateral pudendal neuropathy. Impact on 

outcome of anal sphincter repair. Dis Colon 

Rectum 1996 Jun; 39(6):686-9. Not eligible 

exposure 

3893. Sangwan YP, Coller JA, Barrett RC, et al. Can 

manometric parameters predict response to 

biofeedback therapy in fecal incontinence? 

Dis Colon Rectum 1995 Oct; 38(10):1021-5. 

Case-series 

3894. Sangwan YP, Coller JA, Schoetz DJ, Jr., et al. 

Latency measurement of rectoanal reflexes. 

Dis Colon Rectum 1995 Dec; 38(12):1281-5. 

Question 4 

3895. Sangwan YP, Coller JA, Schoetz DJ, Jr., et al. 

Relationship between manometric anal waves 

and fecal incontinence. Dis Colon Rectum 

1995 Apr; 38(4):370-4. Not eligible outcomes 

3896. Sangwan YP, Coller JA, Schoetz DJ, et al. 

Spectrum of abnormal rectoanal reflex 

patterns in patients with fecal incontinence. 

Dis Colon Rectum 1996 Jan; 39(1):59-65. 

Question 4 

3897. Sangwan YP, Schoetz DJ, Jr., Murray JJ, et al. 

Perianal Crohn's disease. Results of local 

surgical treatment. Dis Colon Rectum 1996 

May; 39(5):529-35. Case-series 

3898. Santoro GA, Eitan BZ, Pryde A, et al. Open 

study of low-dose amitriptyline in the 

treatment of patients with idiopathic fecal 

incontinence. Dis Colon Rectum 2000 Dec; 

43(12):1676-81; discussion 81-2. Not eligible 

target population 

3899. Santoro GA, Makhdoomi KR, Eitan BZ, et al. 

Functional outcome after coloanal 

anastomosis with J-colonic pouch for rectal 

cancer. Ann Ital Chir 1998 Jul-Aug; 

69(4):485-9. Case-series 
B-174 

3900. Sapin E, Centonze A, Moog R, et al. 

Transanal coloanal anastomosis for 

Hirschsprung's disease: comparison between 

endorectal and perirectal pull-through 

procedures. Eur J Pediatr Surg 2006 Oct; 

16(5):312-7. Not eligible target population 

3901. Sapmaz E, Celik H. Burch colposuspension 

performed at cesarean delivery in pregnancies 

complicated by genuine stress urinary 

incontinence. J Reprod Med 2003 Mar; 

48(3):191-3. Case-reports 

3902. Sapsford RR, Hodges PW. Contraction of the 

pelvic floor muscles during abdominal 

maneuvers. Arch Phys Med Rehabil 2001 

Aug; 82(8):1081-8. Not eligible target 

population 

3903. Saraiva MM, Saraiva AM. Anal tonometry: a 

quick method of anal manometry. Dis Colon 

Rectum 1991 May; 34(5):396-400. Not 

eligible exposure 

3904. Sarli L, Pavlidis C, Cinieri FG, et al. 

Prospective comparison of laparoscopic left 

hemicolectomy for colon cancer with 

laparoscopic left hemicolectomy for benign 

colorectal disease. World J Surg 2006 Mar; 

30(3):446-52. Case-series 

3905. Sartore A, Pregazzi R, Bortoli P, et al. The 

urine stream interruption test and pelvic 

muscle function in the puerperium. Int J 

Gynaecol Obstet 2002 Sep; 78(3):235-9. Not 

eligible outcomes 

3906. Sartore A, Pregazzi R, Bortoli P, et al. 

Perineal evaluation in the puerperium. Role of 

testing with a cotton-tipped swab. J Reprod 

Med 2002 Aug; 47(8):670-4. Not eligible 

outcomes 

3907. Sartore A, Pregazzi R, Bortoli P, et al. 

Assessment of pelvic floor muscle function 

after vaginal delivery. Clinical value of 

different tests. J Reprod Med 2003 Mar; 

48(3):171-4. 

3908. Sato T, Konishi F, Minakami H, et al. Pelvic 

floor disturbance after childbirth: vaginal 

delivery damages the upper levels of sphincter 

innervation. Dis Colon Rectum 2001 Aug; 

44(8):1155-61. Not eligible outcomes 

3909. Sauer HA, Klutke CG. Transvaginal 

sacrospinous ligament fixation for treatment 

of vaginal prolapse. J Urol 1995 Sep; 

154(3):1008-12. Case-series 

3910. Sauerwein D, Ingunza W, Fischer J, et al. 

Extradural implantation of sacral anterior root 

stimulators. J Neurol Neurosurg Psychiatry 

1990 Aug; 53(8):681-4. Case-series 

3911. Saunders JR, Darakhshan AA, Eccersley AJ, 

et al. The Colorectal Development Unit: 

impact on functional outcome for the 

electrically stimulated gracilis neoanal 

sphincter. Colorectal Dis 2006 Jan; 8(1):46-

55. Case-series 

3912. Saunders JR, Eccersley AJ, Williams NS. Use 

of a continent colonic conduit for treatment of 

refractory evacuatory disorder following 

construction of an electrically stimulated 

gracilis neoanal sphincter. Br J Surg 2003 

Nov; 90(11):1416-21. Case-series 

3913. Saunders JR, Williams NS, Eccersley AJ. The 

combination of electrically stimulated gracilis 

neoanal sphincter and continent colonic 

conduit: a step forward for total anorectal 

reconstruction? Dis Colon Rectum 2004 Mar; 

47(3):354-63; discussion 63-6. Case-series 

3914. Savoye G, Leroi AM, Denis P, et al. 

Manometric assessment of an artificial bowel 

sphincter. Br J Surg 2000 May; 87(5):586-9. 

Case-series 

3915. Savoye-Collet C, Savoye G, Koning E, et al. 

Defecographic disorders in anal incontinent 

women: relation to symptoms and anal 

endosonographic patterns. Scand J 

Gastroenterol 2005 Feb; 40(2):141-6. Not 

eligible outcomes 

3916. Savoye-Collet C, Savoye G, Koning E, et al. 

Defecography in symptomatic older women 

living at home. Age Ageing 2003 May; 

32(3):347-50. Not eligible exposure 

3917. Savoye-Collet C, Savoye G, Koning E, et al. 

Endosonography in the evaluation of anal 

function after primary repair of a third-degree 

obstetric tear. Scand J Gastroenterol 2003 

Nov; 38(11):1149-53. Case-series 

3918. Savoye-Collet C, Savoye G, Koning E, et al. 

Anal endosonography after sphincter repair: 

specific patterns related to clinical outcome. 

Abdom Imaging 1999 Nov-Dec; 24(6):569-

73. Case-series 

3919. Saxer S, Halfens RJ, Muller M, et al. Risk 

factors for urinary incontinence in nursing 

home residents. Swiss Med Wkly 2005 Aug 

20; 135(33-34):495-502. Not eligible level of 

evidence 

3920. Sayegh ME, French ME. Urge incontinence 

secondary to a large abdominal haematoma. 

Br J Urol 1995 Aug; 76(2):261-2. Case 

Reports 
B-175 

3921. Scarpa KP, Herrmann V, Palma PC, et al. 

Prevalence and correlates of stress urinary 

incontinence during pregnancy: a survey at 

UNICAMP Medical School, Sao Paulo, 

Brazil. Int Urogynecol J Pelvic Floor Dysfunct 

2006 May; 17(3):219-23. Not eligible 

outcomes 

3922. Scarpero HM, Fiske J, Xue X, et al. American 

Urological Association Symptom Index for 

lower urinary tract symptoms in women: 

correlation with degree of bother and impact 

on quality of life. Urology 2003 Jun; 

61(6):1118-22. Not eligible exposure 

3923. Schaal CH, Costa RP, Sala FC, et al. 

Longitudinal urethral sling with prepubic and 

retropubic fixation for male urinary 

incontinence. Int Braz J Urol 2004 Jul-Aug; 

30(4):307-11; discussion 12. Case-series 

3924. Schaan M, Boszczyk B, Jaksche H, et al. 

Intraoperative urodynamics in spinal cord 

surgery: a study of feasibility. Eur Spine J 

2004 Feb; 13(1):39-43. Case-series 

3925. Schaer GN, Koechli OR, Schuessler B, et al. 

Improvement of perineal sonographic bladder 

neck imaging with ultrasound contrast 

medium. Obstet Gynecol 1995 Dec; 

86(6):950-4. Not eligible exposure 

3926. Schaer GN, Koechli OR, Schuessler B, et al. 

Can simultaneous perineal sonography and 

urethrocystometry help explain urethral 

pressure variations? Neurourol Urodyn 1997; 

16(1):31-8. Not eligible outcomes 

3927. Schaer GN, Perucchini D, Munz E, et al. 

Sonographic evaluation of the bladder neck in 

continent and stress-incontinent women. 

Obstet Gynecol 1999 Mar; 93(3):412-6. Not 

eligible outcomes 

3928. Schaer GN, Siegwart R, Perucchini D, et al. 

Examination of voiding in seated women 

using a remote-controlled ultrasound probe. 

Obstet Gynecol 1998 Feb; 91(2):297-301. Not 

eligible outcomes 

3929. Schafer A, Enck P, Heyer T, et al. 

Endosonography of the anal sphincters: 

incontinent and continent patients and healthy 

controls. Z Gastroenterol 1994 Jun; 32(6):328-

31. Not eligible outcomes 

3930. Schafer R, Heyer T, Gantke B, et al. Anal 

endosonography and manometry: comparison 

in patients with defecation problems. Dis 

Colon Rectum 1997 Mar; 40(3):293-7. Not 

eligible outcomes 

3931. Schatz H, Henriksson L. Pain during the TVT 

procedure performed under local anesthesia. 

Int Urogynecol J Pelvic Floor Dysfunct 2003 

Nov; 14(5):347-9; discussion 9. Case-series 

3932. Schatzl G, Madersbacher S, Hofbauer J, et al. 

The impact of urinary extravasation after 

radical retropubic prostatectomy on urinary 

incontinence and anastomotic strictures. Eur 

Urol 1999 Sep; 36(3):187-90. Not eligible 

exposure 

3933. Scheepens WA, Weil EH, van Koeveringe 

GA, et al. Buttock placement of the 

implantable pulse generator: a new 

implantation technique for sacral 

neuromodulation--a multicenter study. Eur 

Urol 2001 Oct; 40(4):434-8. Not eligible 

target population 

3934. Scheinfeld N. The legal aspects of 

incontinence. Ostomy Wound Manage 2005 

Dec; 51(12):24, 6. Comment 

3935. Schettini M, Fortunato P, Gallucci M. 

Abdominal sacral colpopexy with prolene 

mesh. Int Urogynecol J Pelvic Floor Dysfunct 

1999; 10(5):295-9. Case-series 

3936. Scheuer M, Kuijpers HC, Bleijenberg G. 

Effect of electrostimulation on sphincter 

function in neurogenic fecal continence. Dis 

Colon Rectum 1994 Jun; 37(6):590-3; 

discussion 3-4. Case-series 

3937. Scheve AA, Engel BT, McCormick KA, et al. 

Exercise in continence. Geriatr Nurs 1991 

May-Jun; 12(3):124. Comment 

3938. Schick E, Jolivet-Tremblay M, Tessier J, et al. 

Observations on the function of the female 

urethra: III: An overview with special 

reference to the relation between urethral 

hypermobility and urethral incompetence. 

Neurourol Urodyn 2004; 23(1):22-6. Not 

eligible outcomes 

3939. Schiedeck TH, Schwandner O, Scheele J, et 

al. Rectal prolapse: which surgical option is 

appropriate? Langenbecks Arch Surg 2005 

Feb; 390(1):8-14. Review 

3940. Schiessel R, Karner-Hanusch J, Herbst F, et 

al. Intersphincteric resection for low rectal 

tumours. Br J Surg 1994 Sep; 81(9):1376-8. 

Case-series 

3941. Schiessel R, Novi G, Holzer B, et al. 

Technique and long-term results of 

intersphincteric resection for low rectal 

cancer. Dis Colon Rectum 2005 Oct; 

48(10):1858-65; discussion 65-7. Case-series 

3942. Schiff D, O'Neill BP. Intramedullary spinal 

cord metastases: clinical features and 

treatment outcome. Neurology 1996 Oct; 

47(4):906-12. Case-series 

3943. Schiller LR. Electrifying progress for fecal 

incontinence. Curr Gastroenterol Rep 2004 

Oct; 6(5):387-8. Comment 
B-176 

3944. Schilling A, Krawczak G, Friesen A, et al. 

Pregnancy in a patient with an ileal substitute 

bladder followed by severe destabilization of 

the pelvic support. J Urol 1996 Apr; 

155(4):1389-90. Case-reports 

3945. Schiotz HA. One month maximal 

electrostimulation for genuine stress 

incontinence in women. Neurourol Urodyn 

1994; 13(1):43-50. Not eligible target 

population 

3946. Schiotz HA. Comparison of 1 and 3 days' 

transurethral Foley catheterization after 

retropubic incontinence surgery. Int 

Urogynecol J Pelvic Floor Dysfunct 1996; 

7(2):98-101. Not eligible outcomes 

3947. Schirm V, Baumgardner J, Dowd T, et al. 

Development of a healthy bladder education 

program for older adults. Geriatr Nurs 2004 

Sep-Oct; 25(5):301-6. Not eligible outcomes 

3948. Schlossmacher MG, Hamann C, Cole AG, et 

al. Case records of the Massachusetts General 

Hospital. Weekly clinicopathological 

exercises. Case 27-2004. A 79-year-old 

woman with disturbances in gait, cognition, 

and autonomic function. N Engl J Med 2004 

Aug 26; 351(9):912-22. Case- Reports 

3949. Schluender SJ, Mei L, Yang H, et al. Can a 

meta-analysis answer the question: is 

mucosectomy and handsewn or double-stapled 

anastomosis better in ileal pouch-anal 

anastomosis? Am Surg 2006 Oct; 72(10):912-

6. Review and meta-analysis 

3950. Schmid DM, Curt A, Hauri D, et al. Motor 

evoked potentials (MEP) and evoked pressure 

curves (EPC) from the urethral compressive 

musculature (UCM) by functional magnetic 

stimulation in healthy volunteers and patients 

with neurogenic incontinence. Neurourol 

Urodyn 2005; 24(2):117-27. Not eligible 

outcomes 

3951. Schmid DM, Sauermann P, Werner M, et al. 

Experience with 100 cases treated with 

botulinum-A toxin injections in the detrusor 

muscle for idiopathic overactive bladder 

syndrome refractory to anticholinergics. J 

Urol 2006 Jul; 176(1):177-85. Not eligible 

target population 

3952. Schmidt CM, Horton KM, Sitzmann JV, et al. 

Simple radiographic evaluation of ileoanal 

pouch volume. Dis Colon Rectum 1996 Jan; 

39(1):66-73. Case-series 

3953. Schmidt RA. Treatment of unstable bladder. 

Urology 1991 Jan; 37(1):28-32. Case Reports 

3954. Schneider T, Sperling H, Rossi R, et al. Do 

early injections of bulking agents following 

radical prostatectomy improve early 

continence? World J Urol 2005 Nov; 

23(5):338-42. Case-series 

3955. Schnelle JF. Treatment of urinary 

incontinence in nursing home patients by 

prompted voiding. J Am Geriatr Soc 1990 

Mar; 38(3):356-60. 

3956. Schnelle JF, Adamson GM, Cruise PA, et al. 

Skin disorders and moisture in incontinent 

nursing home residents: intervention 

implications. J Am Geriatr Soc 1997 Oct; 

45(10):1182-8. Not eligible outcomes 

3957. Schnelle JF, Alessi CA, Al-Samarrai NR, et 

al. The nursing home at night: effects of an 

intervention on noise, light, and sleep. J Am 

Geriatr Soc 1999 Apr; 47(4):430-8. Not 

eligible outcomes 

3958. Schnelle JF, Bates-Jensen BM, Chu L, et al. 

Accuracy of nursing home medical record 

information about care-process delivery: 

implications for staff management and 

improvement. J Am Geriatr Soc 2004 Aug; 

52(8):1378-83. Not eligible outcomes 

3959. Schnelle JF, Cadogan MP, Grbic D, et al. A 

standardized quality assessment system to 

evaluate incontinence care in the nursing 

home. J Am Geriatr Soc 2003 Dec; 

51(12):1754-61. Not eligible outcomes 

3960. Schnelle JF, Cadogan MP, Yoshii J, et al. The 

minimum data set urinary incontinence quality 

indicators: do they reflect differences in care 

processes related to incontinence? Med Care 

2003 Aug; 41(8):909-22. Not eligible level of 

evidence 

3961. Schnelle JF, Cruise PA, Alessi CA, et al. 

Individualizing nighttime incontinence care in 

nursing home residents. Nurs Res 1998 JulAug; 47(4):197-204. Not eligible target 

population 

3962. Schnelle JF, Kapur K, Alessi C, et al. Does an 

exercise and incontinence intervention save 

healthcare costs in a nursing home 

population? J Am Geriatr Soc 2003 Feb; 

51(2):161-8. Not eligible outcomes 

3963. Schnelle JF, Keeler E, Hays RD, et al. A cost 

and value analysis of two interventions with 

incontinent nursing home residents. J Am 

Geriatr Soc 1995 Oct; 43(10):1112-7. Not 

eligible outcomes 
B-177 

3964. Schnelle JF, MacRae PG, Ouslander JG, et al. 

Functional Incidental Training, mobility 

performance, and incontinence care with 

nursing home residents. J Am Geriatr Soc 

1995 Dec; 43(12):1356-62. Not eligible 

outcomes 

3965. Schnelle JF, Smith RL. Quality indicators for 

the management of urinary incontinence in 

vulnerable community-dwelling elders. Ann 

Intern Med 2001 Oct 16; 135(8 Pt 2):752-8. 

Review 

3966. Scholes D, Hooton TM, Roberts PL, et al. 

Risk factors associated with acute 

pyelonephritis in healthy women. Ann Intern 

Med 2005 Jan 4; 142(1):20-7. Not eligible 

outcomes 

3967. Scholler-Gyure M, Nesselaar C, van 

Wieringen H, et al. Treatment of defecation 

disorders by colonic enemas in children with 

spina bifida. Eur J Pediatr Surg 1996 Dec; 6 

Suppl 1:32-4. Not eligible target population 

3968. Schonherr MC, Groothoff JW, Mulder GA, et 

al. Functional outcome of patients with spinal 

cord injury: rehabilitation outcome study. Clin 

Rehabil 1999 Dec; 13(6):457-63. Case-series 

3969. Schostak M, Miller K, Muller M, et al. 

Transvaginal bone anchors in female stress 

urinary incontinence: poor results. Gynecol 

Obstet Invest 2002; 54(3):154-8. Case-series 

3970. Schouten WR, Briel JW, Auwerda JJ. 

Relationship between anal pressure and 

anodermal blood flow. The vascular 

pathogenesis of anal fissures. Dis Colon 

Rectum 1994 Jul; 37(7):664-9. Not eligible 

exposure 

3971. Schouten WR, Gosselink MJ, Boerma MO, et 

al. Rectal wall contractility in response to an 

evoked urge to defecate in patients with 

obstructed defecation. Dis Colon Rectum 

1998 Apr; 41(4):473-9. Case-series 

3972. Schouten WR, Zimmerman DD, Briel JW. 

Transanal advancement flap repair of 

transsphincteric fistulas. Dis Colon Rectum 

1999 Nov; 42(11):1419-22; discussion 22-3. 

Case-series 

3973. Schraffordt Koops SE, Bisseling TM, Heintz 

AP, et al. Prospective analysis of 

complications of tension-free vaginal tape 

from The Netherlands Tension-free Vaginal 

Tape study. Am J Obstet Gynecol 2005 Jul; 

193(1):45-52. Not eligible outcomes 

3974. Schraffordt Koops SE, Bisseling TM, Heintz 

AP, et al. Quality of life before and after TVT, 

a prospective multicentre cohort study, results 

from the Netherlands TVT database. Bjog 

2006 Jan; 113(1):26-9. Not eligible outcomes 

3975. Schulman SL, Zderic S, Kaplan P. Increased 

prevalence of urinary symptoms and voiding 

dysfunction in Williams syndrome. J Pediatr 

1996 Sep; 129(3):466-9. Not eligible target 

population 

3976. Schulte-Baukloh H, Thalau F, Sturzebecher B, 

et al. Pubovaginal bone anchor fixation with 

polyethylene versus fascia lata slings in the 

treatment of female stress incontinence: sling 

material and processing are predominant 

factors in success. Can J Urol 2005 Apr; 

12(2):2581-7. Case-series 

3977. Schulte-Baukloh H, Weiss C, Stolze T, et al. 

Botulinum-A toxin detrusor and sphincter 

injection in treatment of overactive bladder 

syndrome: objective outcome and patient 

satisfaction. Eur Urol 2005 Dec; 48(6):984-

90; discussion 90. Not eligible target 

population 

3978. Schultheiss D, Hofner K, Oelke M, et al. Does 

bone anchor fixation improve the outcome of 

percutaneous bladder neck suspension in 

female stress urinary incontinence? Br J Urol 

1998 Aug; 82(2):192-5. Case-series 

3979. Schultz A, Talseth T. Continent urinary 

diversion in patients with dysfunction of the 

lower urinary tract. Experience with the 

detubularized right colonic segment as urinary 

reservoir. Scand J Urol Nephrol Suppl 1996; 

179:93-6. Case-series 

3980. Schultz I, Mellgren A, Dolk A, et al. 

Continence is improved after the Ripstein 

rectopexy. Different mechanizms in rectal 

prolapse and rectal intussusception? Dis Colon 

Rectum 1996 Mar; 39(3):300-6. Case-series 

3981. Schultz I, Mellgren A, Nilsson BY, et al. 

Preoperative electrophysiologic assessment 

cannot predict continence after rectopexy. Dis 

Colon Rectum 1998 Nov; 41(11):1392-8. 

Case-series 

3982. Schurch B, de Seze M, Denys P, et al. 

Botulinum toxin type a is a safe and effective 

treatment for neurogenic urinary incontinence: 

results of a single treatment, randomized, 

placebo controlled 6-month study. J Urol 2005 

Jul; 174(1):196-200. Not eligible exposure 

3983. Schurch B, Reilly I, Reitz A, et al. 

Electrophysiological recordings during the 

peripheral nerve evaluation (PNE) test in 

complete spinal cord injury patients. World J 

Urol 2003 May; 20(6):319-22. Case-series 
B-178 

3984. Schurch B, Stohrer M, Kramer G, et al. 

Botulinum-A toxin for treating detrusor 

hyperreflexia in spinal cord injured patients: a 

new alternative to anticholinergic drugs? 

Preliminary results. J Urol 2000 Sep; 164(3 Pt 

1):692-7. Case-series 

3985. Schuur PM, Kasteren ME, Sabbe L, et al. 

Urinary tract infections with Aerococcus 

urinae in the south of The Netherlands. Eur J 

Clin Microbiol Infect Dis 1997 Dec; 

16(12):871-5. Not eligible outcomes 

3986. Schwandner O, Schiedeck TH, Bruch HP. 

Stoma creation for fecal diversion: is the 

laparoscopic technique appropriate? Int J 

Colorectal Dis 1998; 13(5-6):251-5. Caseseries 

3987. Schwartz SL, Kennelly MJ, McGuire EJ, et al. 

Incontinent ileo-vesicostomy urinary diversion 

in the treatment of lower urinary tract 

dysfunction. J Urol 1994 Jul; 152(1):99-102. 

case-series 

3988. Scott AD, Henry MM, Phillips RK. Clinical 

assessment and anorectal manometry before 

postanal repair: failure to predict outcome. Br 

J Surg 1990 Jun; 77(6):628-9. Case-series 

3989. Scott D. Continence. Bangladeshi venture. 

Nurs Times 1999 Oct 20-26; 95(42):76-9. 

Comment 

3990. Scotti RJ, Garely AD, Greston WM, et al. 

Paravaginal repair of lateral vaginal wall 

defects by fixation to the ischial periosteum 

and obturator membrane. Am J Obstet 

Gynecol 1998 Dec; 179(6 Pt 1):1436-45. 

Case-series 

3991. Seaman EK, Benson MC. Improved 

continence with tubularized bladder neck 

reconstruction following radical retropubic 

prostatectomy. Urology 1996 Apr; 47(4):532-

5. Case-series 

3992. Seccia M, Banti P, Zocco G, et al. Restoration 

of fecal continence with chronic 

electrostimulation of gracilis muscle 17 years 

after a Pickrell's operation. Int J Colorectal 

Dis 2001 Nov; 16(6):391-4. Case- Reports 

3993. Seccia M, Lippolis PV, Menconi C. Applied 

electrophysiology of transposed muscle 

stimulation: practical considerations and 

surgical experience on graciloplasty for faecal 

incontinence. Acta Biomed Ateneo Parmense 

2003; 74 Suppl 2:84-8. Case-series 

3994. Seccia M, Menconi C, Balestri R, et al. Study 

protocols and functional results in 86 

electrostimulated graciloplasties. Dis Colon 

Rectum 1994 Sep; 37(9):897-904. Case-series 

3995. Secil M, Goktay AY, Dicle O, et al. Bilateral 

epididymal Candida abscesses: sonographic 

findings and sonographically guided fineneedle aspiration. J Clin Ultrasound 1998 Oct; 

26(8):413-5. Case Reports 

3996. Sedgwick DM, Howard GC, Ferguson A. 

Pathogenesis of acute radiation injury to the 

rectum. A prospective study in patients. Int J 

Colorectal Dis 1994 Apr; 9(1):23-30. Caseseries 

3997. Seidel GK, Millis SR, Lichtenberg PA, et al. 

Predicting bowel and bladder continence from 

cognitive status in geriatric rehabilitation 

patients. Arch Phys Med Rehabil 1994 May; 

75(5):590-3. Not eligible exposure 

3998. Seiler WO, Stahelin HB, Hefti U. 

Desmopressin reduces night urine volume in 

geriatric patients: implication for treatment of 

the nocturnal incontinence. Clin Investig 1992 

Jul; 70(7):619. Comment 

3999. Seim A, Eriksen BC, Hunskaar S. A study of 

female urinary incontinence in general 

practice. Demography, medical history, and 

clinical findings. Scand J Urol Nephrol 1996 

Dec; 30(6):465-71. Not eligible target 

population 

4000. Seim A, Hermstad R, Hunskaar S. 

Management in general practice significantly 

reduced psychosocial consequences of female 

urinary incontinence. Qual Life Res 1997 Apr; 

6(3):257-64. Not eligible outcomes 

4001. Sekido N, Hinotsu S, Kawai K, et al. How 

many uncomplicated male and female 

overactive bladder patients reveal detrusor 

overactivity during urodynamic study? Int J 

Urol 2006 Oct; 13(10):1276-9. Not eligible 

target population 

4002. Sekido N, Kawai K, Akaza H. Lower urinary 

tract dysfunction as persistent complication of 

radical hysterectomy. Int J Urol 1997 May; 

4(3):259-64. Case-series 

4003. Selcuki M, Vatansever S, Inan S, et al. Is a 

filum terminale with a normal appearance 

really normal? Childs Nerv Syst 2003 Jan; 

19(1):3-10. Not eligible outcomes 

4004. Selli C, De Antoni P, Moro U, et al. Role of 

bladder neck preservation in urinary 

continence following radical retropubic 

prostatectomy. Scand J Urol Nephrol 2004; 

38(1):32-7. Case-series 

4005. Sen I, Onaran M, Aksakal N, et al. The impact 

of urinary incontinence on female sexual 

function. Adv Ther 2006 Nov-Dec; 23(6):999-

1008. Not eligible outcomes 
B-179 

4006. Senapati A, Phillips RK. The trephine 

colostomy: a permanent left iliac fossa end 

colostomy without recourse to laparotomy. 

Ann R Coll Surg Engl 1991 Sep; 73(5):305-6. 

Case-series 

4007. Sendag F, Vidinli H, Kazandi M, et al. Role of 

perineal sonography in the evaluation of 

patients with stress urinary incontinence. Aust 

N Z J Obstet Gynaecol 2003 Feb; 43(1):54-7. 

Not eligible outcomes 

4008. Sengstaken EA, King SA. Chronic 

schizophrenia or meningioma? J Am Board 

Fam Pract 1994 Jan-Feb; 7(1):71-3. Not 

eligible exposure 

4009. Sentovich SM. Fibrin glue for anal fistulas: 

long-term results. Dis Colon Rectum 2003 

Apr; 46(4):498-502. Case-series 

4010. Sentovich SM, Blatchford GJ, Rivela LJ, et al. 

Diagnosing anal sphincter injury with 

transanal ultrasound and manometry. Dis 

Colon Rectum 1997 Dec; 40(12):1430-4. Not 

eligible exposure 

4011. Sentovich SM, Rivela LJ, Blatchford GJ, et al. 

Patterns of male fecal incontinence. Dis Colon 

Rectum 1995 Mar; 38(3):281-5. Not eligible 

outcomes 

4012. Sentovich SM, Wong WD, Blatchford GJ. 

Accuracy and reliability of transanal 

ultrasound for anterior anal sphincter injury. 

Dis Colon Rectum 1998 Aug; 41(8):1000-4. 

Not eligible outcomes 

4013. Seoud M, Abbas J, Kaspar H, et al. Long-term 

survival following aggressive surgery and 

radiotherapy for pelvic fibromatosis. Int J 

Gynecol Cancer 2005 Nov-Dec; 15(6):1112-4. 

Case- Reports 

4014. Seow C, Phillips RK. Insights gained from the 

management of problematical anal fistulae at 

St. Mark's Hospital, 1984-88. Br J Surg 1991 

May; 78(5):539-41. Not eligible exposure 

4015. Seow-Choen F, Leong AF, Goh HS. Results 

of a policy of selective immediate fistulotomy 

for primary anal abscess. Aust N Z J Surg 

1993 Jun; 63(6):485-9. Not eligible exposure 

4016. Seracchioli R, Hourcabie JA, Vianello F, et al. 

Laparoscopic treatment of pelvic floor defects 

in women of reproductive age. J Am Assoc 

Gynecol Laparosc 2004 Aug; 11(3):332-5. 

Case-series 

4017. Serel TA, Gungor M. Urodynamic evaluation 

after endoscopic modified bladder neck 

suspension. Urol Int 1999; 62(1):17-20. Not 

eligible exposure 

4018. Serels S, Stein M. Prospective study 

comparing hyoscyamine, doxazosin, and 

combination therapy for the treatment of 

urgency and frequency in women. Neurourol 

Urodyn 1998; 17(1):31-6. Not eligible target 

population 

4019. Serels SR, Rackley RR, Appell RA. In situ 

slings with concurrent cystocele repair. Tech 

Urol 1999 Sep; 5(3):129-32. Case-series 

4020. Serels SR, Rackley RR, Appell RA. Surgical 

treatment for stress urinary incontinence 

associated with valsalva induced detrusor 

instability. J Urol 2000 Mar; 163(3):884-7. 

Case-series 

4021. Serra DB, Affrime MB, Bedigian MP, et al. 

QT and QTc interval with standard and 

supratherapeutic doses of darifenacin, a 

muscarinic M3 selective receptor antagonist 

for the treatment of overactive bladder. J Clin 

Pharmacol 2005 Sep; 45(9):1038-47. Not 

eligible exposure 

4022. Sertcelik N, Sagnak L, Imamoglu A, et al. The 

use of self-expanding metallic urethral stents 

in the treatment of recurrent bulbar urethral 

strictures: long-term results. BJU Int 2000 

Oct; 86(6):686-9. Case-series 

4023. Servoll E, Halvorsen OJ, Haukaas S, et al. 

Radical retropubic prostatectomy: our 

experience with the first 54 patients. Scand J 

Urol Nephrol 1992; 26(3):231-4. Case-series 

4024. Setti Carraro P, Kamm MA, Nicholls RJ. 

Long-term results of postanal repair for 

neurogenic faecal incontinence. Br J Surg 

1994 Jan; 81(1):140-4. Case-series 

4025. Setti Carraro P, Nicholls RJ. Postanal repair 

for faecal incontinence persisting after 

rectopexy. Br J Surg 1994 Feb; 81(2):305-7. 

Case-series 

4026. Setti-Carraro P, Ritchie JK, Wilkinson KH, et 

al. The first 10 years' experience of restorative 

proctocolectomy for ulcerative colitis. Gut 

1994 Aug; 35(8):1070-5. Not eligible 

outcomes 

4027. Sevestre S, Ciofu C, Deval B, et al. Results of 

the tension-free vaginal tape technique in the 

elderly. Eur Urol 2003 Jul; 44(1):128-31. 

Case-series 

4028. Sezai D, Demirbas S, Akin L, et al. The 

impact of laparoscopic resection rectopexy in 

patients with total rectal prolapse. Mil Med 

2005 Sep; 170(9):743-7. Case-series 

4029. Shader RI, Oesterheld JR. Case 7: the addled 

nonagenarian. J Clin Psychopharmacol 1995 

Oct; 15(5):378. Case- Reports 
B-180 

4030. Shafik A. Detrusor-rectal neck dyssynergia 

syndrome. A new syndrome with report of 

nine cases. Int Surg 1991 Oct-Dec; 76(4):241-

4. Case-series 

4031. Shafik A. Dilatation and closing anal reflexes. 

Description and clinical significance of new 

reflexes: preliminary report. Acta Anat (Basel) 

1991; 142(4):293-8. Not eligible outcomes 

4032. Shafik A. Uninhibited anal sphincter 

relaxation syndrome. A new syndrome with 

report of four cases. J Clin Gastroenterol 1992 

Jul; 15(1):29-32. Case- Reports 

4033. Shafik A. Polytetrafluoroethylene injection for 

the treatment of partial fecal incontinence. Int 

Surg 1993 Apr-Jun; 78(2):159-61. Case-series 

4034. Shafik A. Basic testing of an artificial 

pacemaker in the normal and incontinent 

anorectum. Digestion 1993; 54(2):112-7. Not 

eligible exposure 

4035. Shafik A. Anorectal tightening reflex: role in 

fecal incontinence. Eur Surg Res 1993; 

25(6):399-405. Question 4 

4036. Shafik A. Perianal injection of autologous fat 

for treatment of sphincteric incontinence. Dis 

Colon Rectum 1995 Jun; 38(6):583-7. Caseseries 

4037. Shafik A. Electrovesicogram in stress urinary 

incontinence: a preliminary study. Int 

Urogynecol J Pelvic Floor Dysfunct 1996; 

7(4):203-7. Not eligible outcomes 

4038. Shafik A. Pudendal canal decompression for 

the treatment of fecal incontinence in 

complete rectal prolapse. Am Surg 1996 May; 

62(5):339-43. Case-series 

4039. Shafik A. Endoscopic pudendal canal 

decompression for the treatment of fecal 

incontinence due to pudendal canal syndrome. 

J Laparoendosc Adv Surg Tech A 1997 Aug; 

7(4):227-34. Case-series 

4040. Shafik A. Role of pudendal canal syndrome in 

the etiology of fecal incontinence in rectal 

prolapse. Digestion 1997; 58(5):489-93. Not 

eligible outcomes 

4041. Shafik A. Pudendal canal syndrome as a cause 

of vulvodynia and its treatment by pudendal 

nerve decompression. Eur J Obstet Gynecol 

Reprod Biol 1998 Oct; 80(2):215-20. Caseseries 

4042. Shafik A. Suppression of uninhibited rectal 

detrusor by functional magnetic stimulation of 

sacral root. J Spinal Cord Med 2000 Spring; 

23(1):45-50. Case-series 

4043. Shafik A. Injured external anal sphincter in 

erectile dysfunction. Andrologia 2001 Jan; 

33(1):35-41. Not eligible outcomes 

4044. Shafik A. Magnetic pudendal 

neurostimulation: a novel method for 

measuring pudendal nerve terminal motor 

latency. Clin Neurophysiol 2001 Jun; 

112(6):1049-52. Not eligible outcomes 

4045. Shafik A. Stress urinary incontinence: new 

concept of pathogenesis and treatment by 

pudendal canal decompression. Adv Exp Med 

Biol 2003; 539(Pt A):415-40. Case-series 

4046. Shafik A, Ahmed A. The "uninhibited 

rectum": a cause of fecal incontinence. J 

Spinal Cord Med 2001 Fall; 24(3):159-63. Not 

eligible outcomes 

4047. Shafik A, Ahmed I, El Sibai O, et al. Study of 

the rectal electric activity of the uninhibited 

rectal detrusor (overactive rectum): a new 

concept of pathogenesis. J Spinal Cord Med 

2005; 28(1):64-8. Not eligible outcomes 

4048. Shafik A, Ahmed I, El-Sibai O, et al. 

Percutaneous peripheral neuromodulation in 

the treatment of fecal incontinence. Eur Surg 

Res 2003 Mar-Apr; 35(2):103-7. Not eligible 

target population 

4049. Shafik A, Doss S, Ali YA, et al. Transverse 

folds of rectum: anatomic study and clinical 

implications. Clin Anat 2001 May; 14(3):196-

203. Not eligible outcomes 

4050. Shafik A, El Sibai O, Shafik IA, et al. Stress, 

urge, and mixed types of partial fecal 

incontinence: pathogenesis, clinical 

presentation, and treatment. Am Surg 2007 

Jan; 73(1):6-9. Not eligible outcomes 

4051. Shafik A, El-Sibai O. The anocavernosal 

erectile dysfunction syndrome. II Anal fissure 

and erectile dysfunction. Int J Impot Res 2000 

Oct; 12(5):279-83. Not eligible outcomes 

4052. Shafik A, El-Sibai O. Study of the levator ani 

muscle in the multipara: role of levator 

dysfunction in defecation disorders. J Obstet 

Gynaecol 2002 Mar; 22(2):187-92. Not 

eligible exposure 

4053. Shafik A, El-Sibai O, Shafik I, et al. Effect of 

micturition on the external anal sphincter: 

identification of the urethro-anal reflex. J 

Spinal Cord Med 2005; 28(5):421-5. Not 

eligible target population 

4054. Shafik A, Shafik IA. Overactive bladder 

inhibition in response to pelvic floor muscle 

exercises. World J Urol 2003 May; 20(6):374-

7. Not eligible outcomes 

4055. Shah DK, Paul EM, Rastinehad AR, et al. 

Short-term outcome analysis of total pelvic 

reconstruction with mesh: the vaginal 

approach. J Urol 2004 Jan; 171(1):261-3. 

Case-series 
B-181 

4056. Shah M, Moogerfeld MS, Ahmed J, et al. 

Metastatic cervical cancer with unusual 

presentation: a case report. Conn Med 2001 

Sep; 65(9):523-5. Case report 

4057. Shah PN, Maly RC, Frank JC, et al. Managing 

geriatric syndromes: what geriatric assessment 

teams recommend, what primary care 

physicians implement, what patients adhere to. 

J Am Geriatr Soc 1997 Apr; 45(4):413-9. Not 

eligible outcomes 

4058. Shah SM, Bukkapatnam R, Rodriguez LV. 

Impact of vaginal surgery for stress urinary 

incontinence on female sexual function: is the 

use of polypropylene mesh detrimental? 

Urology 2005 Feb; 65(2):270-4. Not eligible 

outcomes 

4059. Shaker DA, De Boer F. Performance of the 

tension free vaginal tape procedure when 

combined with sacrospinous fixation for 

apical prolapse. J Obstet Gynaecol 2006 Oct; 

26(7):663-6. Case-series 

4060. Shakhatreh FM. Epidemiology of urinary 

incontinence in Jordanian women. Saudi Med 

J 2005 May; 26(5):830-5. Not eligible level of 

evidence 

4061. Shamim SM, Hameed K. Surgically treated 

rectal prolapse: experience at a teaching 

hospital. J Pak Med Assoc 2005 Jun; 

55(6):247-50. Case-series 

4062. Shandera KC. Diagnosis and management of 

female urinary incontinence. Hawaii Med J 

1998 Dec; 57(12):746-8. Comment 

4063. Shandling B, Chait PG, Richards HF. 

Percutaneous cecostomy: a new technique in 

the management of fecal incontinence. J 

Pediatr Surg 1996 Apr; 31(4):534-7. Not 

eligible target population 

4064. Shankar KR, Losty PD, Kenny SE, et al. 

Functional results following the antegrade 

continence enema procedure. Br J Surg 1998 

Jul; 85(7):980-2. Not eligible target 

population 

4065. Sharma B, Oligbo N. Delayed vaginal erosion 

of the tape--a rare complication with TVT. J 

Obstet Gynaecol 2004 Jan; 24(1):96-8. Not 

eligible exposure 

4066. Sharp HT, Doucette RC, Norton PA. 

Dyspareunia and recurrent stress urinary 

incontinence after laparoscopic 

colposuspension with mesh and staples. A 

case report. J Reprod Med 2000 Nov; 

45(11):947-9. Case Reports 

4067. Shatari T, Fujita M, Kodaira S. Dynamic 

graciloplasty resulting fecal continence 

without electrical stimulation: report of a case. 

Surg Today 2004; 34(5):463-5. Case- Reports 

4068. Shatari T, Hayes J, Pretlove S, et al. 

Importance of evacuatory disturbance in 

evaluation of faecal incontinence after third 

degree obstetric tear. Colorectal Dis 2005 Jan; 

7(1):18-21. Case-series 

4069. Shaul DB, Harrison EA, Muenchow SK. 

Avoidance of leakage and strictures when 

creating an invisible conduit for antegrade 

colonic enemas. J Pediatr Surg 2002 Dec; 

37(12):1768-71. Case-series 

4070. Shaw C, McColl E, Bond S. Functional 

abilities and continence: the use of proxy 

respondents in research involving older 

people. Qual Life Res 2000; 9(10):1117-26. 

Not eligible outcomes 

4071. Shaw F. Continence--it's never too late. Nurs 

Times 1998 Feb 11-17; 94(6):68-70, 2. Case 

Reports 

4072. Shaw M, Birch N. Facet joint cysts causing 

cauda equina compression. J Spinal Disord 

Tech 2004 Oct; 17(5):442-5. Not eligible 

exposure 

4073. Shaya MR, Willis BK, Nanda A. Diffuse back 

pain and urological symptoms: recognizing 

tethered cord syndrome early. J La State Med 

Soc 2005 Jan-Feb; 157(1):39-41. Case report 

4074. Sheldon CA, Minevich E, Wacksman J, et al. 

Role of the antegrade continence enema in the 

management of the most debilitating 

childhood recto-urogenital anomalies. J Urol 

1997 Sep; 158(3 Pt 2):1277-9; discussion 9-

80. Not eligible target population 

4075. Sheldon R, Kiff ES, Clarke A, et al. Sacral 

nerve stimulation reduces corticoanal 

excitability in patients with faecal 

incontinence. Br J Surg 2005 Nov; 

92(11):1423-31. Case-series 

4076. Shepherd BD, Merchant N, Fasig J, et al. 

Endoscopic ultrasound diagnosis of pelvic 

lipoma causing neurologic symptoms. Dig Dis 

Sci 2006 Aug; 51(8):1364-6. Not eligible 

exposure 

4077. Sherer DM, Abramowicz JS, Perillo AM, et 

al. Post cesarean delivery atonic bladder with 

overflow incontinence appearing 

sonographically as a large retrovesical 

hypoechoic mass. J Ultrasound Med 1993 Jun; 

12(6):365-7. Case-reports 

4078. Sheriff MK, Foley S, McFarlane J, et al. 

Endoscopic correction of intractable stress 

incontinence with silicone micro-implants. 

Eur Urol 1997; 32(3):284-8. Case-series 
B-182 

4079. Sheriff MK, Shah PJ, Fowler C, et al. 

Neuromodulation of detrusor hyper-reflexia 

by functional magnetic stimulation of the 

sacral roots. Br J Urol 1996 Jul; 78(1):39-46. 

Case-series 

4080. Sherman AM. An introduction to urinary 

incontinence. Orthop Nurs 1993 Nov-Dec; 

12(6):27-30. Comment 

4081. Sherman AM, Shumaker SA, Kancler C, et al. 

Baseline health-related quality of life in 

postmenopausal women with coronary heart 

disease: the Estrogen Replacement and 

Atherosclerosis (ERA) trial. J Womens Health 

(Larchmt) 2003 May; 12(4):351-62. Not 

eligible level of evidence 

4082. Sherman AM, Shumaker SA, Sharp P, et al. 

No effect of HRT on health-related quality of 

life in postmenopausal women with heart 

disease. Minerva Ginecol 2003 Dec; 

55(6):511-7. Not eligible target population 

4083. Sherman FT. Functional assessment. Easy-touse screening tools speed initial office workup. Geriatrics 2001 Aug; 56(8):36-40; quiz 3. 

Not eligible exposure 

4084. Sherman S, Umlauf MG. Urinary incontinence 

in community dwelling elders. Urol Nurs 1993 

Dec; 13(4):120-7. Question 1 

4085. Shetty SD, Kirkemo AK. Bilateral bone 

anchor vaginal vault suspension: an initial 

report of a new technique. Tech Urol 1997 

Spring; 3(1):1-5. Case-series 

4086. Shih YC, Hartzema AG, Tolleson-Rinehart S. 

Labor costs associated with incontinence in 

long-term care facilities. Urology 2003 Sep; 

62(3):442-6. Not eligible outcomes 

4087. Shimanouchi S, Kamei T, Hayashi M. Home 

care for the frail elderly based on urinary 

incontinence level. Public Health Nurs 2000 

Nov-Dec; 17(6):468-73. Not eligible outcomes 

4088. Shinno Y, Koyanagi T, Kakizaki H, et al. 

Urinary control after radical transurethral 

resection of the prostate in male paraplegics: 

urodynamic evaluation of its effectiveness in 

relieving incontinence. Int J Urol 1994 Mar; 

1(1):78-84. Case-series 

4089. Shinopulos NM, Dann JA, Smith JJ, 3rd. 

Patient selection and education for use of the 

CapSure (Re/Stor) continence shield. Urol 

Nurs 1999 Jun; 19(2):135-40. Case-series 

4090. Shinopulos NM, Jacobson J. Relationship 

between health promotion lifestyle profiles 

and patient outcomes of biofeedback therapy 

for urinary incontinence. Urol Nurs 1999 Dec; 

19(4):249-53. Case-series 

4091. Shiohama N, Shinomiya S, Nagaoka M. 

Clinical features of anterior bradyrhythmia. 

Clin Electroencephalogr 1993 Oct; 24(4):194-

201. Not eligible exposure 

4092. Shiwach RS, Peris L. Treatment of major 

depression complicated by bilateral foot drop 

and double incontinence with ECT. J Ect 2000 

Dec; 16(4):419-20. Case- Reports 

4093. Shobeiri SA, Chesson RR, Echols KT. 

Cystoscopic fistulography: a new technique 

for the diagnosis of vesicocervical fistula. 

Obstet Gynecol 2001 Dec; 98(6):1124-6. 

Case-reports 

4094. Shobeiri SA, Echols KT, Franco N. Sinus 

formation after insertion of a silicone-coated 

suburethral sling. Int Urogynecol J Pelvic 

Floor Dysfunct 2003 Nov; 14(5):356-7. Case 

Reports 

4095. Shobeiri SA, Nolan TE, Yordan-Jovet R, et al. 

Digital examination compared to transperineal ultrasound for the evaluation of anal 

sphincter repair. Int J Gynaecol Obstet 2002 

Jul; 78(1):31-6. Not eligible outcomes 

4096. Shoukry MS, el-Salmy S. Urethral needle 

suspension for male urinary incontinence. 

Scand J Urol Nephrol 1997 Jun; 31(3):267-70. 

Case-series 

4097. Showalter PR, Zimmern PE, Roehrborn CG, 

et al. Standing cystourethrogram: an outcome 

measure after anti-incontinence procedures 

and cystocele repair in women. Urology 2001 

Jul; 58(1):33-7. Not eligible outcomes 

4098. Sibbald B. Unique health needs of elderly 

women being ignored, symposium told. Cmaj 

1999 Nov 16; 161(10):1309-10. Comment 

4099. Siddiqui AA, Shah AA. Chance-type flexiondistraction fracture of lumbar spine. J Coll 

Physicians Surg Pak 2004 Jun; 14(6):372-3. 

Case- Reports 

4100. Sidi AA, Becher EF, Reddy PK, et al. 

Augmentation enterocystoplasty for the 

management of voiding dysfunction in spinal 

cord injury patients. J Urol 1990 Jan; 

143(1):83-5. Case-series 

4101. Siegel SW, Catanzaro F, Dijkema HE, et al. 

Long-term results of a multicenter study on 

sacral nerve stimulation for treatment of 

urinary urge incontinence, urgency-frequency, 

and retention. Urology 2000 Dec 4; 56(6 

Suppl 1):87-91. Not eligible target population 

4102. Siegel SW, Richardson DA, Miller KL, et al. 

Pelvic floor electrical stimulation for the 

treatment of urge and mixed urinary 

incontinence in women. Urology 1997 Dec; 

50(6):934-40. Not eligible outcomes 
B-183 

4103. Siegelman ES, Banner MP, Ramchandani P, et 

al. Multicoil MR imaging of symptomatic 

female urethral and periurethral disease. 

Radiographics 1997 Mar-Apr; 17(2):349-65. 

Not eligible exposure 

4104. Siegler EL, Reidenberg M. Treatment of 

urinary incontinence with anticholinergics in 

patients taking cholinesterase inhibitors for 

dementia. Clin Pharmacol Ther 2004 May; 

75(5):484-8. Case- Reports 

4105. Siltberg H, Larsson G, Victor A. 

Reproducibility of a new method to determine 

cough-induced leak-point pressure in women 

with stress urinary incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 1996; 

7(1):13-9. Case-series 

4106. Siltberg H, Larsson G, Victor A. 

Frequency/volume chart: the basic tool for 

investigating urinary symptoms. Acta Obstet 

Gynecol Scand Suppl 1997; 166:24-7. 

4107. Siltberg H, Larsson G, Victor A. Coughinduced leak-point pressure--a valid measure 

for assessing treatment in women with stress 

incontinence. Acta Obstet Gynecol Scand 

1998 Nov; 77(10):1000-7. Not eligible target 

population 

4108. Silva C, Silva J, Ribeiro MJ, et al. 

Urodynamic effect of intravesical 

resiniferatoxin in patients with neurogenic 

detrusor overactivity of spinal origin: results 

of a double-blind randomized placebocontrolled trial. Eur Urol 2005 Oct; 48(4):650-

5. Not eligible exposure 

4109. Silva WA, Pauls RN, Segal JL, et al. 

Uterosacral ligament vault suspension: fiveyear outcomes. Obstet Gynecol 2006 Aug; 

108(2):255-63. Case-series 

4110. Silverman M, McDowell BJ, Musa D, et al. 

To treat or not to treat: issues in decisions not 

to treat older persons with cognitive 

impairment, depression, and incontinence. J 

Am Geriatr Soc 1997 Sep; 45(9):1094-101. 

Not eligible outcomes 

4111. Silvis R, Gooszen HG, Kahraman T, et al. 

Novel approach to combined defaecation and 

micturition disorders with 

rectovaginovesicopexy. Br J Surg 1998 Jun; 

85(6):813-7. Case-series 

4112. Silvis R, Gooszen HG, van Essen A, et al. 

Abdominal rectovaginopexy: modified 

technique to treat constipation. Dis Colon 

Rectum 1999 Jan; 42(1):82-8. Case-series 

4113. Silvis R, van Eekelen JW, Delemarre JB, et al. 

Endosonography of the anal sphincter after 

ileal pouch-anal anastomosis. Relation with 

anal manometry and fecal continence. Dis 

Colon Rectum 1995 Apr; 38(4):383-8. Not 

eligible outcomes 

4114. Simeonova Z, Bengtsson C. Prevalence of 

urinary incontinence among women at a 

Swedish primary health care centre. Scand J 

Prim Health Care 1990 Dec; 8(4):203-6. Not 

eligible level of evidence 

4115. Simforoosh N, Norbala MH, Danesh A, et al. 

Proper use of gastrointestinal tract to achieve 

continent urinary diversion in 73 patients. J 

Urol (Paris) 1992; 98(4):206-9. Case-series 

4116. Simmang C, Birnbaum EH, Kodner IJ, et al. 

Anal sphincter reconstruction in the elderly: 

does advancing age affect outcome? Dis 

Colon Rectum 1994 Nov; 37(11):1065-9. 

Case-series 

4117. Simmons SF, Ouslander JG. Resident and 

family satisfaction with incontinence and 

mobility care: sensitivity to intervention 

effects? Gerontologist 2005 Jun; 45(3):318-

26. Not eligible outcomes 

4118. Simonis LA, Borovets S, Van Driel MF, et al. 

Erectile dysfunction due to a 'hidden' penis 

after pelvic trauma. Int J Impot Res 1999 Feb; 

11(1):53-5. Case Reports 

4119. Simons AM, Dowell CJ, Bryant CM, et al. 

Use of the Dowell Bryant Incontinence Cost 

Index as a post-treatment outcome measure 

after non-surgical therapy. Neurourol Urodyn 

2001; 20(1):85-93. Case-series 

4120. Simons AM, Yoong WC, Buckland S, et al. 

Inadequate repeatability of the one-hour pad 

test: the need for a new incontinence outcome 

measure. Bjog 2001 Mar; 108(3):315-9. Caseseries 

4121. Simor AE, Yake SL, Tsimidis K. Infection 

due to Clostridium difficile among elderly 

residents of a long-term-care facility. Clin 

Infect Dis 1993 Oct; 17(4):672-8. Not eligible 

outcomes 

4122. Simpson RR, Kennedy ML, Nguyen MH, et 

al. Anal manometry: a comparison of 

techniques. Dis Colon Rectum 2006 Jul; 

49(7):1033-8. Not eligible outcomes 

4123. Simsiman AJ, Luber KM, Menefee SA. 

Vaginal paravaginal repair with porcine 

dermal reinforcement: correction of advanced 

anterior vaginal prolapse. Am J Obstet 

Gynecol 2006 Dec; 195(6):1832-6. Not 

eligible outcomes 
B-184 

4124. Singh G, Thomas DG. Artificial urinary 

sphincter in patients with neurogenic bladder 

dysfunction. Br J Urol 1996 Feb; 77(2):252-5. 

Case-series 

4125. Singh G, Thomas DG. Artificial urinary 

sphincter for post-prostatectomy incontinence. 

Br J Urol 1996 Feb; 77(2):248-51. Case-series 

4126. Singh G, Thomas DG. Bowel problems after 

enterocystoplasty. Br J Urol 1997 Mar; 

79(3):328-32. Case-series 

4127. Singh G, Wilkinson JM, Thomas DG. 

Supravesical diversion for incontinence: a 

long-term follow-up. Br J Urol 1997 Mar; 

79(3):348-53. Case-series 

4128. Singh H, Karakiewicz P, Shariat SF, et al. 

Impact of unilateral interposition sural nerve 

grafting on recovery of urinary function after 

radical prostatectomy. Urology 2004 Jun; 

63(6):1122-7. Case-series 

4129. Singh K, Cortes E, Reid WM. Evaluation of 

the fascial technique for surgical repair of 

isolated posterior vaginal wall prolapse. 

Obstet Gynecol 2003 Feb; 101(2):320-4. Not 

eligible exposure 

4130. Singh M, Sharma A, Duthie G, et al. Early 

results of a rotation flap to treat chronic anal 

fissures. Asian J Surg 2005 Jul; 28(3):189-91. 

Not eligible exposure 

4131. Singh R, Hunter J, Philip A, et al. Predicting 

those who will walk after rehabilitation in a 

specialist stroke unit. Clin Rehabil 2006 Feb; 

20(2):149-52. Not eligible level of evidence 

4132. Sinha D, Nallaswamy V, Arunkalaivanan AS. 

Value of leak point pressure study in women 

with incontinence. J Urol 2006 Jul; 

176(1):186-8; discussion 8. Not eligible 

outcomes 

4133. Siow A, Morris AR, Lam A. Laparoscopic 

treatment of tension free vaginal tape erosion. 

Aust N Z J Obstet Gynaecol 2005 Aug; 

45(4):333. Case Reports 

4134. Siproudhis L, Bellissant E, Juguet F, et al. 

Perception of and adaptation to rectal isobaric 

distension in patients with faecal incontinence. 

Gut 1999 May; 44(5):687-92. Not eligible 

outcomes 

4135. Siproudhis L, Bellissant E, Juguet F, et al. 

Rectal adaptation to distension in patients with 

overt rectal prolapse. Br J Surg 1998 Nov; 

85(11):1527-32. Not eligible outcomes 

4136. Siproudhis L, Bellissant E, Pagenault M, et al. 

Fecal incontinence with normal anal canal 

pressures: where is the pitfall? Am J 

Gastroenterol 1999 Jun; 94(6):1556-63. No 

associative hypothesis tested 

4137. Siproudhis L, Dautreme S, Ropert A, et al. 

Dyschezia and rectocele--a marriage of 

convenience? Physiologic evaluation of the 

rectocele in a group of 52 women complaining 

of difficulty in evacuation. Dis Colon Rectum 

1993 Nov; 36(11):1030-6. Not eligible 

outcomes 

4138. Siproudhis L, Pigot F, Godeberge P, et al. 

Defecation disorders: a French population 

survey. Dis Colon Rectum 2006 Feb; 

49(2):219-27. Not eligible level of evidence 

4139. Siracusano S, Bertolotto M, Silvestre G, et al. 

The feasibility of urethral color ultrasound 

imaging in the diagnosis of female intrinsic 

sphincter deficiency: preliminary results. 

Spinal Cord 2002 Apr; 40(4):192-5. Not 

eligible outcomes 

4140. Siracusano S, Pregazzi R, d'Aloia G, et al. 

Prevalence of urinary incontinence in young 

and middle-aged women in an Italian urban 

area. Eur J Obstet Gynecol Reprod Biol 2003 

Apr 25; 107(2):201-4. Not eligible level of 

evidence 

4141. Sirls LT, Foote JE, Kaufman JM, et al. Longterm results of the FemSoft urethral insert for 

the management of female stress urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2002; 13(2):88-95; discussion Caseseries 

4142. Sirls LT, Keoleian CM, Korman HJ, et al. The 

effect of study methodology on reported 

success rates of the modified Pereyra bladder 

neck suspension. J Urol 1995 Nov; 

154(5):1732-5. Not eligible exposure 

4143. Sitoh YY, Lau TC, Zochling J, et al. 

Determinants of health-related quality of life 

in institutionalised older persons in northern 

Sydney. Intern Med J 2005 Feb; 35(2):131-4. 

Not eligible outcomes 

4144. Sitoh YY, Sitoh YY, Sahadevan S. Clinical 

significance of cerebral white matter lesions in 

older Asians with suspected dementia. Age 

Ageing 2004 Jan; 33(1):67-71. Not eligible 

outcomes 

4145. Siu AL, Beers MH, Morgenstern H. The 

geriatric "medical and public health" 

imperative revisited. J Am Geriatr Soc 1993 

Jan; 41(1):78-84. Review 

4146. Siu LS, Chang AM, Yip SK, et al. 

Compliance with a pelvic muscle exercise 

program as a causal predictor of urinary stress 

incontinence amongst Chinese women. 

Neurourol Urodyn 2003; 22(7):659-63. Not 

eligible outcomes 
B-185 

4147. Skala C, Emons G, Krauss T, et al. 

Postoperative funneling after antiincontinence surgery--a prognostic indicator?-

-Part 1: colposuspension. Neurourol Urodyn 

2004; 23(7):636-42. Not eligible outcomes 

4148. Skeil D, Thorpe AC. Transcutaneous electrical 

nerve stimulation in the treatment of 

neurological patients with urinary symptoms. 

BJU Int 2001 Dec; 88(9):899-908. Case-series 

4149. Skelly J, Boblin-Cummings S. Promoting 

seniors' health--confronting the issue of 

incontinence. Can J Nurs Leadersh 1999 SepOct; 12(3):13-7. Not eligible outcomes 

4150. Skilling PM, Petros P. Synergistic nonsurgical management of pelvic floor 

dysfunction: second report. Int Urogynecol J 

Pelvic Floor Dysfunct 2004 Mar-Apr; 

15(2):106-10; discussion 10. Case-series 

4151. Skinner MH, Kuan HY, Skerjanec A, et al. 

Effect of age on the pharmacokinetics of 

duloxetine in women. Br J Clin Pharmacol 

2004 Jan; 57(1):54-61. Not eligible outcomes 

4152. Skoner MM. Self-management of urinary 

incontinence among women 31 to 50 years of 

age. Rehabil Nurs 1994 Nov-Dec; 19(6):339-

43, 47. Not eligible outcomes 

4153. Skoner MM, Haylor MJ. Managing 

incontinence: women's normalizing strategies. 

Health Care Women Int 1993 Nov-Dec; 

14(6):549-60. Not eligible outcomes 

4154. Skoner MM, Thompson WD, Caron VA. 

Factors associated with risk of stress urinary 

incontinence in women. Nurs Res 1994 SepOct; 43(5):301-6. Not eligible level of 

evidence 

4155. Skorupski P, Krol J, Starega J, et al. An alpha1 chain of type I collagen Sp1-binding site 

polymorphism in women suffering from stress 

urinary incontinence. Am J Obstet Gynecol 

2006 Feb; 194(2):346-50. Not eligible 

outcomes 

4156. Slack M, Tracey M, Hunsicker K, et al. 

Urethral retro-resistance pressure: a new 

clinical measure of urethral function. 

Neurourol Urodyn 2004; 23(7):656-61. Not 

eligible exposure 

4157. Sladden MJ, Hughes AM, Hirst GH, et al. A 

community study of lower urinary tract 

symptoms in older men in Sydney, Australia. 

Aust N Z J Surg 2000 May; 70(5):322-8. Not 

eligible outcomes 

4158. Slors FJ, van Zuijlen PP, van Dijk GJ. Sexual 

and bladder dysfunction after total mesorectal 

excision for benign diseases. Scand J 

Gastroenterol Suppl 2000; (232):48-51. Caseseries 

4159. Sloss EM, Solomon DH, Shekelle PG, et al. 

Selecting target conditions for quality of care 

improvement in vulnerable older adults. J Am 

Geriatr Soc 2000 Apr; 48(4):363-9. Secondary 

data analysis 

4160. Small KA, Wynne JM. Evaluating the pelvic 

floor in obstetric patients. Aust N Z J Obstet 

Gynaecol 1990 Feb; 30(1):41-4, 5. Caseseries 

4161. Smart RF. Polytef paste for urinary 

incontinence. Aust N Z J Surg 1991 Sep; 

61(9):663-6. Case-series 

4162. Smeenk RM, Bex A, Verwaal VJ, et al. 

Pseudomyxoma peritonei and the urinary 

tract: involvement and treatment related 

complications. J Surg Oncol 2006 Jan 1; 

93(1):20-3. Case-series 

4163. Smith A, Rovner E. Long-term chronic 

complications from Stamey endoscopic 

bladder neck suspension: a case series. Int 

Urogynecol J Pelvic Floor Dysfunct 2006 

May; 17(3):290-4. Case Reports 

4164. Smith DA, Newman DK. Basic elements of 

biofeedback therapy for pelvic muscle 

rehabilitation. Urol Nurs 1994 Sep; 14(3):130-

5. Comment 

4165. Smith DB, Boileau MA, Buan LD. A selfdirected home biofeedback system for women 

with symptoms of stress, urge, and mixed 

incontinence. J Wound Ostomy Continence 

Nurs 2000 Jul; 27(4):240-6. Not eligible target 

population 

4166. Smith DB, Lekan-Rutledge D. Continence 

management and wound care for a patient in a 

residential facility. J Wound Ostomy 

Continence Nurs 1997 May; 24(3):172-8. 

Case Reports 

4167. Smith DN, Appell RA, Rackley RR, et al. 

Collagen injection therapy for postprostatectomy incontinence. J Urol 1998 Aug; 

160(2):364-7. Case-series 

4168. Smith DN, Appell RA, Winters JC, et al. 

Collagen injection therapy for female intrinsic 

sphincteric deficiency. J Urol 1997 Apr; 

157(4):1275-8. Case-series 

4169. Smith DN, Fralick R, Appell RA. 

Incontinence after placement of a sphincter. 

Urology 1997 Dec; 50(6):974. Case Reports 

4170. Smith DS, Krygiel J, Nease RF, Jr., et al. 

Patient preferences for outcomes associated 

with surgical management of prostate cancer. 

J Urol 2002 May; 167(5):2117-22. Not 

eligible outcomes 
B-186 

4171. Smith LJ, Franchetti B, McCoull K, et al. A 

behavioural approach to retraining bowel 

function after long-standing constipation and 

faecal impaction in people with learning 

disabilities. Dev Med Child Neurol 1994 Jan; 

36(1):41-9. Case Reports 

4172. Smith M. Stress factor. Nurs Stand 2001 Mar 

28-Apr 3; 15(28):26. Comment 

4173. Smith M. Better continence management. 

Nurs Stand 2001 Jan 31-Feb 6; 15(20):26-7. 

Comment 

4174. Smith MD, Bohlman HH. Spondylolisthesis 

treated by a single-stage operation combining 

decompression with in situ posterolateral and 

anterior fusion. An analysis of eleven patients 

who had long-term follow-up. J Bone Joint 

Surg Am 1990 Mar; 72(3):415-21. Caseseries 

4175. Smith MD, Russell A, Hodges PW. Disorders 

of breathing and continence have a stronger 

association with back pain than obesity and 

physical activity. Aust J Physiother 2006; 

52(1):11-6. Not eligible outcomes 

4176. Smith P. Estrogens and the urogenital tract. 

Studies on steroid hormone receptors and a 

clinical study on a new estradiol-releasing 

vaginal ring. Acta Obstet Gynecol Scand 

Suppl 1993; 157:1-26. Case-series 

4177. Smith VC, Boone TB, Truong LD. Collagen 

polyp of the urinary tract: a report of two 

cases. Mod Pathol 1999 Dec; 12(12):1090-3. 

Case- Reports 

4178. Smith W. Initiative to advise shoppers on 

continence. Nurs Times 1995 Sep 13-19; 

91(37):11-2. Comment 

4179. Snape J, Hulman G, Reddy PR, et al. 

Pneumatosis coli: an uncommon but treatable 

cause of faecal incontinence. Int J Clin Pract 

1998 Oct; 52(7):501-3. Case- Reports 

4180. Snijders F, de Boer JB, Steenbergen B, et al. 

Impact of diarrhoea and faecal incontinence 

on the daily life of HIV-infected patients. 

AIDS Care 1998 Oct; 10(5):629-37. Caseseries 

4181. Snodgrass W. A simplified Kropp procedure 

for incontinence. J Urol 1997 Sep; 158(3 Pt 

2):1049-52. Case-series 

4182. Snooks SJ, Swash M, Mathers SE, et al. Effect 

of vaginal delivery on the pelvic floor: a 5-

year follow-up. Br J Surg 1990 Dec; 

77(12):1358-60. Case-series 

4183. Snyder M, Pearson V, Hanscom J, et al. 

Barriers to progress in urinary incontinence: 

achieving quality assessments. Geriatr Nurs 

1998 Mar-Apr; 19(2):77-80. Not eligible 

outcomes 

4184. Sobrado CW, Kiss DR, Nahas SC, et al. 

Surgical treatment of rectal prolapse: 

experience and late results with 51 patients. 

Rev Hosp Clin Fac Med Sao Paulo 2004 Aug; 

59(4):168-71. Not eligible outcomes 

4185. Soderberg MW, Falconer C, Bystrom B, et al. 

Young women with genital prolapse have a 

low collagen concentration. Acta Obstet 

Gynecol Scand 2004 Dec; 83(12):1193-8. Not 

eligible outcomes 

4186. Soergel TM, Shott S, Heit M. Poor surgical 

outcomes after fascia lata allograft slings. Int 

Urogynecol J Pelvic Floor Dysfunct 2001; 

12(4):247-53. Not eligible exposure 

4187. Sohail S, Siddiqui KJ. Trans-vaginal 

sonographic evaluation of vesicovaginal 

fistula. J Pak Med Assoc 2005 Jul; 55(7):292-

4. Not eligible outcomes 

4188. Sokol AI, Jelovsek JE, Walters MD, et al. 

Incidence and predictors of prolonged urinary 

retention after TVT with and without 

concurrent prolapse surgery. Am J Obstet 

Gynecol 2005 May; 192(5):1537-43. Not 

eligible target population 

4189. Sole-Balcells F, Villavicencio H, Ortiz A. 

Postsurgical management of the patient 

undergoing radical prostatectomy. Br J Urol 

1992 Nov; 70 Suppl 1:43-9. Case-series 

4190. Solomon MJ. Fistulae and abscesses in 

symptomatic perianal Crohn's disease. Int J 

Colorectal Dis 1996; 11(5):222-6. Review 

4191. Solomon MJ, Rex J, Eyers AA, et al. 

Biofeedback for fecal incontinence using 

transanal ultrasonography: novel approach. 

Dis Colon Rectum 2000 Jun; 43(6):788-92. 

Not eligible outcomes 

4192. Soloway MS, Neulander E. Bladder-neck 

preservation during radical retropubic 

prostatectomy. Semin Urol Oncol 2000 Feb; 

18(1):51-6. Question 2 

4193. Sommerfeld DK, von Arbin MH. Disability 

test 10 days after acute stroke to predict early 

discharge home in patients 65 years and older. 

Clin Rehabil 2001 Oct; 15(5):528-34. Not 

eligible outcomes 

4194. Sone J, Hishikawa N, Koike H, et al. Neuronal 

intranuclear hyaline inclusion disease showing 

motor-sensory and autonomic neuropathy. 

Neurology 2005 Nov 22; 65(10):1538-43. Not 

eligible exposure 

4195. Song JT, Rozanski TA, Belville WD. Stress 

leak point pressure: a simple and reproducible 

method utilizing a fiberoptic microtransducer. 

Urology 1995 Jul; 46(1):81-4. Case-series 
B-187 

4196. Song YF, Zhang WJ, Song J, et al. Prevalence 

and risk factors of urinary incontinence in 

Fuzhou Chinese women. Chin Med J (Engl) 

2005 Jun 5; 118(11):887-92. Not eligible level 

of evidence 

4197. Sonnino RE, Reinberg O, Bensoussan AL, et 

al. Gracilis muscle transposition for anal 

incontinence in children: long-term follow-up. 

J Pediatr Surg 1991 Oct; 26(10):1219-23. Not 

eligible target population 

4198. Sood AK, Nygaard I, Shahin MS, et al. 

Anorectal dysfunction after surgical treatment 

for cervical cancer. J Am Coll Surg 2002 Oct; 

195(4):513-9. Case-series 

4199. Soon PS, Lynch W, Schwartz P. Breast cancer 

presenting initially with urinary incontinence: 

a case of bladder metastasis from breast 

cancer. Breast 2004 Feb; 13(1):69-71. Case 

report 

4200. Sorbye LW, Finne-Soveri H, Ljunggren G, et 

al. Indwelling catheter use in home care: 

elderly, aged 65+, in 11 different countries in 

Europe. Age Ageing 2005 Jul; 34(4):377-81. 

Not eligible target population 

4201. Sorensen M, Lorentzen M, Petersen J, et al. 

Anorectal dysfunction in patients with 

urologic disturbance due to multiple sclerosis. 

Dis Colon Rectum 1991 Feb; 34(2):136-9. 

Case-series 

4202. Sorensen M, Tetzschner T, Rasmussen OO, et 

al. Sphincter rupture in childbirth. Br J Surg 

1993 Mar; 80(3):392-4. Case-series 

4203. Sorensen M, Tetzschner T, Rasmussen OO, et 

al. Relation between electromyography and 

anal manometry of the external anal sphincter. 

Gut 1991 Sep; 32(9):1031-4. Not eligible level 

of evidence 

4204. Sorensen M, Tetzschner T, Rasmussen OO, et 

al. Viscous fluid retention: a new method for 

evaluating anorectal function. Dis Colon 

Rectum 1992 Apr; 35(4):357-61. Not eligible 

outcomes 

4205. Soriano D, Lemoine A, Laplace C, et al. 

Results of recto-vaginal fistula repair: 

retrospective analysis of 48 cases. Eur J 

Obstet Gynecol Reprod Biol 2001 May; 

96(1):75-9. Case-series 

4206. Sorin V, Ron Y, Smetana S, et al. Fecal 

incontinence secondary to CAPD. Am J 

Kidney Dis 2003 Jan; 41(1):E2. Case- Reports 

4207. Sotomayor M, Bernal GF. Twelve-month 

results of nonsurgical radiofrequency energy 

micro-remodeling for stress incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 2005 

May-Jun; 16(3):192-6; discussion 6. Not 

eligible target population 

4208. Soulie M, Cuvillier X, Benaissa A, et al. The 

tension-free transvaginal tape procedure in the 

treatment of female urinary stress 

incontinence: a French prospective 

multicentre study. Eur Urol 2001 Jun; 

39(6):709-14; discussion 15. Case-series 

4209. Soulie M, Seguin P, Martel P, et al. A 

modified intussuscepted nipple in the Kock 

pouch urinary diversion: assessment of 

perioperative complications and functional 

results. BJU Int 2002 Sep; 90(4):397-402. 

Case-series 

4210. Sousa-Escandon A, Rodriguez Gomez JI, 

Uribarri Gonzalez C, et al. Externally 

readjustable sling for treatment of male stress 

urinary incontinence: points of technique and 

preliminary results. J Endourol 2004 Feb; 

18(1):113-8. Case-series 

4211. Southern D, Henderson P. Setting standards. 

Tackling incontinence. Nurs Times 1990 Mar 

7-13; 86(10):36-8. Comment 

4212. Soygur T, Safak M, Yesilli C, et al. 

Extraperitoneal laparoscopic bladder neck 

suspension using hernia mesh and tacker. 

Urology 2000 Jul; 56(1):121-4. Case-series 

4213. Speakman CT, Burnett SJ, Kamm MA, et al. 

Sphincter injury after anal dilatation 

demonstrated by anal endosonography. Br J 

Surg 1991 Dec; 78(12):1429-30. Case-series 

4214. Speakman CT, Hoyle CH, Kamm MA, et al. 

Adrenergic control of the internal anal 

sphincter is abnormal in patients with 

idiopathic faecal incontinence. Br J Surg 1990 

Dec; 77(12):1342-4. Not eligible target 

population 

4215. Speakman CT, Hoyle CH, Kamm MA, et al. 

Decreased sensitivity of muscarinic but not 5-

hydroxytryptamine receptors of the internal 

anal sphincter in neurogenic faecal 

incontinence. Br J Surg 1992 Aug; 79(8):829-

32. Not eligible target population 

4216. Speakman CT, Hoyle CH, Kamm MA, et al. 

Neuropeptides in the internal anal sphincter in 

neurogenic faecal incontinence. Int J 

Colorectal Dis 1993 Dec; 8(4):201-5. Not 

eligible outcomes 

4217. Speakman CT, Hoyle CH, Kamm MA, et al. 

Abnormal internal anal sphincter fibrosis and 

elasticity in fecal incontinence. Dis Colon 

Rectum 1995 Apr; 38(4):407-10. Not eligible 

outcomes 

4218. Speakman CT, Hoyle CH, Kamm MM, et al. 

Abnormalities of innervation of internal anal 

sphincter in fecal incontinence. Dig Dis Sci 

1993 Nov; 38(11):1961-9. Not eligible target 

population 
B-188 

4219. Speakman CT, Kamm MA. Abnormal visceral 

autonomic innervation in neurogenic faecal 

incontinence. Gut 1993 Feb; 34(2):215-21. 

Not eligible outcomes 

4220. Speakman CT, Kamm MA, Swash M. Rectal 

sensory evoked potentials: an assessment of 

their clinical value. Int J Colorectal Dis 1993 

Mar; 8(1):23-8. Case-series 

4221. Spector WD. Correlates of pressure sores in 

nursing homes: evidence from the National 

Medical Expenditure Survey. J Invest 

Dermatol 1994 Jun; 102(6):42S-5S. Not 

eligible outcomes 

4222. Speights SE, Moore RD, Miklos JR. 

Frequency of lower urinary tract injury at 

laparoscopic burch and paravaginal repair. J 

Am Assoc Gynecol Laparosc 2000 Nov; 

7(4):515-8. Not eligible outcomes 

4223. Spence-Jones C, Kamm MA, Henry MM, et 

al. Bowel dysfunction: a pathogenic factor in 

uterovaginal prolapse and urinary stress 

incontinence. Br J Obstet Gynaecol 1994 Feb; 

101(2):147-52. Not eligible level of evidence 

4224. Spinelli M, Malaguti S, Giardiello G, et al. A 

new minimally invasive procedure for 

pudendal nerve stimulation to treat neurogenic 

bladder: description of the method and 

preliminary data. Neurourol Urodyn 2005; 

24(4):305-9. Not eligible target population 

4225. Spinelli M, Weil E, Ostardo E, et al. New 

tined lead electrode in sacral 

neuromodulation: experience from a 

multicentre European study. World J Urol 

2005 Jul; 23(3):225-9. Not eligible target 

population 

4226. Spinosa JP, Dubuis PY. Suburethral sling 

inserted by the transobturator route in the 

treatment of female stress urinary 

incontinence: preliminary results in 117 cases. 

Eur J Obstet Gynecol Reprod Biol 2005 Dec 

1; 123(2):212-7. Case-series 

4227. Srinivasan V, Blackford HN. Genuine stress 

incontinence induced by prazosin. Br J Urol 

1993 Oct; 72(4):510. Case Reports 

4228. Srisupan V, Senaratana W, Picheansatian W, 

et al. Reduction of the incidence of pressure 

sores by an education program on nursing 

care. J Med Assoc Thai 2005 Dec; 88 Suppl 

10:S166-70. Not eligible outcomes 

4229. St John W, Wallis M. Outcome evaluation of 

a multi-disciplinary community-based 

continence service for Australian women. 

Women Health 2004; 40(2):35-52. Caseseries 

4230. St John W, Wallis M, James H, et al. 

Targeting community-dwelling urinary 

incontinence sufferers: a multi-disciplinary 

community based model for conservative 

continence services. Contemp Nurse 2004 

Oct; 17(3):211-22. Review 

4231. Stach-Lempinen B, Hakala AL, Laippala P, et 

al. Severe depression determines quality of 

life in urinary incontinent women. Neurourol 

Urodyn 2003; 22(6):563-8. Not eligible level 

of evidence 

4232. Stach-Lempinen B, Sintonen H, Kujansuu E. 

The relationship between clinical parameters 

and health-related quality of life as measured 

by the 15D in incontinent women before and 

after treatment. Acta Obstet Gynecol Scand 

2004 Oct; 83(10):983-8. Not eligible outcomes 

4233. Stainton MC, Strahle A, Fethney J. Leaking 

urine prior to pregnancy: a risk factor for 

postnatal incontinence. Aust N Z J Obstet 

Gynaecol 2005 Aug; 45(4):295-9. Not eligible 

level of evidence 

4234. Stanisic TH, Jennings CE, Miller JI. 

Polytetrafluoroethylene injection for postprostatectomy incontinence: experience with 

20 patients during 3 years. J Urol 1991 Dec; 

146(6):1575-7. Case-series 

4235. Staniunas RJ, Keck JO, Counihan T, et al. 

State of the defunctionalized sphincter in 

patients undergoing ileoanal pouch 

anastomosis. Dis Colon Rectum 1995 May; 

38(5):458-61. Case-series 

4236. Stansbury JP, Mathewson-Chapman M, Grant 

KE. Gender schema and prostate cancer: 

veterans' cultural model of masculinity. Med 

Anthropol 2003 Apr-Jun; 22(2):175-204. Not 

eligible outcomes 

4237. Stanton AL, Bernaards CA, Ganz PA. The 

BCPT symptom scales: a measure of physical 

symptoms for women diagnosed with or at 

risk for breast cancer. J Natl Cancer Inst 2005 

Mar 16; 97(6):448-56. Not eligible exposure 

4238. Stanton SL. Cut and dry--urinary incontinence 

in the female. Trans Med Soc Lond 1990; 

107:9-11. Comment 

4239. Starer P, Libow L. Cystometric evaluation of 

bladder dysfunction in elderly diabetic 

patients. Arch Intern Med 1990 Apr; 

150(4):810-3. Case-series 

4240. Starer P, Libow LS. Persistence of detrusor 

hyperreflexia in a continent, institutionalized 

elderly patient with Parkinson's disease. N Y 

State J Med 1991 Apr; 91(4):166-7. CaseReports 
B-189 

4241. Starkman JS, Wolter CE, Scarpero HM, et al. 

Management of refractory urinary urge 

incontinence following urogynecological 

surgery with sacral neuromodulation. 

Neurourol Urodyn 2007; 26(1):29-35; 

discussion 6. Case-series 

4242. Starr CH. The numbers lie. Bus Health 2002 

Spring; Spec No:4-7, 23. No associative 

hypothesis tested 

4243. Starr CH. Eroding the quality of life. Bus 

Health 2002 Spring; Spec No:8-10, 4, 23-4. 

Comment 

4244. Staskin D, Bavendam T, Miller J, et al. 

Effectiveness of a urinary control insert in the 

management of stress urinary incontinence: 

early results of a multicenter study. Urology 

1996 May; 47(5):629-36. Not eligible target 

population 

4245. Staskin DR, Harnett MD. Effect of trospium 

chloride on somnolence and sleepiness in 

patients with overactive bladder. Curr Urol 

Rep 2004 Dec; 5(6):423-6. Not eligible 

outcomes 

4246. Staskin DR, Te AE. Short- and long-term 

efficacy of solifenacin treatment in patients 

with symptoms of mixed urinary incontinence. 

BJU Int 2006 Jun; 97(6):1256-61. Not eligible 

exposure 

4247. Steens J, Bemelman WA, Meijerink WJ, et al. 

Ileoanal pouch function is related to 

postprandial pouch tone. Br J Surg 2001 Nov; 

88(11):1492-7. Case-series 

4248. Steers W, Corcos J, Foote J, et al. An 

investigation of dose titration with 

darifenacin, an M3-selective receptor 

antagonist. BJU Int 2005 Mar; 95(4):580-6. 

Not eligible exposure 

4249. Steffens J, Steffens L, Becht E, et al. Urinary 

undiversion after implantation of an alloplastic 

urethral sling for male continence. J Urol 1994 

Oct; 152(4):1203-5. Case Reports 

4250. Steginga SK, Occhipinti S, Gardiner RA, et al. 

Making decisions about treatment for 

localized prostate cancer. BJU Int 2002 Feb; 

89(3):255-60. Case-series 

4251. Steidle CP, Kennedy KL. Achieving a state of 

urinary continence for residents of nursing 

facilities. Part III: Manufactured incontinence. 

Ostomy Wound Manage 1992 Jan-Feb; 

38(1):36-8. Comment 

4252. Stein A, Ratzkovitzki R, Lurie A. Perivesical 

fat closure during suprapubic prostatectomy: 

does it prevent urinary leakage? A prospective 

randomized study. Tech Urol 1996 Summer; 

2(2):99-101. Not eligible level of evidence 

4253. Stein JP, Grossfeld GD, Freeman JA, et al. 

Orthotopic lower urinary tract reconstruction 

in women using the Kock ileal neobladder: 

updated experience in 34 patients. J Urol 1997 

Aug; 158(2):400-5. Case-series 

4254. Stein M, Discippio W, Davia M, et al. 

Biofeedback for the treatment of stress and 

urge incontinence. J Urol 1995 Mar; 153(3 Pt 

1):641-3. Not eligible target population 

4255. Stein M, Weinberg JJ. Polytetrafluoroethylene 

vs. polypropylene suture for endoscopic 

bladder neck suspension. Urology 1991 Aug; 

38(2):119-22. Not eligible outcomes 

4256. Stein R, Fisch M, Beetz R, et al. Urinary 

diversion in children and young adults using 

the Mainz Pouch I technique. Br J Urol 1997 

Mar; 79(3):354-61. Not eligible target 

population 

4257. Stein R, Fisch M, Black P, et al. Strategies for 

reconstruction after unsuccessful or 

unsatisfactory primary treatment of patients 

with bladder exstrophy or incontinent 

epispadias. J Urol 1999 Jun; 161(6):1934-41. 

Not eligible target population 

4258. Stein R, Hohenfellner K, Fisch M, et al. 

Management of bladder exstrophy and 

incontinent epispadias: 25 years of experience 

with urinary diversion. Arch Esp Urol 1997 

Jan-Feb; 50(1):91-102; discussion -4. Not 

eligible target population 

4259. Stein R, Wiesner C, Beetz R, et al. Urinary 

diversion in children and adolescents with 

neurogenic bladder: the Mainz experience. 

Part I: Bladder augmentation and bladder 

substitution--therapeutic algorisms. Pediatr 

Nephrol 2005 Jul; 20(7):920-5. Not eligible 

target population 

4260. Steiner JF, Kramer AM, Eilertsen TB, et al. 

Development and validation of a clinical 

prediction rule for prolonged nursing home 

residence after hip fracture. J Am Geriatr Soc 

1997 Dec; 45(12):1510-4. Not eligible 

outcomes 

4261. Steiner MS, Burnett AL, Brooks JD, et al. 

Tubularized neourethra following radical 

retropubic prostatectomy. J Urol 1993 Aug; 

150(2 Pt 1):407-9; discussion 9-10. Caseseries 

4262. Steiner MS, Morton RA, Walsh PC. Impact of 

anatomical radical prostatectomy on urinary 

continence. J Urol 1991 Mar; 145(3):512-4; 

discussion 4-5. Question 2 

4263. Stelling JD, Hale AM. Protocol for changing 

condom catheters in males with spinal cord 

injury. SCI Nurs 1996 Jun; 13(2):28-34. Not 

eligible outcomes 
B-190 

4264. Stephenson AJ, Scardino PT, Bianco FJ, Jr., et 

al. Morbidity and functional outcomes of 

salvage radical prostatectomy for locally 

recurrent prostate cancer after radiation 

therapy. J Urol 2004 Dec; 172(6 Pt 1):2239-

43. Case-series 

4265. Sterbis JR, Lewis VL, Bushman W. Urologic 

and plastic surgical collaboration for continent 

diversion when urine leakage is complicated 

by pressure ulcers or obesity. J Spinal Cord 

Med 2003 Summer; 26(2):124-8. Case-series 

4266. Stern JA, Clemens JQ, Tiplitsky SI, et al. 

Long-term results of the bulbourethral sling 

procedure. J Urol 2005 May; 173(5):1654-6. 

Case-series 

4267. Stern RM, Vitellaro K, Thomas M, et al. 

Electrogastrographic biofeedback: a technique 

for enhancing normal gastric activity. 

Neurogastroenterol Motil 2004 Dec; 

16(6):753-7. Not eligible outcomes 

4268. Steven K, Poulsen AL. The orthotopic Kock 

ileal neobladder: functional results, 

urodynamic features, complications and 

survival in 166 men. J Urol 2000 Aug; 

164(2):288-95. Not eligible level of evidence 

4269. Stewart DA, Taylor J, Ghosh S, et al. 

Terodiline causes polymorphic ventricular 

tachycardia due to reduced heart rate and 

prolongation of QT interval. Eur J Clin 

Pharmacol 1992; 42(6):577-80. Case Reports 

4270. Stewart J, Kumar D, Keighley MR. Results of 

anal or low rectal anastomosis and pouch 

construction for megarectum and megacolon. 

Br J Surg 1994 Jul; 81(7):1051-3. Not eligible 

target population 

4271. Stewart ST, Lenert L, Bhatnagar V, et al. 

Utilities for prostate cancer health states in 

men aged 60 and older. Med Care 2005 Apr; 

43(4):347-55. Not eligible outcomes 

4272. Stickler DJ, King JB, Winters C, et al. 

Blockage of urethral catheters by bacterial 

biofilms. J Infect 1993 Sep; 27(2):133-5. 

Case- Reports 

4273. Stikkelbroeck NM, Beerendonk CC, 

Willemsen WN, et al. The long term outcome 

of feminizing genital surgery for congenital 

adrenal hyperplasia: anatomical, functional 

and cosmetic outcomes, psychosexual 

development, and satisfaction in adult female 

patients. J Pediatr Adolesc Gynecol 2003 Oct; 

16(5):289-96. Not eligible exposure 

4274. Stocchi F, Badiali D, Vacca L, et al. Anorectal 

function in multiple system atrophy and 

Parkinson's disease. Mov Disord 2000 Jan; 

15(1):71-6. Not eligible exposure 

4275. Stock RG, Stone NN, DeWyngaert JK, et al. 

Prostate specific antigen findings and biopsy 

results following interactive ultrasound guided 

transperineal brachytherapy for early stage 

prostate carcinoma. Cancer 1996 Jun 1; 

77(11):2386-92. Not eligible target population 

4276. Stoffel JT, McGuire EJ. Outcome of urethral 

closure in patients with neurologic impairment 

and complete urethral destruction. Neurourol 

Urodyn 2006; 25(1):19-22. Case-series 

4277. Stoffel JT, Oh SJ, McGuire EJ. Technique for 

removal of symptomatic bone anchors placed 

during stress incontinence surgery. Urology 

2005 Mar; 65(3):583-6. Case-series 

4278. Stojkovic SG, Balfour L, Burke D, et al. Role 

of resting pressure gradient in the 

investigation of idiopathic fecal incontinence. 

Dis Colon Rectum 2002 May; 45(5):668-73. 

Not eligible outcomes 

4279. Stoker J, Rociu E, Bosch JL, et al. Highresolution endovaginal MR imaging in stress 

urinary incontinence. Eur Radiol 2003 Aug; 

13(8):2031-7. Not eligible outcomes 

4280. Stolzenburg JU, Liatsikos EN, Rabenalt R, et 

al. Nerve sparing endoscopic extraperitoneal 

radical prostatectomy--effect of puboprostatic 

ligament preservation on early continence and 

positive margins. Eur Urol 2006 Jan; 

49(1):103-11; discussion 11-2. Case series 

4281. Stolzenburg JU, Rabenalt R, Do M, et al. 

Nerve-sparing endoscopic extraperitoneal 

radical prostatectomy: University of Leipzig 

technique. J Endourol 2006 Nov; 20(11):925-

9. Case series 

4282. Stone JM, Wolfe VA, Nino-Murcia M, et al. 

Colostomy as treatment for complications of 

spinal cord injury. Arch Phys Med Rehabil 

1990 Jun; 71(7):514-8. Case-series 

4283. Storch JS. Lumbar burst fracture associated 

with bowel, bladder, and sexual dysfunction: 

case study. J Neurosci Nurs 2005 Apr; 

37(2):68-71. Case report 

4284. Strasser H, Klima G, Poisel S, et al. Anatomy 

and innervation of the rhabdosphincter of the 

male urethra. Prostate 1996 Jan; 28(1):24-31. 

Not eligible target population 

4285. Strasser H, Tiefenthaler M, Steinlechner M, et 

al. Age dependent apoptosis and loss of 

rhabdosphincter cells. J Urol 2000 Nov; 

164(5):1781-5. Not eligible outcomes 

4286. Strohbehn K, Quint LE, Prince MR, et al. 

Magnetic resonance imaging anatomy of the 

female urethra: a direct histologic comparison. 

Obstet Gynecol 1996 Nov; 88(5):750-6. Caseseries 
B-191 

4287. Stromberg J, Martinez A, Benson R, et al. 

Improved local control and survival for 

surgically staged patients with locally 

advanced prostate cancer treated with up-front 

low dose rate iridium-192 prostate 

implantation and external beam irradiation. Int 

J Radiat Oncol Biol Phys 1994 Jan 1; 

28(1):67-75. No associative hypothesis tested 

4288. Su TH, Huang JP, Wang YL, et al. Is modified 

in situ vaginal wall sling operation the 

treatment of choice for recurrent genuine 

stress incontinence? J Urol 1999 Dec; 

162(6):2073-7. Not eligible target population 

4289. Su TH, Wang KG, Hsu CY, et al. Periurethral 

fat injection in the treatment of recurrent 

genuine stress incontinence. J Urol 1998 Feb; 

159(2):411-4. Not eligible target population 

4290. Subak LL, Brown JS, Kraus SR, et al. The 

"costs" of urinary incontinence for women. 

Obstet Gynecol 2006 Apr; 107(4):908-16. Not 

eligible outcomes 

4291. Subak LL, Johnson C, Whitcomb E, et al. 

Does weight loss improve incontinence in 

moderately obese women? Int Urogynecol J 

Pelvic Floor Dysfunct 2002; 13(1):40-3. Caseseries 

4292. Sueppel C, Arthur C, Van Why K, et al. A 

comprehensive screening program for urinary 

dysfunction in older adults. Urol Nurs 1996 

Mar; 16(1):14-9. Not eligible outcomes 

4293. Sueppel C, Kreder K, See W. Improved 

continence outcomes with preoperative pelvic 

floor muscle strengthening exercises. Urol 

Nurs 2001 Jun; 21(3):201-10. Review 

4294. Sugarman ID, Malone PS, Terry TR, et al. 

Transversely tubularized ileal segments for the 

Mitrofanoff or Malone antegrade colonic 

enema procedures: the Monti principle. Br J 

Urol 1998 Feb; 81(2):253-6. Not eligible 

target population 

4295. Sugaya K, Nishijima S, Oda M, et al. 

Transabdominal vesical sonography of 

urethral syndrome and stress incontinence. Int 

J Urol 2003 Jan; 10(1):36-42. Not eligible 

outcomes 

4296. Sugaya K, Nishizawa O, Satoh T, et al. 

Bladder-pumping therapy for the treatment of 

low-capacity or low-compliance bladders. 

Neurourol Urodyn 2000; 19(1):19-28. Caseseries 

4297. Sugaya K, Owan T, Hatano T, et al. Device to 

promote pelvic floor muscle training for stress 

incontinence. Int J Urol 2003 Aug; 10(8):416-

22. Not eligible target population 

4298. Sugerman HJ, Felton WL, 3rd, Salvant JB, Jr., 

et al. Effects of surgically induced weight loss 

on idiopathic intracranial hypertension in 

morbid obesity. Neurology 1995 Sep; 

45(9):1655-9. Case-series 

4299. Sugerman HJ, Felton WL, 3rd, Sismanis A, et 

al. Gastric surgery for pseudotumor cerebri 

associated with severe obesity. Ann Surg 1999 

May; 229(5):634-40; discussion 40-2. Not 

eligible exposure 

4300. Sugerman HJ, Sugerman EL, Wolfe L, et al. 

Risks and benefits of gastric bypass in 

morbidly obese patients with severe venous 

stasis disease. Ann Surg 2001 Jul; 234(1):41-

6. Not eligible level of evidence 

4301. Sugerman HJ, Wolfe LG, Sica DA, et al. 

Diabetes and hypertension in severe obesity 

and effects of gastric bypass-induced weight 

loss. Ann Surg 2003 Jun; 237(6):751-6; 

discussion 7-8. Not eligible level of evidence 

4302. Sugimura Y, Hioki T, Yamada Y, et al. An 

anterior urethral stitch improves urinary 

incontinence following radical prostatectomy. 

Int J Urol 2001 Apr; 8(4):153-7. Case-series 

4303. Sugiyama T, Hashimoto K, Kiwamoto H, et 

al. Urinary incontinence in senile dementia of 

the Alzheimer type (SDAT). Int J Urol 1994 

Dec; 1(4):337-40. Case-series 

4304. Suilleabhain CB, Horgan AF, McEnroe L, et 

al. The relationship of pudendal nerve 

terminal motor latency to squeeze pressure in 

patients with idiopathic fecal incontinence. 

Dis Colon Rectum 2001 May; 44(5):666-71. 

Not eligible outcomes 

4305. Suita S, Taguchi T, Yanai K, et al. Longterm 

outcomes and quality of life after Z-shaped 

anastomosis for Hirschsprung's disease. J Am 

Coll Surg 1998 Dec; 187(6):577-83. Not 

eligible target population 

4306. Sulak PJ, Kuehl TJ, Shull BL. Vaginal 

pessaries and their use in pelvic relaxation. J 

Reprod Med 1993 Dec; 38(12):919-23. Caseseries 

4307. Sultan AH, Kamm MA, Hudson CN, et al. 

Anal-sphincter disruption during vaginal 

delivery. N Engl J Med 1993 Dec 23; 

329(26):1905-11. Not eligible level of 

evidence 

4308. Sultan AH, Kamm MA, Nicholls RJ, et al. 

Prospective study of the extent of internal anal 

sphincter division during lateral 

sphincterotomy. Dis Colon Rectum 1994 Oct; 

37(10):1031-3. Case-series 
B-192 

4309. Sultan AH, Kamm MA, Talbot IC, et al. Anal 

endosonography for identifying external 

sphincter defects confirmed histologically. Br 

J Surg 1994 Mar; 81(3):463-5. Not eligible 

outcomes 

4310. Sultan AH, Loder PB, Bartram CI, et al. 

Vaginal endosonography. New approach to 

image the undisturbed anal sphincter. Dis 

Colon Rectum 1994 Dec; 37(12):1296-9. Not 

eligible outcomes 

4311. Sultan AH, Monga AK, Kumar D, et al. 

Primary repair of obstetric anal sphincter 

rupture using the overlap technique. Br J 

Obstet Gynaecol 1999 Apr; 106(4):318-23. 

Not eligible outcomes 

4312. Sumathi VP, Murnaghan M, Dobbs SP, et al. 

Extragenital mullerian carcinosarcoma arising 

from the peritoneum: report of two cases. Int J 

Gynecol Cancer 2002 Nov-Dec; 12(6):764-7. 

Not eligible exposure 

4313. Sumi T, Ishiko O, Hirai K, et al. Is measuring 

the posterior urethrovesical angle of clinical 

value for controlling pelvic organ Prolapse?. 

Retrospective analysis of 107 postoperative 

cases. Gynecol Obstet Invest 2000; 49(3):183-

6. Case-series 

4314. Sumiya T, Kawamura K, Tokuhiro A, et al. A 

survey of wheelchair use by paraplegic 

individuals in Japan. Part 2: Prevalence of 

pressure sores. Spinal Cord 1997 Sep; 

35(9):595-8. Not eligible outcomes 

4315. Sun MJ, Chang SY, Lin KC, et al. Is an 

indwelling catheter necessary for bladder 

drainage after modified Burch 

colposuspension? Int Urogynecol J Pelvic 

Floor Dysfunct 2004 May-Jun; 15(3):203-7. 

Not eligible exposure 

4316. Sun MJ, Chen GD, Chang SY, et al. 

Prevalence of lower urinary tract symptoms 

during pregnancy in Taiwan. J Formos Med 

Assoc 2005 Mar; 104(3):185-9. Not eligible 

level of evidence 

4317. Sun MJ, Chen GD, Lin KC. Obturator 

hematoma after the transobturator suburethral 

tape procedure. Obstet Gynecol 2006 Sep; 

108(3 Pt 2):716-8. Case Reports 

4318. Sun MJ, Ng SC, Tsui KP, et al. Are there any 

predictors for failed Burch colposuspension? 

Taiwan J Obstet Gynecol 2006 Mar; 45(1):33-

8. Case-series 

4319. Sun WM, Donnelly TC, Read NW. Utility of a 

combined test of anorectal manometry, 

electromyography, and sensation in 

determining the mechanism of 'idiopathic' 

faecal incontinence. Gut 1992 Jun; 33(6):807-

13. Not eligible outcomes 

4320. Sun WM, Katsinelos P, Horowitz M, et al. 

Disturbances in anorectal function in patients 

with diabetes mellitus and faecal incontinence. 

Eur J Gastroenterol Hepatol 1996 Oct; 

8(10):1007-12. Case-series 

4321. Sun WM, Read NW, Donnelly TC. Anorectal 

function in incontinent patients with 

cerebrospinal disease. Gastroenterology 1990 

Nov; 99(5):1372-9. Not eligible outcomes 

4322. Sun WM, Read NW, Katsinelos P, et al. 

Anorectal function after restorative 

proctocolectomy and low anterior resection 

with coloanal anastomosis. Br J Surg 1994 

Feb; 81(2):280-4. Case-series 

4323. Sun WM, Read NW, Miner PB. Relation 

between rectal sensation and anal function in 

normal subjects and patients with faecal 

incontinence. Gut 1990 Sep; 31(9):1056-61. 

Not eligible outcomes 

4324. Sun WM, Read NW, Miner PB, et al. The role 

of transient internal sphincter relaxation in 

faecal incontinence? Int J Colorectal Dis 1990 

Feb; 5(1):31-6. Not eligible outcomes 

4325. Sungurtekin U, Sungurtekin H, Kabay B, et al. 

Anocutaneous V-Y advancement flap for the 

treatment of complex perianal fistula. Dis 

Colon Rectum 2004 Dec; 47(12):2178-83. Not 

eligible exposure 

4326. Surer I, Baker LA, Jeffs RD, et al. Modified 

Young-Dees-Leadbetter bladder neck 

reconstruction in patients with successful 

primary bladder closure elsewhere: a single 

institution experience. J Urol 2001 Jun; 165(6 

Pt 2):2438-40. Case-series 

4327. Susset J, Galea G, Manbeck K, et al. A 

predictive score index for the outcome of 

associated biofeedback and vaginal electrical 

stimulation in the treatment of female 

incontinence. J Urol 1995 May; 153(5):1461-

6. Case-series 

4328. Susset JG, Galea G, Read L. Biofeedback 

therapy for female incontinence due to low 

urethral resistance. J Urol 1990 Jun; 

143(6):1205-8. Case-series 

4329. Sustersic O, Kralj B. The influence of obesity, 

constitution and physical work on the 

phenomenon of urinary incontinence in 

women. Int Urogynecol J Pelvic Floor 

Dysfunct 1998; 9(3):140-4. Question 2 

4330. Suzuki K, Meguro K, Wada M, et al. Anterior 

spinal artery syndrome associated with severe 

stenosis of the vertebral artery. AJNR Am J 

Neuroradiol 1998 Aug; 19(7):1353-5. Case 

report 
B-193 

4331. Sveen U, Thommessen B, Bautz-Holter E, et 

al. Well-being and instrumental activities of 

daily living after stroke. Clin Rehabil 2004 

May; 18(3):267-74. Case-series 

4332. Swaddiwudhipong W, Koonchote S, Nguntra 

P, et al. Assessment of socio-economic, 

functional and medical problems among the 

elderly in one rural community of Thailand. 

Southeast Asian J Trop Med Public Health 

1991 Sep; 22(3):299-306. Not eligible level of 

evidence 

4333. Swain RA. Exercise-induced diarrhea: when 

to wonder. Med Sci Sports Exerc 1994 May; 

26(5):523-6. Not eligible exposure 

4334. Swami KS, Jurriaans E, Hammonds JC. The 

wider spectrum of megalourethra. Br J Urol 

1995 Apr; 75(4):563. Not eligible exposure 

4335. Swanson JG, Skelly J, Hutchison B, et al. 

Urinary incontinence in Canada. National 

survey of family physicians' knowledge, 

attitudes, and practices. Can Fam Physician 

2002 Jan; 48:86-92. Not eligible outcomes 

4336. Sweat SD, Itano NB, Clemens JQ, et al. 

Polypropylene mesh tape for stress urinary 

incontinence: complications of urethral 

erosion and outlet obstruction. J Urol 2002 

Jul; 168(1):144-6. Not eligible exposure 

4337. Sweat SD, Lightner DJ. Complications of 

sterile abscess formation and pulmonary 

embolism following periurethral bulking 

agents. J Urol 1999 Jan; 161(1):93-6. Not 

eligible outcomes 

4338. Swierzewski SJ, 3rd, Gormley EA, Belville 

WD, et al. The effect of terazosin on bladder 

function in the spinal cord injured patient. J 

Urol 1994 Apr; 151(4):951-4. Case-series 

4339. Swierzewski SJ, 3rd, McGuire EJ. 

Pubovaginal sling for treatment of female 

stress urinary incontinence complicated by 

urethral diverticulum. J Urol 1993 May; 

149(5):1012-4. Case-series 

4340. Swierzewski SJ, 3rd, McGuire EJ, Podrazik 

RM, et al. Aortic occlusion and lower 

extremity exercise induced stress urinary 

incontinence. J Urol 1993 Apr; 149(4):846-7. 

Case Reports 

4341. Swift S, Garely A, Dimpfl T, et al. A new 

once-daily formulation of tolterodine provides 

superior efficacy and is well tolerated in 

women with overactive bladder. Int 

Urogynecol J Pelvic Floor Dysfunct 2003 Feb; 

14(1):50-4; discussion 4-5. Not eligible 

exposure 

4342. Swift S, Woodman P, O'Boyle A, et al. Pelvic 

Organ Support Study (POSST): the 

distribution, clinical definition, and 

epidemiologic condition of pelvic organ 

support defects. Am J Obstet Gynecol 2005 

Mar; 192(3):795-806. Not eligible outcomes 

4343. Swift SE, Rust PF, Ostergard DR. Intrasubject 

variability of the pressure-transmission ratio in 

patients with genuine stress incontinence. Int 

Urogynecol J Pelvic Floor Dysfunct 1996; 

7(6):312-6. 

4344. Swift SE, Yoon EA. Test-retest reliability of 

the cough stress test in the evaluation of 

urinary incontinence. Obstet Gynecol 1999 

Jul; 94(1):99-102. Not eligible outcomes 

4345. Swithinbank L, Abrams P. Lower urinary tract 

symptoms in community-dwelling women: 

defining diurnal and nocturnal frequency and 

'the incontinence case'. BJU Int 2001 Sep; 88 

Suppl 2:18-22; discussion 49-50. Not eligible 

outcomes 

4346. Swithinbank LV, Donovan JL, Rogers CA, et 

al. Nocturnal incontinence in women: a hidden 

problem. J Urol 2000 Sep; 164(3 Pt 1):764-6. 

Not eligible outcomes 

4347. Sykes D, Castro R, Pons ME, et al. 

Characteristics of female outpatients with 

urinary incontinence participating in a 6-

month observational study in 14 European 

countries. Maturitas 2005 Nov 30; 52 Suppl 

2:S13-23. Not eligible level of evidence 

4348. Szabo L, Lombay B, Borbas E, et al. 

Videourodynamics in the diagnosis of urinary 

tract abnormalities in a single center. Pediatr 

Nephrol 2004 Mar; 19(3):326-31. Not eligible 

target population 

4349. Sze EH, Kohli N, Miklos JR, et al. A 

retrospective comparison of abdominal 

sacrocolpopexy with Burch colposuspension 

versus sacrospinous fixation with transvaginal 

needle suspension for the management of 

vaginal vault prolapse and coexisting stress 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 1999; 10(6):390-3. Case-series 

4350. Sze EH, Kohli N, Miklos JR, et al. 

Comparative morbidity and charges associated 

with route of hysterectomy and concomitant 

Burch colposuspension. Obstet Gynecol 1997 

Jul; 90(1):42-5. Case-series 

4351. Sze EH, Miklos JR, Partoll L, et al. 

Sacrospinous ligament fixation with 

transvaginal needle suspension for advanced 

pelvic organ prolapse and stress incontinence. 

Obstet Gynecol 1997 Jan; 89(1):94-6. Not 

eligible target population 
B-194 

4352. Sze KH, Wong E, Leung HY, et al. Falls 

among Chinese stroke patients during 

rehabilitation. Arch Phys Med Rehabil 2001 

Sep; 82(9):1219-25. Not eligible outcomes 

4353. Sze KH, Wong E, Or KH, et al. Factors 

predicting stroke disability at discharge: a 

study of 793 Chinese. Arch Phys Med Rehabil 

2000 Jul; 81(7):876-80. Not eligible outcomes 

4354. Szonyi G, Collas DM, Ding YY, et al. 

Oxybutynin with bladder retraining for 

detrusor instability in elderly people: a 

randomized controlled trial. Age Ageing 1995 

Jul; 24(4):287-91. Not eligible exposure 

4355. Tabbara IA, Sibley DS, Quesenberry PJ. 

Spinal cord compression due to metastatic 

neoplasm. South Med J 1990 May; 83(5):519-

23. Case-series 

4356. Tabibian L, Ginsberg DA. Transurethral 

collagen injection in neuropathic sphincter 

deficiency. Topics in Spinal Cord Injury 

Rehabilitation 2003 Winter; 8(3):54-9. Caseseries 

4357. Tainio H, Kylmala T, Tammela TL. Ulcer 

perforation in gastric urinary conduit: never 

use a gastric segment in the urinary tract if 

there are other options available. Urol Int 

2000; 64(2):101-2; discussion 3. Case Reports 

4358. Takahashi S, Homma Y, Fujishiro T, et al. 

Electromyographic study of the striated 

urethral sphincter in type 3 stress 

incontinence: evidence of myogenic-dominant 

damages. Urology 2000 Dec 20; 56(6):946-50. 

Not eligible outcomes 

4359. Takahashi S, Miyao N, Hisataki T, et al. 

Complications of Stamey needle suspension 

for female stress urinary incontinence. Urol 

Int 2002; 68(3):148-51. Case-series 

4360. Takahashi S, Tajima A, Matsushima H, et al. 

Clinical efficacy of an alpha1A/Dadrenoceptor blocker (naftopidil) on 

overactive bladder symptoms in patients with 

benign prostatic hyperplasia. Int J Urol 2006 

Jan; 13(1):15-20. Case-series 

4361. Takahashi T, Garcia-Osogobio S, Valdovinos 

MA, et al. Extended two-year results of radiofrequency energy delivery for the treatment of 

fecal incontinence (the Secca procedure). Dis 

Colon Rectum 2003 Jun; 46(6):711-5. Caseseries 

4362. Takahashi T, Garcia-Osogobio S, Valdovinos 

MA, et al. Radio-frequency energy delivery to 

the anal canal for the treatment of fecal 

incontinence. Dis Colon Rectum 2002 Jul; 

45(7):915-22. Case-series 

4363. Takano K, Yamaguchi T, Minematsu K, et al. 

Differences in clinical features and computed 

tomographic findings between embolic and 

non-embolic acute ischemic stroke: a 

quantitative differential diagnosis. Intern Med 

1998 Feb; 37(2):141-8. Not eligible outcomes 

4364. Takano M, Hamada A. Evaluation of pelvic 

descent disorders by dynamic contrast 

roentgenography. Dis Colon Rectum 2000 

Oct; 43(10 Suppl):S6-11. Not eligible 

exposure 

4365. Takao Y, Gilliland R, Nogueras JJ, et al. Is 

age relevant to functional outcome after 

restorative proctocolectomy for ulcerative 

colitis?: prospective assessment of 122 cases. 

Ann Surg 1998 Feb; 227(2):187-94. Caseseries 

4366. Takazawa K, Arisawa K. Relationship 

between the type of urinary incontinence and 

falls among frail elderly women in Japan. J 

Med Invest 2005 Aug; 52(3-4):165-71. Caseseries 

4367. Takeda M, Hatano A, Kurumada S, et al. 

Bladder neck suspension using percutaneous 

bladder neck stabilization to the pubic bone 

with a bone-anchor suture fixation system: A 

new extraperitoneal laparoscopic approach. 

Urol Int 1999; 62(1):57-60. Case Reports 

4368. Takei M, Homma Y. Long-term safety, 

tolerability and efficacy of extended-release 

tolterodine in the treatment of overactive 

bladder in Japanese patients. Int J Urol 2005 

May; 12(5):456-64. Not eligible exposure 

4369. Takenaka A, Hara R, Soga H, et al. A novel 

technique for approaching the endopelvic 

fascia in retropubic radical prostatectomy, 

based on an anatomical study of fixed and 

fresh cadavers. BJU Int 2005 Apr; 95(6):766-

71. Case-series 

4370. Takesue Y, Yokoyama T, Kodama T, et al. 

Influence of ileal pouch capacity and anal 

sphincteric function on the clinical outcome 

after ileal pouch-anal anastomosis. Surg 

Today 1997; 27(5):392-7. Case-series 

4371. Tal S, Gurevich A, Guller V, et al. Risk 

factors for recurrence of Clostridium difficileassociated diarrhea in the elderly. Scand J 

Infect Dis 2002; 34(8):594-7. Not eligible 

outcomes 

4372. Talbot LA, Cox M. Differences in coping 

strategies among community-residing older 

adults with functional urinary continence, 

dysfunctional urinary continence and actual 

urinary incontinence. Ostomy Wound Manage 

1995 Nov-Dec; 41(10):30-2, 4-7. Not eligible 

outcomes 
B-195 

4373. Talcott JA, Clark JA, Manola J, et al. Bringing 

prostate cancer quality of life research back to 

the bedside: translating numbers into a format 

that patients can understand. J Urol 2006 Oct; 

176(4 Pt 1):1558-63; discussion 63-4. Not 

eligible outcomes 

4374. Talcott JA, Clark JA, Stark PC, et al. Longterm treatment related complications of 

brachytherapy for early prostate cancer: a 

survey of patients previously treated. J Urol 

2001 Aug; 166(2):494-9. Case-series 

4375. Talcott JA, Rieker P, Propert KJ, et al. 

Patient-reported impotence and incontinence 

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Natl Cancer Inst 1997 Aug 6; 89(15):1117-23. 

No associative hypothesis tested 

4376. Talley NJ, Young L, Bytzer P, et al. Impact of 

chronic gastrointestinal symptoms in diabetes 

mellitus on health-related quality of life. Am J 

Gastroenterol 2001 Jan; 96(1):71-6. Not 

eligible level of evidence 

4377. Tamanini JT, Dambros M, D'Ancona CA, et 

al. Responsiveness to the Portuguese version 

of the International Consultation on 

Incontinence Questionnaire-Short Form 

(ICIQ-SF) after stress urinary incontinence 

surgery. Int Braz J Urol 2005 Sep-Oct; 

31(5):482-9; discussion 90. Not eligible 

exposure 

4378. Tamanini JT, D'Ancona CA, Netto NR. 

Macroplastique implantation system for 

female stress urinary incontinence: long-term 

follow-up. J Endourol 2006 Dec; 20(12):1082-

6. Case-series 

4379. Tamanini JT, D'Ancona CA, Tadini V, et al. 

Macroplastique implantation system for the 

treatment of female stress urinary 

incontinence. J Urol 2003 Jun; 169(6):2229-

33. Not eligible target population 

4380. Tamilselvi A, Duckett JR. Surgical correction 

of genuine stress incontinence in an 

achondroplastic woman. J Obstet Gynaecol 

2002 Nov; 22(6):704. Case Reports 

4381. Tampakoudis P, Tantanassis T, Grimbizis G, 

et al. Cigarette smoking and urinary 

incontinence in women--a new calculative 

method of estimating the exposure to smoke. 

Eur J Obstet Gynecol Reprod Biol 1995 Nov; 

63(1):27-30. Not eligible level of evidence 

4382. Tamura T, Nakajima K, Matsushita T, et al. A 

warning detector for urinary incontinence for 

home health care. Biomed Instrum Technol 

1995 Jul-Aug; 29(4):343-9. Not eligible 

exposure 

4383. Tamussino KF, Hanzal E, Kolle D, et al. 

Tension-free vaginal tape operation: results of 

the Austrian registry. Obstet Gynecol 2001 

Nov; 98(5 Pt 1):732-6. Not eligible outcomes 

4384. Tan AH, Gilling PJ, Kennett KM, et al. Longterm results of high-power holmium laser 

vaporization (ablation) of the prostate. BJU Int 

2003 Nov; 92(7):707-9. Case-series 

4385. Tan M, O'Hanlon DM, Cassidy M, et al. 

Advantages of a posterior fourchette incision 

in anal sphincter repair. Dis Colon Rectum 

2001 Nov; 44(11):1624-9. Case-series 

4386. Tan TL, Bergmann MA, Griffiths D, et al. 

Which stop test is best? Measuring detrusor 

contractility in older females. J Urol 2003 

Mar; 169(3):1023-7. Not eligible outcomes 

4387. Tanaka S, Kubota M, Fujimoto Y, et al. Conus 

medullaris syndrome secondary to an L1 burst 

fracture in osteoporosis. A case report. Spine 

1993 Oct 15; 18(14):2131-4. Case Reports 

4388. Tanaka T, Kitamura H, Takahashi A, et al. 

Long-term functional outcome and late 

complications of Studer's ileal neobladder. Jpn 

J Clin Oncol 2005 Jul; 35(7):391-4. Caseseries 

4389. Tancer ML, Lasser D, Rosenblum N. 

Rectovaginal fistula or perineal and anal 

sphincter disruption, or both, after vaginal 

delivery. Surg Gynecol Obstet 1990 Jul; 

171(1):43-6. Case-series 

4390. Tang WK, Chan SS, Chiu HF, et al. 

Frequency and determinants of poststroke 

dementia in Chinese. Stroke 2004 Apr; 

35(4):930-5. Not eligible level of evidence 

4391. Tang WK, Chan SS, Chiu HF, et al. 

Frequency and clinical determinants of 

poststroke cognitive impairment in 

nondemented stroke patients. J Geriatr 

Psychiatry Neurol 2006 Jun; 19(2):65-71. Not 

eligible outcomes 

4392. Tankova L, Draganov V, Damyanov N. 

Endosonography for assessment of anorectal 

changes in patients with fecal incontinence. 

Eur J Ultrasound 2001 Mar; 12(3):221-5. Not 

eligible outcomes 

4393. Tannenbaum C, Bachand G, Dubeau CE, et al. 

Experience of an incontinence clinic for older 

women: no apparent age limit for potential 

physical and psychological benefits. J 

Womens Health Gend Based Med 2001 Oct; 

10(8):751-6. Case-series 

4394. Tannenbaum C, Labrecque D, Lepage C. 

Understanding barriers to continence care in 

institutions. Can J Aging 2005 Summer; 

24(2):151-9. Not eligible target population 
B-196 

4395. Tapp AJ, Cardozo LD, Versi E, et al. The 

treatment of detrusor instability in postmenopausal women with oxybutynin chloride: 

a double blind placebo controlled study. Br J 

Obstet Gynaecol 1990 Jun; 97(6):521-6. Not 

eligible exposure 

4396. Tapp K, Connolly A, Visco AG. Evaluation of 

Aa point and cotton-tipped swab test as 

predictors of urodynamic stress incontinence. 

Obstet Gynecol 2005 Jan; 105(1):115-9. Not 

eligible outcomes 

4397. Tarbox RS, Williams WL, Friman PC. 

Extended diaper wearing: effects on 

continence in and out of the diaper. J Appl 

Behav Anal 2004 Spring; 37(1):97-100. Case 

Reports 

4398. Tarvonen-Schroder S, Roytta M, Raiha I, et al. 

Clinical features of leuko-araiosis. J Neurol 

Neurosurg Psychiatry 1996 Apr; 60(4):431-6. 

Not eligible exposure 

4399. Taskinen S, Valanne L, Rintala R. Effect of 

spinal cord abnormalities on the function of 

the lower urinary tract in patients with 

anorectal abnormalities. J Urol 2002 Sep; 

168(3):1147-9. Not eligible outcomes 

4400. Tate SB, Franco AV, Fynes MM. Tension-free 

vaginal tape exposure presenting as a 

recurrent sterile paraurethral abscess. Int 

Urogynecol J Pelvic Floor Dysfunct 2005 

Sep-Oct; 16(5):420-3. Case Reports 

4401. Taub DA, Hollenbeck BK, Wei JT, et al. 

Complications following surgical intervention 

for stress urinary incontinence: a national 

perspective. Neurourol Urodyn 2005; 

24(7):659-65. Not eligible outcomes 

4402. Taub NA, Wolfe CD, Richardson E, et al. 

Predicting the disability of first-time stroke 

sufferers at 1 year. 12-month follow-up of a 

population-based cohort in southeast England. 

Stroke 1994 Feb; 25(2):352-7. Not eligible 

outcomes 

4403. Taunton RL, Swagerty DL, Lasseter JA, et al. 

Continent or incontinent? That is the question. 

J Gerontol Nurs 2005 Sep; 31(9):36-44. Caseseries 

4404. Tay KP, Lim PH, Chng HC. Surgical 

management of stress urinary incontinence: 

Burch colposuspension, modified Pereyra and 

Stamey bladder neck suspension, and collagen 

injection--Toa Payoh Hospital experience. 

Singapore Med J 1995 Dec; 36(6):651-5. 

Case-series 

4405. Tay KP, Lim PH, Ravintharan T. 

Laparoscopic bladder-neck suspension for 

urinary stress incontinence in women: our first 

twenty patients. Int J Urol 1996 Jul; 3(4):278-

81. Case-series 

4406. Taylor PH, Sussman DO. Contemporary 

treatment options for overactive bladder. 

Jaapa 2005 Nov; Suppl:3-13; quiz 4-5. No 

associative hypothesis tested 

4407. Taylor RF, Beard MV. Normal pressure 

hydrocephalus and deep white matter stroke: a 

case report. Arch Phys Med Rehabil 1997 

Sep; 78(9):1015-8. Case report 

4408. Tchetgen MB, Sanda MG, Montie JE, et al. 

Collagen injection for the treatment of 

incontinence after cystectomy and orthotopic 

neobladder reconstruction in women. J Urol 

2000 Jan; 163(1):212-4. Case-series 

4409. Te AE, Malloy TR, Stein BS, et al. Impact of 

prostate-specific antigen level and prostate 

volume as predictors of efficacy in 

photoselective vaporization prostatectomy: 

analysis and results of an ongoing prospective 

multicentre study at 3 years. BJU Int 2006 

Jun; 97(6):1229-33. Not eligible exposure 

4410. Tediosi F, Parazzini F, Bortolotti A, et al. The 

cost of urinary incontinence in Italian women. 

A cross-sectional study. Gruppo di Studio 

Incontinenza. Pharmacoeconomics 2000 Jan; 

17(1):71-6. Not eligible level of evidence 

4411. Tefilli MV, Gheiler EL, Tiguert R, et al. 

Quality of life in patients undergoing salvage 

procedures for locally recurrent prostate 

cancer. J Surg Oncol 1998 Nov; 69(3):156-61. 

Not eligible outcomes 

4412. Tei TM, Stolzenburg T, Buntzen S, et al. Use 

of transpelvic rectus abdominis 

musculocutaneous flap for anal cancer salvage 

surgery. Br J Surg 2003 May; 90(5):575-80. 

Not eligible level of evidence 

4413. Teichman JM, Barber DB, Rogenes VJ, et al. 

Malone antegrade continence enemas for 

autonomic dysreflexia secondary to 

neurogenic bowel. J Spinal Cord Med 1998 

Jul; 21(3):245-7. Case Reports 

4414. Teichman JM, Harris JM, Currie DM, et al. 

Malone antegrade continence enema for adults 

with neurogenic bowel disease. J Urol 1998 

Oct; 160(4):1278-81. Case-series 

4415. Teichman JM, Rogenes VJ, Barber DB. The 

malone antegrade continence enema combined 

with urinary diversion in adult neurogenic 

patients: early results. Urology 1997 Jun; 

49(6):963-7. Case Reports 
B-197 

4416. Teichman JM, Rogenes VJ, Barber DB. The 

utility of the Malone antegrade continence 

enema for urologists. Tech Urol 1997 Spring; 

3(1):30-3. Case- Reports 

4417. Tejada Cabrera M, Lopez Cano A, Munoz 

Benvenuty A. Anal incontinence: evaluation 

of the anal sphincter by endoscopic 

ultrasound. Rev Esp Enferm Dig 2005 May; 

97(5):375-6. Case-reports 

4418. Telander RL, Spencer M, Perrault J, et al. 

Long-term follow-up of the ileoanal 

anastomosis in children and young adults. 

Surgery 1990 Oct; 108(4):717-23; discussion 

23-5. Not eligible target population 

4419. Telford KJ, Ali AS, Lymer K, et al. 

Fatigability of the external anal sphincter in 

anal incontinence. Dis Colon Rectum 2004 

May; 47(5):746-52; discussion 52. Not 

eligible outcomes 

4420. Telford KJ, Faulkner G, Hosker GL, et al. The 

strength duration test: a novel tool in the 

identification of occult neuropathy in women 

with pelvic floor dysfunction. Colorectal Dis 

2004 Nov; 6(6):442-5. Case-series 

4421. Telford KJ, Grey BR, MacKenzie N, et al. 

Investigation of stimulus position in the 

production of the strength duration curve of 

the external anal sphincter muscle in women 

with anorectal dysfunction. Colorectal Dis 

2007 Jan; 9(1):67-70. Not eligible outcomes 

4422. Temml C, Heidler S, Ponholzer A, et al. 

Prevalence of the overactive bladder 

syndrome by applying the International 

Continence Society definition. Eur Urol 2005 

Oct; 48(4):622-7. Not eligible outcomes 

4423. Tennstedt SL, Fitzgerald MP, Nager CW, et 

al. Quality of life in women with stress urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2007 May; 18(5):543-9. Case-series 

4424. Teo JS, Briffa NK, Devine A, et al. Do sleep 

problems or urinary incontinence predict falls 

in elderly women? Aust J Physiother 2006; 

52(1):19-24. Not eligible outcomes 

4425. Teo RE, Yisa S, Mayne C, et al. A comparison 

of urodynamic diagnoses and detrusor muscle 

function in white and South Indian Asian 

women. J Urol 2005 Jul; 174(1):184-6. Not 

eligible level of evidence 

4426. ter Meulen PH, Heesakkers JP, Janknegt RA. 

A study on the feasibility of vesicomyotomy 

in patients with motor urge incontinence. Eur 

Urol 1997; 32(2):166-9. Case-series 

4427. ter Meulen PH, Zambon V, Kessels AG, et al. 

Quality of life, functional outcome and 

durability of the AMS 800 artificial urinary 

sphincter in patients with intrinsic sphincter 

deficiency. Urol Int 2003; 71(1):55-60. Caseseries 

4428. Ternent CA, Shashidharan M, Blatchford GJ, 

et al. Transanal ultrasound and anorectal 

physiology findings affecting continence after 

sphincteroplasty. Dis Colon Rectum 1997 

Apr; 40(4):462-7. Case-series 

4429. Terra MP, Beets-Tan RG, van der Hulst VP, et 

al. MRI in evaluating atrophy of the external 

anal sphincter in patients with fecal 

incontinence. AJR Am J Roentgenol 2006 

Oct; 187(4):991-9. Not eligible outcomes 

4430. Terra MP, Beets-Tan RG, van Der Hulst VP, 

et al. Anal sphincter defects in patients with 

fecal incontinence: endoanal versus external 

phased-array MR imaging. Radiology 2005 

Sep; 236(3):886-95. Comment 

4431. Terra MP, Deutekom M, Beets-Tan RG, et al. 

Relationship between external anal sphincter 

atrophy at endoanal magnetic resonance 

imaging and clinical, functional, and anatomic 

characteristics in patients with fecal 

incontinence. Dis Colon Rectum 2006 May; 

49(5):668-78. Not eligible outcomes 

4432. Terra MP, Dobben AC, Berghmans B, et al. 

Electrical stimulation and pelvic floor muscle 

training with biofeedback in patients with 

fecal incontinence: a cohort study of 281 

patients. Dis Colon Rectum 2006 Aug; 

49(8):1149-59. Case-series 

4433. Tetzschner T, Sorensen M, Jonsson L, et al. 

Delivery and pudendal nerve function. Acta 

Obstet Gynecol Scand 1997 Apr; 76(4):324-

31. Not eligible outcomes 

4434. Tetzschner T, Sorensen M, Lose G, et al. Anal 

and urinary incontinence in women with 

obstetric anal sphincter rupture. Br J Obstet 

Gynaecol 1996 Oct; 103(10):1034-40. Caseseries 

4435. Tetzschner T, Sorensen M, Rasmussen OO, et 

al. Pudendal nerve damage increases the risk 

of fecal incontinence in women with anal 

sphincter rupture after childbirth. Acta Obstet 

Gynecol Scand 1995 Jul; 74(6):434-40. Not 

eligible outcomes 

4436. Tetzschner T, Sorensen M, Rasmussen OO, et 

al. Reliability of pudendal nerve terminal 

motor latency. Int J Colorectal Dis 1997; 

12(5):280-4. Not eligible outcomes 
B-198 

4437. Teunissen D, Van Den Bosch W, Van Weel C, 

et al. "It can always happen": the impact of 

urinary incontinence on elderly men and 

women. Scand J Prim Health Care 2006 Sep; 

24(3):166-73. Not eligible outcomes 

4438. Teunissen D, van den Bosch W, van Weel C, 

et al. Urinary incontinence in the elderly: 

attitudes and experiences of general 

practitioners. A focus group study. Scand J 

Prim Health Care 2006 Mar; 24(1):56-61. Not 

eligible target population 

4439. Teunissen D, van Weel C, Lagro-Janssen T. 

Urinary incontinence in older people living in 

the community: examining help-seeking 

behaviour. Br J Gen Pract 2005 Oct; 

55(519):776-82. Not eligible outcomes 

4440. Tewari A, Srivasatava A, Menon M. A 

prospective comparison of radical retropubic 

and robot-assisted prostatectomy: experience 

in one institution. BJU Int 2003 Aug; 

92(3):205-10. Not eligible outcomes 

4441. Thakar R, Stanton S, Prodigalidad L, et al. 

Secondary colposuspension: results of a 

prospective study from a tertiary referral 

centre. Bjog 2002 Oct; 109(10):1115-20. 

Case-series 

4442. Thaler K, Dinnewitzer A, Oberwalder M, et 

al. Quality of life after colectomy for colonic 

inertia. Tech Coloproctol 2005 Jul; 9(2):133-

7. Case-series 

4443. Theerapol A, So BY, Ngoi SS. Routine use of 

setons for the treatment of anal fistulae. 

Singapore Med J 2002 Jun; 43(6):305-7. 

Case-series 

4444. Theisen J, Kauer WK, Nekarda H, et al. 

Neoadjuvant radiochemotherapy for patients 

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impairment of the anal sphincter. J 

Gastrointest Surg 2006 Feb; 10(2):309-14. 

Case-series 

4445. Thelwell S, Symon C, Gay S, et al. 

Continence. Systems for leg bags. Nurs Times 

1995 Apr 19-25; 91(16):62-4. Not eligible 

exposure 

4446. Themistocleous GS, Papagelopoulos PJ, 

Petraki KD, et al. A 23-year-old woman with 

complete paraplegia and anesthesia below the 

T8 level. Clin Orthop Relat Res 2005 Jan; 

(430):258-65. Case- Reports 

4447. Theodoros C, Katsifotis C, Stournaras P, et al. 

Abdomino-perineal repair of recurrent and 

complex bladder neck-prostatic urethra 

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40;discusssion 40-1. Case-series 

4448. Theodorou C, Floratos D, Katsifotis C, et al. 

Transvaginal incisionless bladder neck 

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genuine stress incontinence. Int Urol Nephrol 

1998; 30(3):273-8. Case-series 

4449. Theodorou C, Moutzouris G, Floratos D, et al. 

Incontinence after surgery for benign prostatic 

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and treatment. Eur Urol 1998; 33(4):370-5. 

Case-series 

4450. Theofrastous JP, Cundiff GW, Harris RL, et 

al. The effect of vesical volume on Valsalva 

leak-point pressures in women with genuine 

stress urinary incontinence. Obstet Gynecol 

1996 May; 87(5 Pt 1):711-4. Not eligible 

outcomes 

4451. Thessen CC, Kreder KJ. Ogilvie's syndrome: a 

potential complication of vaginal surgery. J 

Urol 1993 Jun; 149(6):1541-3. Case Reports 

4452. Thiede HA, Thiede FK. A glance at the 

urodynamic database. J Reprod Med 1990 

Oct; 35(10):925-31. Not eligible target 

population 

4453. Thiel DD, Young PR, Broderick GA, et al. Do 

clinical or urodynamic parameters predict 

artificial urinary sphincter outcome in postradical prostatectomy incontinence? Urology 

2007 Feb; 69(2):315-9. Case-series 

4454. Thom DH, Nygaard IE, Calhoun EA. Urologic 

diseases in America project: urinary 

incontinence in women-national trends in 

hospitalizations, office visits, treatment and 

economic impact. J Urol 2005 Apr; 

173(4):1295-301. Not eligible outcomes 

4455. Thomas C, Lefaucheur JP, Galula G, et al. 

Respective value of pudendal nerve terminal 

motor latency and anal sphincter 

electromyography in neurogenic fecal 

incontinence. Neurophysiol Clin 2002 Jan; 

32(1):85-90. Not eligible outcomes 

4456. Thomas P, Ingrand P, Lalloue F, et al. 

Reasons of informal caregivers for 

institutionalizing dementia patients previously 

living at home: the Pixel study. Int J Geriatr 

Psychiatry 2004 Feb; 19(2):127-35. Not 

eligible outcomes 

4457. Thomas PJ, Nurse DE, Deliveliotis C, et al. 

Cystoprostatectomy and substitution 

cystoplasty for locally invasive bladder 

cancer. Br J Urol 1992 Jul; 70(1):40-2. Caseseries 

4458. Thomas S. Investing in continence. Elder Care 

1999 Feb-Mar; 11(1):32. News 
B-199 

4459. Thomas S. Continence: an update on policy 

priorities and practice implications in primary 

care. Nurs Older People 2001 Dec-2002 Jan; 

13(9):21-5; quiz 6. Comment 

4460. Thomas SH, Higham PD, Hartigan-Go K, et 

al. Concentration dependent cardiotoxicity of 

terodiline in patients treated for urinary 

incontinence. Br Heart J 1995 Jul; 74(1):53-6. 

Case-series 

4461. Thomas WM, Jackson J, Lamont GL, et al. 

Early incontinence following flexible 

sigmoidoscopy. Br J Surg 1990 Aug; 

77(8):887. Comment 

4462. Thomason AD, Miller JM, Delancey JO. 

Urinary incontinence symptoms during and 

after pregnancy in continent and incontinent 

primiparas. Int Urogynecol J Pelvic Floor 

Dysfunct 2007 Feb; 18(2):147-51. Not eligible 

level of evidence 

4463. Thommessen B, Bautz-Holter E, Laake K. 

Predictors of outcome of rehabilitation of 

elderly stroke patients in a geriatric ward. Clin 

Rehabil 1999 Apr; 13(2):123-8. Not eligible 

outcomes 

4464. Thompson AN, Levitt M. Colonic J pouch 

reconstruction of the radiation-damaged 

neorectum. Aust N Z J Surg 2000 Aug; 

70(8):560-2. Case-series 

4465. Thompson JA, O'Sullivan PB, Briffa K, et al. 

Assessment of pelvic floor movement using 

transabdominal and transperineal ultrasound. 

Int Urogynecol J Pelvic Floor Dysfunct 2005 

Jul-Aug; 16(4):285-92. Not eligible outcomes 

4466. Thompson JS, Quigley EM. Anal 

sphincteroplasty for incontinence after ileal 

pouch-anal anastomosis. Report of two cases. 

Dis Colon Rectum 1995 Feb; 38(2):215-8. 

Case Reports 

4467. Thomson A, Naidoo P, Crotty B. Bowel 

preparation for colonoscopy: a randomized 

prospective trail comparing sodium phosphate 

and polyethylene glycol in a predominantly 

elderly population. J Gastroenterol Hepatol 

1996 Feb; 11(2):103-7. Not eligible outcomes 

4468. Thornburn P, Fader M, Dean G, et al. 

Improving the performance of small 

incontinence pads: a study of "wet comfort". J 

Wound Ostomy Continence Nurs 1997 Jul; 

24(4):219-25. Not eligible outcomes 

4469. Thornton MJ, Kennedy ML, Lubowski DZ. 

Extracorporeal magnetic stimulation of the 

pelvic floor: impact on anorectal function and 

physiology. A pilot study. Dis Colon Rectum 

2005 Oct; 48(10):1945-50. Case-series 

4470. Thornton MJ, Kennedy ML, Lubowski DZ, et 

al. Long-term follow-up of dynamic 

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Colorectal Dis 2004 Nov; 6(6):470-6. Not 

eligible exposure 

4471. Thornton MJ, Lam A, King DW. 

Laparoscopic or transanal repair of rectocele? 

A retrospective matched cohort study. Dis 

Colon Rectum 2005 Apr; 48(4):792-8. Not 

eligible target population 

4472. Thornton MJ, Lam A, King DW. Bowel, 

bladder and sexual function in women 

undergoing laparoscopic posterior 

compartment repair in the presence of apical 

or anterior compartment dysfunction. Aust N 

Z J Obstet Gynaecol 2005 Jun; 45(3):195-200. 

Case-series 

4473. Thorp JM, Jones LH, Wells E, et al. 

Assessment of pelvic floor function: a series 

of simple tests in nulliparous women. Int 

Urogynecol J Pelvic Floor Dysfunct 1996; 

7(2):94-7. Not eligible outcomes 

4474. Thorpe AC. How do we raise awareness and 

ensure the correct diagnosis and management 

of female urinary incontinence? BJU Int 2006 

Jun; 97(6):1141-3. Comment 

4475. Thorpe AC, Roberts JP, Williams NS, et al. 

Pelvic floor physiology in women with faecal 

incontinence and urinary symptoms. Br J Surg 

1995 Feb; 82(2):173-6. Not eligible level of 

evidence 

4476. Thorpe AC, Williams NS, Badenoch DF, et al. 

Simultaneous dynamic electromyographic 

proctography and cystometrography. Br J 

Surg 1993 Jan; 80(1):115-20. Not eligible 

outcomes 

4477. Thunedborg P, Fischer-Rasmussen W, Jensen 

SB. Stress urinary incontinence and posterior 

bladder suspension defects. Results of vaginal 

repair versus Burch colposuspension. Acta 

Obstet Gynecol Scand 1990; 69(1):55-9. 

Case-series 

4478. Thyssen H, Lose G. New disposable vaginal 

device (continence guard) in the treatment of 

female stress incontinence. Design, efficacy 

and short term safety. Acta Obstet Gynecol 

Scand 1996 Feb; 75(2):170-3. Not eligible 

target population 

4479. Thyssen HH, Clevin L, Olesen S, et al. 

Urinary incontinence in elite female athletes 

and dancers. Int Urogynecol J Pelvic Floor 

Dysfunct 2002; 13(1):15-7. Question 2 
B-200 

4480. Tiainen J, Matikainen M. Health-related 

quality of life after ileal J-pouch-anal 

anastomosis for ulcerative colitis: long-term 

results. Scand J Gastroenterol 1999 Jun; 

34(6):601-5. Case-series 

4481. Tiemann D, Shea L, Klutke CG, et al. 

Artificial urinary sphincters. Treatment for 

post-prostatectomy incontinence. Aorn J 1993 

Jun; 57(6):1366-72, 75-9. Case-reports 

4482. Tierney JP, Robins JB, Anthony GS, et al. A 

costed profile audit of the surgical 

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Scott Med J 2004 Nov; 49(4):133-6. Caseseries 

4483. Tiguert R, Gheiler EL, Gudziak MR. Collagen 

injection in the management of post-radical 

prostatectomy intrinsic sphincteric deficiency. 

Neurourol Urodyn 1999; 18(6):653-8. Caseseries 

4484. Tilling K, Sterne JA, Rudd AG, et al. A new 

method for predicting recovery after stroke. 

Stroke 2001 Dec 1; 32(12):2867-73. Not 

eligible outcomes 

4485. Timor-Tritsch IE, Monteagudo A, Smilen SW, 

et al. Simple ultrasound evaluation of the anal 

sphincter in female patients using a 

transvaginal transducer. Ultrasound Obstet 

Gynecol 2005 Feb; 25(2):177-83. Case-series 

4486. Tincello DG, Adams EJ, Richmond DH. 

Antenatal screening for postpartum urinary 

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study. Eur J Obstet Gynecol Reprod Biol 2002 

Feb 10; 101(1):70-3. Not eligible outcomes 

4487. Tincello DG, Adams EJ, Sutherst JR, et al. 

Oxybutynin for detrusor instability with 

adjuvant salivary stimulant pastilles to 

improve compliance: results of a multicentre, 

randomized controlled trial. BJU Int 2000 

Mar; 85(4):416-20. Not eligible exposure 

4488. Tincello DG, Williams KS, Joshi M, et al. 

Urinary diaries: a comparison of data 

collected for three days versus seven days. 

Obstet Gynecol 2007 Feb; 109(2 Pt 1):277-80. 

Not eligible outcomes 

4489. Tinetti ME, Inouye SK, Gill TM, et al. Shared 

risk factors for falls, incontinence, and 

functional dependence. Unifying the approach 

to geriatric syndromes. Jama 1995 May 3; 

273(17):1348-53. Not eligible level of 

evidence 

4490. Tjandra JJ, Fazio VW, Church JM, et al. 

Ripstein procedure is an effective treatment 

for rectal prolapse without constipation. Dis 

Colon Rectum 1993 May; 36(5):501-7. Caseseries 

4491. Tjandra JJ, Han WR, Ooi BS, et al. Faecal 

incontinence after lateral internal 

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coexisting occult sphincter defects: a study 

using endoanal ultrasonography. ANZ J Surg 

2001 Oct; 71(10):598-602. Case-series 

4492. Tjandra JJ, Lubowski D. Anorectal 

physiological testing in Australia. ANZ J Surg 

2002 Oct; 72(10):757-9. Review 

4493. Tjandra JJ, Milsom JW, Schroeder T, et al. 

Endoluminal ultrasound is preferable to 

electromyography in mapping anal sphincteric 

defects. Dis Colon Rectum 1993 Jul; 

36(7):689-92. Case-series 

4494. Tjandra JJ, Ooi BS, Han WR. Anorectal 

physiologic testing for bowel dysfunction in 

patients with spinal cord lesions. Dis Colon 

Rectum 2000 Jul; 43(7):927-31. Case-series 

4495. Tjandra JJ, Sharma BR, McKirdy HC, et al. 

Anorectal physiological testing in defecatory 

disorders: a prospective study. Aust N Z J 

Surg 1994 May; 64(5):322-6. Not eligible 

outcomes 

4496. Toba K, Ouchi Y, Orimo H, et al. Urinary 

incontinence in elderly inpatients in Japan: a 

comparison between general and geriatric 

hospitals. Aging (Milano) 1996 Feb; 8(1):47-

54. Not eligible target population 

4497. Tobias-Machado M, Lasmar MT, Medina JJ, 

et al. Preliminary experience with 

extraperitoneal endoscopic radical 

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technique. Int Braz J Urol 2005 May-Jun; 

31(3):228-35. Case-series 

4498. Tobin SA, Scott IH. Delorme operation for 

rectal prolapse. Br J Surg 1994 Nov; 

81(11):1681-4. Case-series 

4499. Tocchi A, Mazzoni G, Miccini M, et al. Total 

lateral sphincterotomy for anal fissure. Int J 

Colorectal Dis 2004 May; 19(3):245-9. Caseseries 

4500. Todd LT, Jr., Yaszemski MJ, Currier BL, et 

al. Bowel and bladder function after major 

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Apr; (397):36-9. Case-series 

4501. Toglia MR, Nolan TE. Morbidity and 

mortality rates of elective gynecologic surgery 

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Case-series 

4502. Toh KL, Tan JK. Artificial urinary sphincter 

in adult male with neurogenic stress urinary 

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eligible level of evidence 
B-201 

4503. Tok EC, Ertunc D, Dilek U, et al. The 

prevalence of stress urinary incontinence 

among women operated on for abdominal wall 

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83(10):962-4. Not eligible level of evidence 

4504. Tomita R, Igarash S, Ikeda T, et al. Defecation 

states in patients with or without soiling at 5 

years or more after colectomy, mucosal 

proctectomy and ileal J pouch-anal 

anastomosis for ulcerative colitis. 

Hepatogastroenterology 2007 Jan-Feb; 

54(73):58-62. Case-series 

4505. Tomita R, Igarashi S. Assessments of anal 

canal sensitivity in patients with soiling 5 

years or more after colectomy, mucosal 

proctectomy, and ileal J pouch-anal 

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Surg 2007 Jan; 31(1):210-6. Case-series 

4506. Tomita R, Kurosu Y, Isozumi M, et al. 

Terminal motor latency in the pudendal nerves 

after colectomy with mucosal proctectomy 

and ileal J pouch-anal anastomosis for 

ulcerative colitis. Surg Today 1995; 

25(2):187-9. Not eligible outcomes 

4507. Tomita R, Kurosu Y, Isozumi M, et al. Sacral 

nerve terminal motor latency after ileal J 

pouch-anal anastomosis for ulcerative colitis. 

Surg Today 1995; 25(11):946-9. Not eligible 

outcomes 

4508. Tomoe H, Kondo A, Takei M, et al. Quality of 

life assessments in women operated on by 

tension-free vaginal tape (TVT). Int 

Urogynecol J Pelvic Floor Dysfunct 2005 

Mar-Apr; 16(2):114-8; discussion 08. Caseseries 

4509. Tomoe H, Sekiguchi Y, Horiguchi M, et al. 

Questionnaire survey on female urinary 

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Jul; 12(7):621-30. Not eligible outcomes 

4510. Tong YC. An alternative method of tensionfree vaginal tape implantation for the 

treatment of female urinary incontinence. Urol 

Int 2003; 71(1):51-4. Case-series 

4511. Topper AK, Holliday PJ, Fernie GR. Bladder 

volume estimation in the elderly using a 

portable ultrasound-based measurement 

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4512. Torrance C, Jordan S. Bionursing: assessment 

of stress incontinence. Nurs Stand 1995 Oct 

18-24; 10(4):29-31. Case report 

4513. Torres SA, Holley JA, Ando J, et al. 

Maximizing care outcomes of a patient with 

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Aug; 12(6):64-9. Case-series 

4514. Tosun K, Schafer G, Leonhartsberger N, et al. 

Treatment of severe bilateral nerve pain after 

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67(3):623 e5-6. Case Reports 

4515. Tranberg KG, Moller PH. Palliation of 

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4516. Trezza M, Krogh K, Egekvist H, et al. Bowel 

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Scand J Gastroenterol 1999 Apr; 34(4):409-

13. Case-series 

4517. Trieman N, Hughes J, Leff J. The TAPS 

Project 42: the last to leave hospital--a profile 

of residual long-stay populations and plans for 

their resettlement. Team for the Assessment of 

Psychiatric Services. Acta Psychiatr Scand 

1998 Nov; 98(5):354-9. Not eligible level of 

evidence 

4518. Tries J. Kegel exercises enhanced by 

biofeedback. J Enterostomal Ther 1990 MarApr; 17(2):67-76. Case-series 

4519. Trivalle C, Chassagne P, Bouaniche M, et al. 

Nosocomial febrile illness in the elderly: 

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Intern Med 1998 Jul 27; 158(14):1560-5. Not 

eligible target population 

4520. Troeger C, Gugger M, Holzgreve W, et al. 

Correlation of perineal ultrasound and lateral 

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J Pelvic Floor Dysfunct 2003 Dec; 14(6):380-

4. Not eligible outcomes 

4521. Tromp AM, Pluijm SM, Smit JH, et al. Fallrisk screening test: a prospective study on 

predictors for falls in community-dwelling 

elderly. J Clin Epidemiol 2001 Aug; 

54(8):837-44. Not eligible outcomes 

4522. Tromp AM, Smit JH, Deeg DJ, et al. 

Predictors for falls and fractures in the 

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Miner Res 1998 Dec; 13(12):1932-9. Not 

eligible outcomes 

4523. Trowbridge ER, Morgan D, Trowbridge MJ, 

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severity of anal incontinence after anal 

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Dec; 195(6):1753-7. Case-series 

4524. Truijen G, Wyndaele JJ, Weyler J. 

Conservative treatment of stress urinary 

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Urogynecol J Pelvic Floor Dysfunct 2001; 

12(6):386-90. Case-series 
B-202 

4525. Truss MC, Stief CG, Uckert S, et al. Initial 

clinical experience with the selective 

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World J Urol 2000 Dec; 18(6):439-43. Not 

eligible target population 

4526. Tsai SJ, Lew HL, Date E, et al. Treatment of 

detrusor-sphincter dyssynergia by pudendal 

nerve block in patients with spinal cord injury. 

Arch Phys Med Rehabil 2002 May; 

83(5):714-7. Not eligible target population 

4527. Tse E, Knaus R. Laparoscopic radical 

prostatectomy - results of 200 consecutive 

cases in a Canadian medical institution. Can J 

Urol 2004 Apr; 11(2):2172-85. Case-series 

4528. Tseng LH, Liang CC, Lo HP, et al. The 

prevalence of urinary incontinence and 

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Gung Med J 2006 Nov-Dec; 29(6):596-602. 

Not eligible target population 

4529. Tseng LH, Lo TS, Wang AC, et al. Bladder 

perforation presenting as vulvar edema after 

the tension-free vaginal tape procedure. A 

case report. J Reprod Med 2003 Oct; 

48(10):824-6. Not eligible exposure 

4530. Tsiaoussis J, Chrysos E, Athanasakis E, et al. 

Rectoanal intussusception: presentation of the 

disorder and late results of resection 

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48(4):838-44. Not eligible exposure 

4531. Tsivian A, Kessler O, Mogutin B, et al. Tape 

related complications of the tension-free 

vaginal tape procedure. J Urol 2004 Feb; 

171(2 Pt 1):762-4. Not eligible target 

population 

4532. Tsivian A, Shtricker A, Levin S, et al. Bone 

anchor 4-corner cystourethropexy: long-term 

results. J Urol 2003 Jun; 169(6):2244-5. Caseseries 

4533. Tsugawa C, Hisano K, Nishijima E, et al. 

Posterior sagittal anorectoplasty for failed 

imperforate anus surgery: lessons learned 

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Nov; 35(11):1626-9. Not eligible target 

population 

4534. Tsui KP, Ng SC, Tee YT, et al. Complications 

of synthetic graft materials used in suburethral 

sling procedures. Int Urogynecol J Pelvic 

Floor Dysfunct 2005 Mar-Apr; 16(2):165-7. 

Case Reports 

4535. Tsui KP, Ng SC, Yeh GP, et al. Changes of 

urethral pressure profilometry in pubovaginal 

sling and modified Burch colposuspension 

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Jun; 45(2):129-34. Case-series 

4536. Tsujimura A, Matsumiya K, Miyagawa Y, et 

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urinary incontinence after nerve-sparing and 

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Int 2004; 73(1):31-5. Case-series 

4537. Tsunoda A, Shibusawa M, Kamiyama G, et al. 

The effect of vaginal delivery on the pelvic 

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eligible outcomes 

4538. Tsunoda A, Yasuda N, Yokoyama N, et al. 

Delorme's procedure for rectal prolapse: 

clinical and physiological analysis. Dis Colon 

Rectum 2003 Sep; 46(9):1260-5. Case-series 

4539. Tuckson WB, Fazio VW. Functional 

comparison between double and triple ileal 

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34(1):17-21. Case-series 

4540. Tulchinsky H, McCourtney JS, Rao KV, et al. 

Salvage abdominal surgery in patients with a 

retained rectal stump after restorative 

proctocolectomy and stapled anastomosis. Br 

J Surg 2001 Dec; 88(12):1602-6. Case-series 

4541. Tulikangas PK, Weber AM, Larive AB, et al. 

Intraoperative cystoscopy in conjunction with 

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2000 Jun; 95(6 Pt 1):794-6. Not eligible 

exposure 

4542. Tunn R, DeLancey JO, Howard D, et al. MR 

imaging of levator ani muscle recovery 

following vaginal delivery. Int Urogynecol J 

Pelvic Floor Dysfunct 1999; 10(5):300-7. Not 

eligible exposure 

4543. Tunn R, Goldammer K, Gauruder-Burmester 

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women with stress urinary incontinence 

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Obstet Gynecol 2005 Sep; 26(3):287-92. 

Case-series 

4544. Tunn R, Goldammer K, Neymeyer J, et al. 

MRI morphology of the levator ani muscle, 

endopelvic fascia, and urethra in women with 

stress urinary incontinence. Eur J Obstet 

Gynecol Reprod Biol 2006 Jun 1; 126(2):239-

45. Case-series 

4545. Tunn R, Paris S, Fischer W, et al. Static 

magnetic resonance imaging of the pelvic 

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stress urinary incontinence and pelvic 

prolapse. Neurourol Urodyn 1998; 17(6):579-

89. Not eligible outcomes 
B-203 

4546. Tunn R, Rieprich M, Kaufmann O, et al. 

Morphology of the suburethral pubocervical 

fascia in women with stress urinary 

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MRI findings. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Nov-Dec; 16(6):480-6. Not 

eligible outcomes 

4547. Tunuguntla HS, Gousse AE. Missed bilateral 

bladder perforation during pubovaginal sling 

procedure. J Urol 2004 Jul; 172(1):189-90. 

Case Reports 

4548. Tur BS, Suldur N, Ataman S, et al. Brucellar 

spondylitis: a rare cause of spinal cord 

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42(5):321-4. Case- Reports 

4549. Turkan A, Inci Y, Fazli D. The short-term 

effects of physical therapy in different 

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Gynecol Obstet Invest 2005; 59(1):43-8. 

Case-series 

4550. Turner T. Continence. Muscle control. Nurs 

Times 1994 Mar 9-15; 90(10):64-9. Comment 

4551. Turner WH, Danuser H, Moehrle K, et al. The 

effect of nerve sparing cystectomy technique 

on postoperative continence after orthotopic 

bladder substitution. J Urol 1997 Dec; 

158(6):2118-22. Case-series 

4552. Turner-Stokes L, Frank AO. Urinary 

incontinence among patients with arthritis--a 

neglected disability. J R Soc Med 1992 Jul; 

85(7):389-93. Not eligible level of evidence 

4553. Tutuarima JA, van der Meulen JH, de Haan 

RJ, et al. Risk factors for falls of hospitalized 

stroke patients. Stroke 1997 Feb; 28(2):297-

301. Not eligible outcomes 

4554. Tuygun C, Imamoglu A, Keyik B, et al. 

Significance of fibrosis around and/or at 

external urinary sphincter on pelvic magnetic 

resonance imaging in patients with 

postprostatectomy incontinence. Urology 

2006 Dec; 68(6):1308-12. Not eligible 

outcomes 

4555. Twiss C, Fleischmann N, Nitti VW. 

Correlation of abdominal leak point pressure 

with objective incontinence severity in men 

with post-radical prostatectomy stress 

incontinence. Neurourol Urodyn 2005; 

24(3):207-10. Case-series 

4556. Uchiyama T, Sakakibara R, Hattori T, et al. 

Short-term effect of a single levodopa dose on 

micturition disturbance in Parkinson's disease 

patients with the wearing-off phenomenon. 

Mov Disord 2003 May; 18(5):573-8. Not 

eligible target population 

4557. Ullrich NF, Comiter CV. The male sling for 

stress urinary incontinence: 24-month 

followup with questionnaire based assessment. 

J Urol 2004 Jul; 172(1):207-9. Case-series 

4558. Ullrich NF, Comiter CV. The male sling for 

stress urinary incontinence: urodynamic and 

subjective assessment. J Urol 2004 Jul; 

172(1):204-6. Case-series 

4559. Ulmsten U, Falconer C, Johnson P, et al. A 

multicenter study of tension-free vaginal tape 

(TVT) for surgical treatment of stress urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 1998; 9(4):210-3. Not eligible target 

population 

4560. Ulmsten U, Henriksson L, Johnson P, et al. 

An ambulatory surgical procedure under local 

anesthesia for treatment of female urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 1996; 7(2):81-5; discussion 5-6. Not 

eligible exposure 

4561. Ulmsten U, Johnson P, Rezapour M. A threeyear follow up of tension free vaginal tape for 

surgical treatment of female stress urinary 

incontinence. Br J Obstet Gynaecol 1999 Apr; 

106(4):345-50. Not eligible target population 

4562. Ulmsten U, Petros P. Intravaginal slingplasty 

(IVS): an ambulatory surgical procedure for 

treatment of female urinary incontinence. 

Scand J Urol Nephrol 1995 Mar; 29(1):75-82. 

Not eligible target population 

4563. Ulrich A, Z'Graggen K, Weitz J, et al. 

Functional results of the colon J-pouch versus 

transverse coloplasty pouch in Heidelberg. 

Recent Results Cancer Res 2005; 165:205-11. 

No associative hypothesis testes 

4564. Uludag O, Koch SM, Dejong CH, et al. Sacral 

neuromodulation; does it affect colonic transit 

time in patients with faecal incontinence? 

Colorectal Dis 2006 May; 8(4):318-22. Not 

eligible target population 

4565. Uludag O, Koch SM, van Gemert WG, et al. 

Sacral neuromodulation in patients with fecal 

incontinence: a single-center study. Dis Colon 

Rectum 2004 Aug; 47(8):1350-7. Not eligible 

target population 

4566. Uludag O, Morren GL, Dejong CH, et al. 

Effect of sacral neuromodulation on the 

rectum. Br J Surg 2005 Aug; 92(8):1017-23. 

Case-series 

4567. Uma R, Libby G, Murphy DJ. Obstetric 

management of a woman's first delivery and 

the implications for pelvic floor surgery in 

later life. Bjog 2005 Aug; 112(8):1043-6. Not 

eligible outcomes 
B-204 

4568. Umstad MP, Glenning PP. Urodynamic 

investigation in the management of 

incontinent women. Asia Oceania J Obstet 

Gynaecol 1991 Dec; 17(4):307-13. Caseseries 

4569. Unterweger M, Marincek B, Gottstein-Aalame 

N, et al. Ultrafast MR imaging of the pelvic 

floor. AJR Am J Roentgenol 2001 Apr; 

176(4):959-63. Case-series 

4570. Upton N, Reed V. The meaning of 

incontinence in dementia care. Int J Psychiatr 

Nurs Res 2005 Sep; 11(1):1200-10. Not 

eligible outcomes 

4571. Urso E, Serpentini S, Pucciarelli S, et al. 

Complications, functional outcome and 

quality of life after intensive preoperative 

chemoradiotherapy for rectal cancer. Eur J 

Surg Oncol 2006 Dec; 32(10):1201-8. No 

associative hypothesis tested 

4572. Ushiroyama T, Ikeda A, Ueki M. Prevalence, 

incidence, and awareness in the treatment of 

menopausal urinary incontinence. Maturitas 

1999 Oct 24; 33(2):127-32. Not eligible level 

of evidence 

4573. Ushiroyama T, Ikeda A, Ueki M. Clinical 

efficacy of clenbuterol and propiverine in 

menopausal women with urinary 

incontinence: improvement in quality of life. J 

Med 2000; 31(5-6):311-9. Not eligible target 

population 

4574. Ustun Y, Engin-Ustun Y, Gungor M, et al. 

Randomized comparison of Burch 

urethropexy procedures concomitant with 

gynecologic operations. Gynecol Obstet Invest 

2005; 59(1):19-23. Not eligible exposure 

4575. Vaccaro CA, Cheong DM, Wexner SD, et al. 

Pudendal neuropathy in evacuatory disorders. 

Dis Colon Rectum 1995 Feb; 38(2):166-71. 

Not eligible outcomes 

4576. Vaidya A, Soloway MS. Salvage radical 

prostatectomy for radiorecurrent prostate 

cancer: morbidity revisited. J Urol 2000 Dec; 

164(6):1998-2001. Case-series 

4577. Vaidyananthan S, Soni BM, Brown E, et al. 

Effect of intermittent urethral catheterization 

and oxybutynin bladder instillation on urinary 

continence status and quality of life in a 

selected group of spinal cord injury patients 

with neuropathic bladder dysfunction. Spinal 

Cord 1998 Jun; 36(6):409-14. Not eligible 

target population 

4578. Vaidyanathan S, Soni BM, Sett P, et al. 

Flawed trial of micturition in cervical spinal 

cord injury patients: guidelines for trial of 

voiding in men with tetraplegia. Spinal Cord 

2003 Dec; 41(12):667-72. Case-series 

4579. Vaizey CJ, Carapeti E, Cahill JA, et al. 

Prospective comparison of faecal incontinence 

grading systems. Gut 1999 Jan; 44(1):77-80. 

Case-series 

4580. Vaizey CJ, Kamm MA. Prospective 

assessment of the clinical value of anorectal 

investigations. Digestion 2000; 61(3):207-14. 

Not eligible outcomes 

4581. Vaizey CJ, Kamm MA, Bartram CI. Primary 

degeneration of the internal anal sphincter as a 

cause of passive faecal incontinence. Lancet 

1997 Mar 1; 349(9052):612-5. Not eligible 

outcomes 

4582. Vaizey CJ, Kamm MA, Gold DM, et al. 

Clinical, physiological, and radiological study 

of a new purpose-designed artificial bowel 

sphincter. Lancet 1998 Jul 11; 352(9122):105-

9. Case-series 

4583. Vaizey CJ, Kamm MA, Roy AJ, et al. Doubleblind crossover study of sacral nerve 

stimulation for fecal incontinence. Dis Colon 

Rectum 2000 Mar; 43(3):298-302. Not 

eligible target population 

4584. Vaizey CJ, Kamm MA, Turner IC, et al. 

Effects of short term sacral nerve stimulation 

on anal and rectal function in patients with 

anal incontinence. Gut 1999 Mar; 44(3):407-

12. Case-series 

4585. Vaizey CJ, Norton C, Thornton MJ, et al. 

Long-term results of repeat anterior anal 

sphincter repair. Dis Colon Rectum 2004 Jun; 

47(6):858-63. Case-series 

4586. Vajda P, Buyukunal CS, Soylet Y, et al. A 

therapeutic method for failed bladder 

augmentation in children: re-augmentation. 

BJU Int 2006 Apr; 97(4):816-9, discussion 9. 

Not eligible target population 

4587. Valappil SV, Nan A. Successful treatment of 

persistent voiding dysfunction following 

Tension Free Vaginal Tape procedure. J 

Obstet Gynaecol 2005 Jan; 25(1):79. Case 

Reports 

4588. Valiquette L, Duclos AJ, Lapointe SP. 

FPSUND: a new clinical classification of 

urinary incontinence. Can J Urol 2000 Jun; 

7(3):1038-42. Not eligible outcomes 

4589. Valk M, Post MW, Cools HJ, et al. Measuring 

disability in nursing home residents: validity 

and reliability of a newly developed 

instrument. J Gerontol B Psychol Sci Soc Sci 

2001 May; 56(3):P187-91. Not eligible 

outcomes 
B-205 

4590. Valldeoriola F, Valls-Sole J, Tolosa ES, et al. 

Striated anal sphincter denervation in patients 

with progressive supranuclear palsy. Mov 

Disord 1995 Sep; 10(5):550-5. Not eligible 

exposure 

4591. Valvanne J, Juva K, Erkinjuntti T, et al. Major 

depression in the elderly: a population study in 

Helsinki. Int Psychogeriatr 1996 Fall; 

8(3):437-43. Not eligible outcomes 

4592. Van Andel G, Visser AP, Hulshof MC, et al. 

Health-related quality of life and psychosocial 

factors in patients with prostate cancer 

scheduled for radical prostatectomy or 

external radiation therapy. BJU Int 2003 Aug; 

92(3):217-22. Case-series 

4593. van Andel G, Visser AP, Zwinderman AH, et 

al. A prospective longitudinal study 

comparing the impact of external radiation 

therapy with radical prostatectomy on health 

related quality of life (HRQOL) in prostate 

cancer patients. Prostate 2004 Mar 1; 

58(4):354-65. Case series 

4594. van Balken MR, Vergunst H, Bemelmans BL. 

Sexual functioning in patients with lower 

urinary tract dysfunction improves after 

percutaneous tibial nerve stimulation. Int J 

Impot Res 2006 Sep-Oct; 18(5):470-5; 

discussion 6. Not eligible target population 

4595. van Balken MR, Vergunst H, Bemelmans BL. 

Prognostic factors for successful percutaneous 

tibial nerve stimulation. Eur Urol 2006 Feb; 

49(2):360-5. Not eligible target population 

4596. van Bennekom CA, Jelles F, Lankhorst GJ, et 

al. The Rehabilitation Activities Profile: a 

validation study of its use as a disability index 

with stroke patients. Arch Phys Med Rehabil 

1995 Jun; 76(6):501-7. Not eligible outcomes 

4597. Van Brummen HJ, Bruinse HW, Van de Pol 

G, et al. What is the effect of overactive 

bladder symptoms on woman's quality of life 

during and after first pregnancy? BJU Int 2006 

Feb; 97(2):296-300. Not eligible outcomes 

4598. van Brummen HJ, van de Pol G, Aalders CI, 

et al. Sacrospinous hysteropexy compared to 

vaginal hysterectomy as primary surgical 

treatment for a descensus uteri: effects on 

urinary symptoms. Int Urogynecol J Pelvic 

Floor Dysfunct 2003 Nov; 14(5):350-5; 

discussion 5. Case-series 

4599. van Dam JH, Huisman WM, Hop WC, et al. 

Fecal continence after rectocele repair: a 

prospective study. Int J Colorectal Dis 2000 

Feb; 15(1):54-7. Case-series 

4600. van de Port IG, Kwakkel G, Schepers VP, et 

al. Predicting mobility outcome one year after 

stroke: a prospective cohort study. J Rehabil 

Med 2006 Jul; 38(4):218-23. Not eligible 

outcomes 

4601. van der Hagen SJ, van Gemert WG, Baeten 

CG. PTQ Implants in the treatment of faecal 

soiling. Br J Surg 2007 Feb; 94(2):222-3. 

Case-series 

4602. van der Hurk PR, Middelkoop HA, van 

Waalwijk-van Doorn ES, et al. Long-term 

ambulatory monitoring of urine leakage in the 

elderly: an evaluation of the validity and 

clinical applicability of thermistor signalling. J 

Med Eng Technol 1998 Mar-Apr; 22(2):91-3. 

Case-reports 

4603. van der Linden MC, Gerretsen G, Brandhorst 

MS, et al. The effect of estriol on the cytology 

of urethra and vagina in postmenopausal 

women with genito-urinary symptoms. Eur J 

Obstet Gynecol Reprod Biol 1993 Sep; 

51(1):29-33. Not eligible outcomes 

4604. van der Pal F, van Balken MR, Heesakkers JP, 

et al. Percutaneous tibial nerve stimulation in 

the treatment of refractory overactive bladder 

syndrome: is maintenance treatment 

necessary? BJU Int 2006 Mar; 97(3):547-50. 

Not eligible target population 

4605. van der Vaart CH, de Leeuw JR, Roovers JP, 

et al. Measuring health-related quality of life 

in women with urogenital dysfunction: the 

urogenital distress inventory and incontinence 

impact questionnaire revisited. Neurourol 

Urodyn 2003; 22(2):97-104. Not eligible 

outcomes 

4606. van der Weide M, Smits J. Adoption of 

innovations by specialised nurses: personal, 

work and organisational characteristics. 

Health Policy 2004 Apr; 68(1):81-92. Not 

eligible exposure 

4607. van Dijk MM, Mochtar CA, Wijkstra H, et al. 

The bell-shaped nitinol prostatic stent in the 

treatment of lower urinary tract symptoms: 

experience in 108 patients. Eur Urol 2006 

Feb; 49(2):353-9. Case-series 

4608. van Duijvendijk P, Slors F, Taat CW, et al. A 

prospective evaluation of anorectal function 

after total mesorectal excision in patients with 

a rectal carcinoma. Surgery 2003 Jan; 

133(1):56-65. Not eligible exposure 

4609. van Eijken M, Wensing M, de Konink M, et 

al. Health education on self-management and 

seeking health care in older adults: a 

randomised trial. Patient Educ Couns 2004 

Oct; 55(1):48-54. Not eligible outcomes 
B-206 

4610. van Geelen JM, van de Weijer PH, Arnolds 

HT. Urogenital symptoms and resulting 

discomfort in non-institutionalized Dutch 

women aged 50-75 years. Int Urogynecol J 

Pelvic Floor Dysfunct 2000; 11(1):9-14. Not 

eligible level of evidence 

4611. Van Gossum A, Zalcman M, Adler M, et al. 

Anorectal stenosis in patients with prolonged 

use of suppositories containing paracetamol 

and acetylsalicylic acid. Dig Dis Sci 1993 

Nov; 38(11):1970-7. Case-reports 

4612. Van Kampen M, De Weerdt W, Van Poppel 

H, et al. Prediction of urinary continence 

following radical prostatectomy. Urol Int 

1998; 60(2):80-4. Not eligible level of 

evidence 

4613. Van Kerrebroeck EV, van der Aa HE, Bosch 

JL, et al. Sacral rhizotomies and electrical 

bladder stimulation in spinal cord injury. Part 

I: Clinical and urodynamic analysis. Dutch 

Study Group on Sacral Anterior Root 

Stimulation. Eur Urol 1997; 31(3):263-71. Not 

eligible target population 

4614. van Kerrebroeck P, Abrams P, Lange R, et al. 

Duloxetine versus placebo in the treatment of 

European and Canadian women with stress 

urinary incontinence. BJOG 2004 Mar; 

111(3):249-57. Not eligible exposure 

4615. Van Kerrebroeck P, Kreder K, Jonas U, et al. 

Tolterodine once-daily: superior efficacy and 

tolerability in the treatment of the overactive 

bladder. Urology 2001 Mar; 57(3):414-21. Not 

eligible exposure 

4616. van Kerrebroeck P, ter Meulen F, Larsson G, 

et al. Treatment of stress urinary incontinence 

using a copolymer system: impact on quality 

of life. BJU Int 2004 Nov; 94(7):1040-3. Not 

eligible target population 

4617. Van Kerrebroeck PE, Koldewijn EL, 

Debruyne FM. Worldwide experience with the 

Finetech-Brindley sacral anterior root 

stimulator. Neurourol Urodyn 1993; 

12(5):497-503. Review 

4618. van Laarhoven CJ, Andriesse GI, Schipper 

ME, et al. Ileoneorectal anastomosis: early 

clinical results of a restorative procedure for 

ulcerative colitis and familial adenomatous 

polyposis without formation of an ileoanal 

pouch. Ann Surg 1999 Dec; 230(6):750-7; 

discussion 7-8. Case-series 

4619. van Melick HH, Gisolf KW, Eckhardt MD, et 

al. One 24-hour frequency-volume chart in a 

woman with objective urinary motor urge 

incontinence is sufficient. Urology 2001 Aug; 

58(2):188-92. Case-series 

4620. van Os-Bossagh P, Pols T, Hop WC, et al. 

Voiding symptoms in chronic pelvic pain 

(CPP). Eur J Obstet Gynecol Reprod Biol 

2003 Apr 25; 107(2):185-90. Case-series 

4621. Van Rijswijk L. AHCPR update. The 

guidelines for urinary incontinence in adults. 

Ostomy Wound Manage 1992 May; 38(4):8, 

10. Guideline 

4622. Van Savage JG, Chancellor MB, 

Slaughenhoupt B. Transverse retubularized 

ileovesicostomy continent urinary diversion to 

the umbilicus. Tech Urol 2000 Mar; 6(1):29-

33. Case-series 

4623. Van Savage JG, Khoury AE, McLorie GA, et 

al. Outcome analysis of Mitrofanoff principle 

applications using appendix and ureter to 

umbilical and lower quadrant stomal sites. J 

Urol 1996 Nov; 156(5):1794-7. Not eligible 

target population 

4624. Van Savage JG, Yepuri JN. Transverse 

retubularized sigmoidovesicostomy continent 

urinary diversion to the umbilicus. J Urol 

2001 Aug; 166(2):644-7. Not eligible target 

population 

4625. Van Savage JG, Yohannes P. Laparoscopic 

antegrade continence enema in situ appendix 

procedure for refractory constipation and 

overflow fecal incontinence in children with 

spina bifida. J Urol 2000 Sep; 164(3 Pt 

2):1084-7. Not eligible target population 

4626. van Straaten EC, Fazekas F, Rostrup E, et al. 

Impact of white matter hyperintensities 

scoring method on correlations with clinical 

data: the LADIS study. Stroke 2006 Mar; 

37(3):836-40. Not eligible outcomes 

4627. Van Tets WF, Kuijpers JH. Seton treatment of 

perianal fistula with high anal or rectal 

opening. Br J Surg 1995 Jul; 82(7):895-7. 

Case-series 

4628. van Tets WF, Kuijpers JH, Bleijenberg G. 

Biofeedback treatment is ineffective in 

neurogenic fecal incontinence. Dis Colon 

Rectum 1996 Sep; 39(9):992-4. Case-series 

4629. Van Tets WF, Kuijpers JH, Mortelmans LJ, et 

al. Sphincter-saving surgery for rectal and 

colorectal disorders. Scand J Gastroenterol 

Suppl 1996; 218:34-7. Case-series 

4630. van Venrooij GE, Boon TA. Extensive 

urodynamic investigation: interaction among 

diuresis, detrusor instability, urethral 

relaxation, incontinence and complaints in 

women with a history of urge incontinence. J 

Urol 1994 Nov; 152(5 Pt 1):1535-8. Not 

eligible exposure 
B-207 

4631. van Voskuilen AC, Oerlemans DJ, Weil EH, 

et al. Long term results of neuromodulation by 

sacral nerve stimulation for lower urinary tract 

symptoms: a retrospective single center study. 

Eur Urol 2006 Feb; 49(2):366-72. Not eligible 

outcomes 

4632. van Waalwijk van Doorn ES, Remmers A, 

Janknegt RA. Extramural ambulatory 

urodynamic monitoring during natural filling 

and normal daily activities: evaluation of 100 

patients. J Urol 1991 Jul; 146(1):124-31. Not 

eligible outcomes 

4633. Van Zak DB. Non-invasive feedback of 

external pubococcegii muscle activity as a 

treatment for urinary incontinence. Int J 

Psychosom 1993; 40(1-4):56-9. Case-series 

4634. van Zon-Rabelink I, Laven J, Vleugels M. The 

bacteriological changes after re-using a 

vaginal continence guard. Acta Obstet 

Gynecol Scand 1999 Sep; 78(8):722-7. Caseseries 

4635. Vandoninck V, Van Balken MR, Finazzi Agro 

E, et al. Posterior tibial nerve stimulation in 

the treatment of urge incontinence. Neurourol 

Urodyn 2003; 22(1):17-23. Not eligible target 

population 

4636. Vandoninck V, van Balken MR, Finazzi Agro 

E, et al. Percutaneous tibial nerve stimulation 

in the treatment of overactive bladder: 

urodynamic data. Neurourol Urodyn 2003; 

22(3):227-32. Not eligible target population 

4637. Varkarakis J, Pinggera GM, Sebe P, et al. 

Radical retropubic prostatectomy in men 

younger than 45 years diagnosed during early 

prostate cancer detection program. Urology 

2004 Feb; 63(2):337-41. Not eligible 

outcomes 

4638. Varma A, Gunn J, Gardiner A, et al. Obstetric 

anal sphincter injury: prospective evaluation 

of incidence. Dis Colon Rectum 1999 Dec; 

42(12):1537-43. Not eligible outcomes 

4639. Varma A, Gunn J, Lindow SW, et al. Do 

routinely measured delivery variables predict 

anal sphincter outcome? Dis Colon Rectum 

1999 Oct; 42(10):1261-4. Not eligible 

outcomes 

4640. Varma JS. Autonomic influences on colorectal 

motility and pelvic surgery. World J Surg 

1992 Sep-Oct; 16(5):811-9. Case-series 

4641. Varner RE, Plessala KJ, Richter H. Effects of 

sacrocolposuspension on the lower urinary 

tract. Am J Obstet Gynecol 1995 Dec; 

173(6):1684-8; discussion 8-9. Case-series 

4642. Vaseemuddin M, Sam R. Large B-cell nonHodgkin lymphoma. Am J Kidney Dis 2005 

Dec; 46(6):A52, e101-2. Case- Reports 

4643. Vassallo BJ, Kleeman SD, Segal J, et al. 

Urethral erosion of a tension-free vaginal tape. 

Obstet Gynecol 2003 May; 101(5 Pt 2):1055-

8. Case Reports 

4644. Vassallo BJ, Kleeman SD, Segal JL, et al. 

Tension-free vaginal tape: a quality-of-life 

assessment. Obstet Gynecol 2002 Sep; 

100(3):518-24. Not eligible exposure 

4645. Vassilakis JS, Pechlivanides G, Zoras OJ, et 

al. Anorectal function after low anterior 

resection of the rectum. Int J Colorectal Dis 

1995; 10(2):101-6. Case-series 

4646. Vazzoler N, Soulie M, Escourrou G, et al. 

Pubourethral ligaments in women: anatomical 

and clinical aspects. Surg Radiol Anat 2002 

Feb; 24(1):33-7. Not eligible target population 

4647. Vecchioli Scaldazza C. Rehabilitative 

treatment of non-neurogenic female urinary 

incontinence. Clinical and urodynamic 

evaluation. Minerva Urol Nefrol 1997 Mar; 

49(1):5-8. Not eligible target population 

4648. Vegh A. Two methods in the treatment of 

prostate cancer T1-T2. Acta Chir Hung 1997; 

36(1-4):383-5. Case-series 

4649. Vehmas T, Lindell O, Soimakallio S, et al. 

Percutaneous nephrostomy in the management 

of urinary leakages and fistulas. 

Rontgenblatter 1990 Dec; 43(12):512-5. Caseseries 

4650. Velez JB. Behavior therapy for urge 

incontinence in older women. J Fam Pract 

1999 Mar; 48(3):168-9. News 

4651. Venkatesan P, Gladman J, Macfarlane JT, et 

al. A hospital study of community acquired 

pneumonia in the elderly. Thorax 1990 Apr; 

45(4):254-8. Case-series 

4652. Venkatesh KS, Ramanujam P. Surgical 

treatment of traumatic cloaca. Dis Colon 

Rectum 1996 Jul; 39(7):811-6. Case-series 

4653. Vereecken RL, Van Nuland T. Detrusor 

pressure in ambulatory versus standard 

urodynamics. Neurourol Urodyn 1998; 

17(2):129-33. Case-series 

4654. Verelst M, Maltau JM, Orbo A. Computerised 

morphometric study of the paraurethral tissue 

in young and elderly women. Neurourol 

Urodyn 2002; 21(6):529-33. Not eligible 

outcomes 

4655. Verhoef M, Barf HA, Post MW, et al. 

Functional independence among young adults 

with spina bifida, in relation to hydrocephalus 

and level of lesion. Dev Med Child Neurol 

2006 Feb; 48(2):114-9. Not eligible target 

population 
B-208 

4656. Verhoef M, Lurvink M, Barf HA, et al. High 

prevalence of incontinence among young 

adults with spina bifida: description, 

prediction and problem perception. Spinal 

Cord 2005 Jun; 43(6):331-40. Not eligible 

target population 

4657. Vernava AM, 3rd, Longo WE, Daniel GL. 

Pudendal neuropathy and the importance of 

EMG evaluation of fecal incontinence. Dis 

Colon Rectum 1993 Jan; 36(1):23-7. Caseseries 

4658. Vernon S, Bleakley S. A successful bladder 

retraining program. Nurs Times 1997 Sep 17-

23; 93(38):50-1. Case Reports 

4659. Vernon T. Managing excoriation. Nurs Times 

2000 Jul 20; 96(29 Suppl):12. Case Reports 

4660. Veronikis DK, Nichols DH, Spino C. The 

Noble-Mengert-Fish operation-revisited: a 

composite approach for persistent rectovaginal 

fistulas and complex perineal defects. Am J 

Obstet Gynecol 1998 Dec; 179(6 Pt 1):1411-

6; discussion 6-7. Case-series 

4661. Veronikis DK, Nichols DH, Wakamatsu MM. 

The incidence of low-pressure urethra as a 

function of prolapse-reducing technique in 

patients with massive pelvic organ prolapse 

(maximum descent at all vaginal sites). Am J 

Obstet Gynecol 1997 Dec; 177(6):1305-13; 

discussion 13-4. Not eligible level of evidence 

4662. Versi E. Incontinence in the climacteric. Clin 

Obstet Gynecol 1990 Jun; 33(2):392-8. 

Review 

4663. Versi E, Appell R, Mobley D, et al. Dry 

mouth with conventional and controlledrelease oxybutynin in urinary incontinence. 

The Ditropan XL Study Group. Obstet 

Gynecol 2000 May; 95(5):718-21. Not eligible 

exposure 

4664. Versi E, Griffiths DJ, Harvey MA. A new 

external urethral occlusive device for female 

urinary incontinence. Obstet Gynecol 1998 

Aug; 92(2):286-91. Not eligible target 

population 

4665. Versi E, Harvey MA. Efficacy of an external 

urethral device in women with genuine stress 

urinary incontinence. Int Urogynecol J Pelvic 

Floor Dysfunct 1998; 9(5):271-4. Not eligible 

target population 

4666. Versi E, Lyell DJ, Griffiths DJ. 

Videourodynamic diagnosis of occult genuine 

stress incontinence in patients with anterior 

vaginal wall relaxation. J Soc Gynecol 

Investig 1998 Nov-Dec; 5(6):327-30. Caseseries 

4667. Versluis PJ, Konsten J, Geerdes B, et al. 

Defecographic evaluation of dynamic 

graciloplasty for fecal incontinence. Dis Colon 

Rectum 1995 May; 38(5):468-73. Case-series 

4668. Vgontzas AN, Sollenberger SE, Kales A, et al. 

Narcolepsy-cataplexy and loss of sphincter 

control. Postgrad Med J 1996 Aug; 

72(850):493-4. Case- Reports 

4669. Vicini FA, Kestin LL, Martinez AA. Use of 

conformal high-dose rate brachytherapy for 

management of patients with prostate cancer: 

optimizing dose escalation. Tech Urol 2000 

Jun; 6(2):135-45. Not eligible outcomes 

4670. Vickerman J. Environmental problems: 

valuable equipment. Nurs Times 2002 Apr 23-

29; 98(17):57. Comment 

4671. Videla FL, Wall LL. Stress incontinence 

diagnosed without multichannel urodynamic 

studies. Obstet Gynecol 1998 Jun; 91(6):965-

8. Not eligible outcomes 

4672. Viereck V, Bader W, Krauss T, et al. Intraoperative introital ultrasound in Burch 

colposuspension reduces post-operative 

complications. Bjog 2005 Jun; 112(6):791-6. 

Case-series 

4673. Viereck V, Bader W, Skala C, et al. 

Determination of bladder neck position by 

intraoperative introital ultrasound in 

colposuspension: outcome at 6-month followup. Ultrasound Obstet Gynecol 2004 Aug; 

24(2):186-91. Case-series 

4674. Viereck V, Pauer HU, Bader W, et al. Introital 

ultrasound of the lower genital tract before 

and after colposuspension: a 4-year objective 

follow-up. Ultrasound Obstet Gynecol 2004 

Mar; 23(3):277-83. Not eligible target 

population 

4675. Vierhout ME. Severe hemorrhage 

complicating tension-free vaginal tape (TVT): 

a case report. Int Urogynecol J Pelvic Floor 

Dysfunct 2001; 12(2):139-40. Case Reports 

4676. Vierhout ME, Gianotten WL. Mechanisms of 

urine loss during sexual activity. Eur J Obstet 

Gynecol Reprod Biol 1993 Nov; 52(1):45-7. 

Not eligible outcomes 

4677. Vierhout ME, Hol M. Vaginal ultrasound 

studies before and after successful 

colposuspension and in continent controls. 

Acta Obstet Gynecol Scand 1998 Jan; 

77(1):101-4. Not eligible oucomes 

4678. Vigod SN, Stewart DE. Major depression in 

female urinary incontinence. Psychosomatics 

2006 Mar-Apr; 47(2):147-51. Not eligible 

outcomes 
B-209 

4679. Viktrup L, Lose G. Epidural anesthesia during 

labor and stress incontinence after delivery. 

Obstet Gynecol 1993 Dec; 82(6):984-6. Caseseries 

4680. Viktrup L, Lose G. Lower urinary tract 

symptoms 5 years after the first delivery. Int 

Urogynecol J Pelvic Floor Dysfunct 2000 

Dec; 11(6):336-40. Not eligible level of 

evidence 

4681. Viktrup L, Lose G. Do fertile women 

remember the onset of stress incontinence? 

Recall bias 5 years after 1st delivery. Acta 

Obstet Gynecol Scand 2001 Oct; 80(10):952-

5. Not eligible outcomes 

4682. Viktrup L, Lose G. The risk of stress 

incontinence 5 years after first delivery. Am J 

Obstet Gynecol 2001 Jul; 185(1):82-7. Not 

eligible level of evidence 

4683. Vinker S, Kaplan B, Nakar S, et al. Urinary 

incontinence in women: prevalence, 

characteristics and effect on quality of life. A 

primary care clinic study. Isr Med Assoc J 

2001 Sep; 3(9):663-6. Not eligible level of 

evidence 

4684. Vinsnes AG, Haltbakk J, Hunskaar S. A 

Norwegian version of the Incontinence Stress 

Questionnaire-Staff Reaction: translation and 

validation for cross-cultural use. J Nurs Meas 

2000 Summer; 8(1):71-86. Not eligible 

exposure 

4685. Vinsnes AG, Hunskaar S. Distress associated 

with urinary incontinence, as measured by a 

visual analogue scale. Scand J Caring Sci 

1991; 5(1):57-61. Not eligible outcomes 

4686. Vinson J, Proch J. Inhibition of moisture 

penetration to the skin by a novel incontinence 

barrier product. J Wound Ostomy Continence 

Nurs 1998 Sep; 25(5):256-60. Not eligible 

outcomes 

4687. Violi V, Boselli AS, De Bernardinis M, et al. 

Surgical results and functional outcome after 

total anorectal reconstruction by double 

graciloplasty supported by external-source 

electrostimulation and/or implantable pulse 

generators: an 8-year experience. Int J 

Colorectal Dis 2004 May; 19(3):219-27. 

Case-series 

4688. Violi V, Boselli AS, De Bernardinis M, et al. 

A patient-rated, surgeon-corrected scale for 

functional assessment after total anorectal 

reconstruction. An adaptation of the Working 

Party on Anal Sphincter Replacement scoring 

system. Int J Colorectal Dis 2002 Sep; 

17(5):327-37. Not eligible outcomes 

4689. Violi V, Boselli AS, Sarli L, et al. Rectal 

cancer in anorectal malformation with 

rectovestibular fistula: sphincter-restoring 

surgery by anterior resection and dynamic 

vaginoanograciloplasty. Dis Colon Rectum 

2001 Jul; 44(7):1043-8. Case Reports 

4690. Violi V, Roncoroni L, Boselli AS, et al. 

Continent perineal colostomy by 

electrostimulated graciloplasty in 

abdominoperineal resection. A preliminary 

report. Acta Biomed Ateneo Parmense 1996; 

67(3-4):131-42. Case-series 

4691. Violi V, Roncoroni L, Boselli AS, et al. Total 

anorectal reconstruction by double 

graciloplasty: experience with delayed, 

selective use of implantable pulse generators. 

Int J Colorectal Dis 1999 Aug; 14(3):164-71. 

Not eligible target population 

4692. Virgili A, Corazza M, Califano A. Diaper 

dermatitis in an adult. A case of erythema 

papuloerosive of Sevestre and Jacquet. J 

Reprod Med 1998 Nov; 43(11):949-51. Casereports 

4693. Vironen JH, Kairaluoma M, Aalto AM, et al. 

Impact of functional results on quality of life 

after rectal cancer surgery. Dis Colon Rectum 

2006 May; 49(5):568-78. Case-series 

4694. Virtanen H, Hirvonen T, Makinen J, et al. 

Outcome of thirty patients who underwent 

repair of posthysterectomy prolapse of the 

vaginal vault with abdominal sacral 

colpopexy. J Am Coll Surg 1994 Mar; 

178(3):283-7. Case-series 

4695. Virtanen H, Makinen J, Tenho T, et al. Effects 

of abdominal hysterectomy on urinary and 

sexual symptoms. Br J Urol 1993 Dec; 

72(6):868-72. Case-series 

4696. Virtanen HS, Kiilholma P. Urogynecologic 

ultrasound is a useful aid in the assessment of 

female stress urinary incontinence--a 

prospective study with TVT procedure. Int 

Urogynecol J Pelvic Floor Dysfunct 2002; 

13(4):218-22; discussion 23. Case-series 

4697. Virtanen HS, Makinen JI. Vesicocervical 

fistula--a rare cause of urinary incontinence. 

Eur J Obstet Gynecol Reprod Biol 1994 Oct; 

57(1):54-5. Case Reports 

4698. Visco AG, Weidner AC, Cundiff GW, et al. 

Observed patient compliance with a structured 

outpatient bladder retraining program. Am J 

Obstet Gynecol 1999 Dec; 181(6):1392-4. Not 

eligible outcomes 
B-210 

4699. Viseshsindh W, Kochakarn W, Waikakul W, 

et al. A randomized controlled trial of 

pubovaginal sling versus vaginal wall sling for 

stress urinary incontinence. J Med Assoc Thai 

2003 Apr; 86(4):308-15. Not available 

publication 

4700. Visser AJ, Heyns CF, Visser Jun AJ. 

Vesicosuspension for female stress 

incontinence and cystocele using pubic bone 

anchors. S Afr J Surg 2001 Nov; 39(4):129-

32. Case-series 

4701. Voderholzer WA, Neuhaus DA, Klauser AG, 

et al. Paradoxical sphincter contraction is 

rarely indicative of anismus. Gut 1997 Aug; 

41(2):258-62. Not eligible outcomes 

4702. Volk RJ, Cantor SB, Cass AR, et al. 

Preferences of husbands and wives for 

outcomes of prostate cancer screening and 

treatment. J Gen Intern Med 2004 Apr; 

19(4):339-48. Not eligible target population 

4703. Volkan T, Ihsan TA, Yilmaz O, et al. Short 

term outcomes of high power (80 W) 

potassium-titanyl-phosphate laser vaporization 

of the prostate. Eur Urol 2005 Oct; 48(4):608-

13. Q2 

4704. Volkmer BG, Kuefer R, Nesslauer T, et al. 

Colour Doppler ultrasound in vesicovaginal 

fistulas. Ultrasound Med Biol 2000 Jun; 

26(5):771-5. Not eligible exposure 

4705. Volkmer BG, Nesslauer T, Rinnab L, et al. 

Surgical intervention for complications of 

tension-free vaginal tape procedure. J Urol 

2003 Feb; 169(2):570-4. Case Reports 

4706. von Pechmann WS, Mutone M, Fyffe J, et al. 

Total colpocleisis with high levator plication 

for the treatment of advanced pelvic organ 

prolapse. Am J Obstet Gynecol 2003 Jul; 

189(1):121-6. Case-series 

4707. von Theobald P, Barjot P, Levy G. Feasibility 

of and interest in laparoscopic assessment in 

recurrent urinary stress incontinence after 

Burch procedure performed by laparotomy. 

Surg Endosc 1997 May; 11(5):468-71. Not 

eligible exposure 

4708. von Theobald P, Guillaumin D, Levy G. 

Laparoscopic preperitoneal colposuspension 

for stress incontinence in women. Technique 

and results of 37 procedures. Surg Endosc 

1995 Nov; 9(11):1189-92. Case-series 

4709. von Wendt L, Simila S, Niskanen P, et al. 

Development of bowel and bladder control in 

the mentally retarded. Dev Med Child Neurol 

1990 Jun; 32(6):515-8. Not eligible target 

population 

4710. Voorham-van der Zalm PJ, Pelger RC, 

Stiggelbout AM, et al. Effects of magnetic 

stimulation in the treatment of pelvic floor 

dysfunction. BJU Int 2006 May; 97(5):1035-8. 

Case-series 

4711. Vorburger SA, Von Flue M, Harder F. Pelvic 

floor herniation after modified York-Mason 

approach to the rectum: report of a case. Dis 

Colon Rectum 1998 Mar; 41(3):389-90. Case 

Reports 

4712. Vordermark D, Flentje M, Sailer M, et al. 

Intracavitary afterloading boost in anal canal 

carcinoma. Results, function and quality of 

life. Strahlenther Onkol 2001 May; 

177(5):252-8. Not eligible target population 

4713. Vordermark D, Schwab M, Flentje M, et al. 

Chronic fatigue after radiotherapy for 

carcinoma of the prostate: correlation with 

anorectal and genitourinary function. 

Radiother Oncol 2002 Mar; 62(3):293-7. Not 

eligible exposure 

4714. Vordermark D, Schwab M, Ness-Dourdoumas 

R, et al. Association of anorectal dose-volume 

histograms and impaired fecal continence after 

3D conformal radiotherapy for carcinoma of 

the prostate. Radiother Oncol 2003 Nov; 

69(2):209-14. Case-series 

4715. Vorobiev GI, Odaryuk TS, Tsarkov PV, et al. 

Resection of the rectum and total excision of 

the internal anal sphincter with smooth muscle 

plasty and colonic pouch for treatment of 

ultralow rectal carcinoma. Br J Surg 2004 

Nov; 91(11):1506-12. Case-series 

4716. Votolato NA, Stern S, Caputo RM. 

Serotonergic antidepressants and urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2000 Dec; 11(6):386-8. CaseReports 

4717. Voyvodic F, Rieger NA, Skinner S, et al. 

Endosonographic imaging of anal sphincter 

injury: does the size of the tear correlate with 

the degree of dysfunction? Dis Colon Rectum 

2003 Jun; 46(6):735-41. Not eligible outcomes 

4718. Voyvodic F, Schloithe AC, Wattchow DA, et 

al. Delayed pudendal nerve conduction and 

endosonographic appearance of the anal 

sphincter complex. Dis Colon Rectum 2000 

Dec; 43(12):1689-94. Case-series 

4719. Vujovic S, Zidverc J, Stojanovic M, et al. 

Drospirenone in the treatment of severe 

premenstrual cerebral edema in a woman with 

antiphospholipid syndrome, lateral sinus 

thrombosis, situs inversus and epileptic 

seizures. Gynecol Endocrinol 2005 Nov; 

21(5):243-7. Case-reports 
B-211 

4720. Waaldijk K. The immediate surgical 

management of fresh obstetric fistulas with 

catheter and/or early closure. Int J Gynaecol 

Obstet 1994 Apr; 45(1):11-6. Case-series 

4721. Waaldijk K. Surgical classification of 

obstetric fistulas. Int J Gynaecol Obstet 1995 

May; 49(2):161-3. No associative hypothesis 

tested 

4722. Wade BE. Colostomy patients: psychological 

adjustment at 10 weeks and 1 year after 

surgery in districts which employed stomacare nurses and districts which did not. J Adv 

Nurs 1990 Nov; 15(11):1297-304. Not eligible 

outcomes 

4723. Wadie BS, Shehab El-Dein AB, Mosbah A, et 

al. A 2-year follow-up after rotoresection of 

the prostate: a prospective study. BJU Int 

2005 Oct; 96(6):828-30. Case-series 

4724. Waetjen LE, Subak LL, Shen H, et al. Stress 

urinary incontinence surgery in the United 

States. Obstet Gynecol 2003 Apr; 101(4):671-

6. Not eligible level of evidence 

4725. Wagg A, Bayliss M, Ingham NJ, et al. 

Urodynamic variables cannot be used to 

classify the severity of detrusor instability. Br 

J Urol 1998 Oct; 82(4):499-502. Not eligible 

outcomes 

4726. Wagg A, Das Gupta R, Assassa P, et al. 

Secondary-care treatment patterns in the UK 

for women with urinary incontinence. BJU Int 

2005 Oct; 96(6):839-42. Not eligible outcomes 

4727. Wagg A, Mian S, Lowe D, et al. National 

audit of continence care for older people: 

results of a pilot study*. J Eval Clin Pract 

2005 Dec; 11(6):525-32. Not eligible 

outcomes 

4728. Wagner TH, Patrick DL, Bavendam TG, et al. 

Quality of life of persons with urinary 

incontinence: development of a new measure. 

Urology 1996 Jan; 47(1):67-71; discussion -2. 

Not eligible outcomes 

4729. Wagner VP, Osgood SB. Patient with a 

recessed, stenosed stoma located in an 

irregular, pendulous abdomen and the 

presence of pseudoverrucous lesions. J Wound 

Ostomy Continence Nurs 1998 Sep; 

25(5):261-6. Case Reports 

4730. Wai CY, Atnip SD, Williams KN, et al. 

Urethral erosion of tension-free vaginal tape 

presenting as recurrent stress urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2004 Sep-Oct; 15(5):353-5. Not 

eligible exposure 

4731. Wai CY, Margulis V, Baugh BR, et al. 

Multiple vesical calculi and complete vaginal 

vault prolapse. Am J Obstet Gynecol 2003 

Sep; 189(3):884-5. Not eligible exposure 

4732. Wainstein MA, Klutke CG. Antegrade 

techniques of collagen injection for postprostatectomy stress urinary incontinence: the 

Washington University experience. World J 

Urol 1997; 15(5):310-5. Case-series 

4733. Wainstein MA, Klutke CG. Periurethral 

pseudocyst following cystoscopic collagen 

injection. Urology 1998 May; 51(5):835-6. 

Case Reports 

4734. Wakavaiachi VM, Girao MJ, Sartori MG, et 

al. Changes in the lower urinary tract in 

continent women and in women with stress 

urinary incontinence, according to menopausal 

status. Int Urogynecol J Pelvic Floor Dysfunct 

2001; 12(3):156-60. Case-series 

4735. Wakhlu A, Dalela D, Tandon RK, et al. The 

single ectopic ureter. Br J Urol 1998 Aug; 

82(2):246-51. Not eligible target population 

4736. Wald A. Pathophysiology and management of 

fecal incontinence. Rev Gastroenterol Mex 

1994 Apr-Jun; 59(2):139-46. Comment 

4737. Wald A. Fecal incontinence: three steps to 

successful management. Geriatrics 1997 Jul; 

52(7):44-6, 9-52. Comment 

4738. Waldron DJ, Horgan PG, Patel FR, et al. 

Multiple sclerosis: assessment of colonic and 

anorectal function in the presence of faecal 

incontinence. Int J Colorectal Dis 1993 Dec; 

8(4):220-4. Case-series 

4739. Walker LJ, Evison JG, Garrett C. Recurrent 

pancreatitis: not just alcohol, gallstones and 

scorpion venom. J R Soc Med 2004 Feb; 

97(2):82-3. Case Reports 

4740. Walker RD, 3rd, Flack CE, Hawkins-Lee B, et 

al. Rectus fascial wrap: early results of a 

modification of the rectus fascial sling. J Urol 

1995 Aug; 154(2 Pt 2):771-4. Case-series 

4741. Wall J, Colley T. A study to evaluate factors 

for inclusion in a new self-assessed risk 

indicator for persons who use a wheelchair for 

mobility. J Tissue Viability 2005 Jan; 15(1):9-

16. Not eligible outcomes 

4742. Wall LL. Fitsari 'dan Duniya. An African 

(Hausa) praise song about vesicovaginal 

fistulas. Obstet Gynecol 2002 Dec; 

100(6):1328-32. Comment 

4743. Wall LL, Addison WA. Prazosin-induced 

stress incontinence. Obstet Gynecol 1990 

Mar; 75(3 Pt 2):558-60. Case report 
B-212 

4744. Wall LL, Hewitt JK, Helms MJ. Are vaginal 

and rectal pressures equivalent 

approximations of one another for the purpose 

of performing subtracted cystometry? Obstet 

Gynecol 1995 Apr; 85(4):488-93. Not eligible 

exposure 

4745. Wallace RA, Webb PM, Schluter PJ. 

Environmental, medical, behavioural and 

disability factors associated with Helicobacter 

pylori infection in adults with intellectual 

disability. J Intellect Disabil Res 2002 Jan; 

46(Pt 1):51-60. Not eligible outcomes 

4746. Wallner K, Lee H, Wasserman S, et al. Low 

risk of urinary incontinence following prostate 

brachytherapy in patients with a prior 

transurethral prostate resection. Int J Radiat 

Oncol Biol Phys 1997 Feb 1; 37(3):565-9. 

Case-series 

4747. Wallwiener D, Grischke EM, Rimbach S, et 

al. Endoscopic retropubic colposuspension: 

"Retziusscopy" versus laparoscopy--a 

reasonable enlargement of the operative 

spectrum in the management of recurrent 

stress incontinence? Endosc Surg Allied 

Technol 1995 Apr-Jun; 3(2-3):115-8. No 

associative hypothesis tested 

4748. Walsh IK, Williams SG, Mahendra V, et al. 

Artificial urinary sphincter implantation in the 

irradiated patient: safety, efficacy and 

satisfaction. BJU Int 2002 Mar; 89(4):364-8. 

Case-series 

4749. Walsh K, Generao SE, White MJ, et al. The 

influence of age on quality of life outcome in 

women following a tension-free vaginal tape 

procedure. J Urol 2004 Mar; 171(3):1185-8. 

Case-series 

4750. Walsh PC, Marschke P, Ricker D, et al. 

Patient-reported urinary continence and sexual 

function after anatomic radical prostatectomy. 

Urology 2000 Jan; 55(1):58-61. Case-series 

4751. Walsh PC, Marschke PL. Intussusception of 

the reconstructed bladder neck leads to earlier 

continence after radical prostatectomy. 

Urology 2002 Jun; 59(6):934-8. Case-series 

4752. Walsh PC, Partin AW. Treatment of early 

stage prostate cancer: radical prostatectomy. 

Important Adv Oncol 1994:211-23. Review 

4753. Walter AJ, Morse AN, Hammer RA, et al. 

Laparoscopic versus open Burch retropubic 

urethropexy: comparison of morbidity and 

costs when performed with concurrent vaginal 

prolapse repairs. Am J Obstet Gynecol 2002 

Apr; 186(4):723-8. Case-series 

4754. Walton JC, Miller JM. Evaluating physical 

and behavioral changes in older adults. 

Medsurg Nurs 1998 Apr; 7(2):85-90. Case 

Reports 

4755. Waltregny D, Reul O, Mathantu B, et al. 

Inside out transobturator vaginal tape for the 

treatment of female stress urinary 

incontinence: interim results of a prospective 

study after a 1-year minimum followup. J Urol 

2006 Jun; 175(6):2191-5. Case-series 

4756. Wang AC. Burch colposuspension vs. Stamey 

bladder neck suspension. A comparison of 

complications with special emphasis on 

detrusor instability and voiding dysfunction. J 

Reprod Med 1996 Jul; 41(7):529-33. Not 

eligible target population 

4757. Wang AC. Bladder-sphincter biofeedback as 

treatment of detrusor instability in women 

who failed to respond to oxybutynin. Chang 

Gung Med J 2000 Oct; 23(10):590-9. Not 

eligible target population 

4758. Wang AC, Chen MC. Randomized 

comparison of local versus epidural anesthesia 

for tension-free vaginal tape operation. J Urol 

2001 Apr; 165(4):1177-80. Not eligible 

outcomes 

4759. Wang AC, Lee LY, Lin CT, et al. A histologic 

and immunohistochemical analysis of 

defective vaginal healing after continence 

taping procedures: a prospective casecontrolled pilot study. Am J Obstet Gynecol 

2004 Dec; 191(6):1868-74. Not eligible 

exposure 

4760. Wang D, Yamana T, Iwadare J. Long-term 

results and quality-of-life outcomes in patients 

with transsphincteric fistulas after musclefilling procedure. Dis Colon Rectum 2002 

Aug; 45(8):1011-5. Not eligible target 

population 

4761. Wang KH, Wang KH, Neimark M, et al. 

Voiding dysfunction following TVT 

procedure. Int Urogynecol J Pelvic Floor 

Dysfunct 2002 Nov; 13(6):353-7; discussion 

8. Case-series 

4762. Wang MY, Levi AD, Green BA. Intradural 

spinal arachnoid cysts in adults. Surg Neurol 

2003 Jul; 60(1):49-55; discussion -6. Caseseries 

4763. Wang PS, Levin R, Zhao SZ, et al. Urinary 

antispasmodic use and the risks of ventricular 

arrhythmia and sudden death in older patients. 

J Am Geriatr Soc 2002 Jan; 50(1):117-24. Not 

eligible outcomes 
B-213 

4764. Wang R, Visootsak J, Danielpour M, et al. 

Midline defects in FG syndrome: does 

tethered spinal cord contribute to the 

phenotype? J Pediatr 2005 Apr; 146(4):537-

41. Not eligible target population 

4765. Wang WL, Li Z, Wang HZ, et al. 

Comprehensive assessment of long-term 

postoperative continence in pediatric 

imperforate anus. Clinical, manometric and 

contrast studies. Chin Med J (Engl) 1991 Nov; 

104(11):949-53. Not eligible target population 

4766. Wang Y, Lim LL, Heller RF, et al. A 

prediction model of 1-year mortality for acute 

ischemic stroke patients. Arch Phys Med 

Rehabil 2003 Jul; 84(7):1006-11. Not eligible 

outcomes 

4767. Wang Y, Lim LL, Levi C, et al. A prognostic 

index for 30-day mortality after stroke. J Clin 

Epidemiol 2001 Aug; 54(8):766-73. Not 

eligible level of evidence 

4768. Ward JF, Sebo TJ, Blute ML, et al. Salvage 

surgery for radiorecurrent prostate cancer: 

contemporary outcomes. J Urol 2005 Apr; 

173(4):1156-60. Not eligible level of evidence 

4769. Warner JP, Harvey CA, Barnes TR. Clozapine 

and urinary incontinence. Int Clin 

Psychopharmacol 1994 Sep; 9(3):207-9. Caseseries 

4770. Warren JW. Urine-collection devices for use 

in adults with urinary incontinence. J Am 

Geriatr Soc 1990 Mar; 38(3):364-7. Review 

4771. Warshaw E, Nix D, Kula J, et al. Clinical and 

cost effectiveness of a cleanser protectant 

lotion for treatment of perineal skin 

breakdown in low-risk patients with 

incontinence. Ostomy Wound Manage 2002 

Jun; 48(6):44-51. Not eligible outcomes 

4772. Washington JL. Staple erosion into the 

bladder after mesh and staple laparoscopic 

colposuspension. A case report. J Reprod Med 

2002 Apr; 47(4):325-6. Case Reports 

4773. Wasserberg N, Kaiser AM, Nunoo-Mensah 

JW, et al. Preservation of bowel and urinary 

continence in the management of locally 

recurrent rectal cancer. J Surg Oncol 2005 Oct 

1; 92(1):76-81. Case-series 

4774. Wasserman GA. Correction of a vault 

suspension graft complication. J Am Assoc 

Gynecol Laparosc 1995 May; 2(3):359-61. 

Case Reports 

4775. Watanabe T, Rivas DA, Miettinen M, et al. 

Total incontinence secondary to sphincter 

destruction after prostate cryotherapy for 

recurrent prostatic carcinoma. Int J Urol 1996 

Jul; 3(4):324-5. Case-reports 

4776. Watanabe T, Yokoyama T, Sasaki K, et al. 

Intravesical resiniferatoxin for patients with 

neurogenic detrusor overactivity. Int J Urol 

2004 Apr; 11(4):200-5. Not eligible target 

population 

4777. Watson AJ, Currie I, Curran S, et al. A 

prospective study examining the association 

between the symptoms of anxiety and 

depression and severity of urinary 

incontinence. Eur J Obstet Gynecol Reprod 

Biol 2000 Jan; 88(1):7-9. Not eligible 

outcomes 

4778. Watson AJ, Currie I, Jarvis GJ. A prospective 

placebo controlled double blind randomised 

study to investigate the use of indoramin to 

prevent post-operative voiding disorders after 

surgical treatment for genuine stress 

incontinence. Br J Obstet Gynaecol 1999 Mar; 

106(3):270-2. Not eligible exposure 

4779. Watson R. Incontinence in perspective. 

Nursing (Lond) 1991 Jul 25-Aug 21; 4(39):7-

10. Comment 

4780. Watson R, Kuhn M. The influence of 

component parts on the performance of 

urinary sheath systems. J Adv Nurs 1990 Apr; 

15(4):417-22. Not eligible exposure 

4781. Weatherall M, Arnold T. Nocturia in adults: 

draft New Zealand guidelines for its 

assessment and management in primary care. 

N Z Med J 2006; 119(1234):U1976. Guideline 

4782. Weatherall M, Slow T, Wiltshire K. Risk 

factors for entry into residential care after a 

support-needs assessment. N Z Med J 2004 

Sep 24; 117(1202):U1075. Not eligible level 

of evidence 

4783. Weaver A, Dobson P, Swithinbank L. 

Addressing the needs of teenagers with 

continence problems. Nurs Times 2004 May 

18; 100(20):61-3. Review 

4784. Webb HW, Barraza MA, Crump JM. 

Laparoscopic appendicostomy for 

management of fecal incontinence. J Pediatr 

Surg 1997 Mar; 32(3):457-8. Not eligible 

target population 

4785. Webb J. Continence: help for the elderly 

confused. Nurs Times 1990 Apr 18-24; 

86(16):64-8. Comment 

4786. Webb ML. Urinary incontinence in younger 

women. Nurse Pract Forum 1994 Sep; 

5(3):164-9. Not eligible outcomes 

4787. Webb S, Patterson V, Hutchinson M. Two 

families with autosomal recessive spastic 

paraplegia, pigmented maculopathy, and 

dementia. J Neurol Neurosurg Psychiatry 

1997 Nov; 63(5):628-32. Not eligible 

exposure 
B-214 

4788. Webb V, Simpson R. Older man's burden. 

Nurs Times 1997 Jan 29-Feb 4; 93(5):77-80. 

No associative hypothesis tested 

4789. Weber AM, Taylor RJ, Wei JT, et al. The 

cost-effectiveness of preoperative testing 

(basic office assessment vs. urodynamics) for 

stress urinary incontinence in women. BJU Int 

2002 Mar; 89(4):356-63. Not eligible 

outcomes 

4790. Weber AM, Walters MD, Piedmonte MR. 

Sexual function and vaginal anatomy in 

women before and after surgery for pelvic 

organ prolapse and urinary incontinence. Am J 

Obstet Gynecol 2000 Jun; 182(6):1610-5. Not 

eligible outcomes 

4791. Weber AM, Walters MD, Schover LR, et al. 

Functional outcomes and satisfaction after 

abdominal hysterectomy. Am J Obstet 

Gynecol 1999 Sep; 181(3):530-5. Case-series 

4792. Weber AM, Walters MD, Schover LR, et al. 

Sexual function in women with uterovaginal 

prolapse and urinary incontinence. Obstet 

Gynecol 1995 Apr; 85(4):483-7. Not eligible 

outcomes 

4793. Weber BA, Roberts BL, Resnick M, et al. The 

effect of dyadic intervention on self-efficacy, 

social support, and depression for men with 

prostate cancer. Psychooncology 2004 Jan; 

13(1):47-60. Not eligible outcomes 

4794. Webster JJ, Williams G. Adhesions of the 

labia minora. Br J Urol 1996 Jul; 78(1):146-7. 

Case Reports 

4795. Webster TM, Gerridzen RG. Urethral erosion 

following autologous rectus fascial 

pubovaginal sling. Can J Urol 2003 Dec; 

10(6):2068-9. Case Reports 

4796. Weckermann D, Wawroschek F, Schipp J, et 

al. Metabolic changes and urodynamic 

findings after continent urinary diversion. Int 

Urol Nephrol 1999; 31(5):665-74. Case-series 

4797. Wedderburn A, Lee RS, Denny A, et al. 

Synchronous bladder reconstruction and 

antegrade continence enema. J Urol 2001 Jun; 

165(6 Pt 2):2392-3. Not eligible target 

population 

4798. Weese DL, Roskamp DA, Leach GE, et al. 

Intravesical oxybutynin chloride: experience 

with 42 patients. Urology 1993 Jun; 

41(6):527-30. Case-series 

4799. Wehle MJ, Lisson SW, Buskirk SJ, et al. 

Prediction of genitourinary tract morbidity 

after brachytherapy for prostate 

adenocarcinoma. Mayo Clin Proc 2004 Mar; 

79(3):314-7. Case-series 

4800. Wei JT, Dunn RL, Marcovich R, et al. 

Prospective assessment of patient reported 

urinary continence after radical prostatectomy. 

J Urol 2000 Sep; 164(3 Pt 1):744-8. Caseseries 

4801. Wei JT, Montie JE. Comparison of patients' 

and physicians' rating of urinary incontinence 

following radical prostatectomy. Semin Urol 

Oncol 2000 Feb; 18(1):76-80. Not eligible 

outcomes 

4802. Wei TS, Su TH. Tension-free vaginal tape 

failure caused by sling displacement and 

successfully retreated using Burch 

colposuspension. Acta Obstet Gynecol Scand 

2003 Apr; 82(4):385-6. Case-reports 

4803. Weidner AC, Barber MD, Visco AG, et al. 

Pelvic muscle electromyography of levator ani 

and external anal sphincter in nulliparous 

women and women with pelvic floor 

dysfunction. Am J Obstet Gynecol 2000 Dec; 

183(6):1390-9; discussion 9-401. Not eligible 

outcomes 

4804. Weigel R, Senn P, Weis J, et al. Severe 

complications after intrathecal methotrexate 

(MTX) for treatment of primary central 

nervous system lymphoma (PCNSL). Clin 

Neurol Neurosurg 2004 Mar; 106(2):82-7. 

Case Reports 

4805. Weil EH, Eerdmans PH, Dijkman GA, et al. 

Randomized double-blind placebo-controlled 

multicenter evaluation of efficacy and dose 

finding of midodrine hydrochloride in women 

with mild to moderate stress urinary 

incontinence: a phase II study. Int Urogynecol 

J Pelvic Floor Dysfunct 1998; 9(3):145-50. 

Not eligible exposure 

4806. Weil EH, van Waalwijk van Doorn ES, 

Heesakkers JP, et al. Transvaginal 

ultrasonography: a study with healthy 

volunteers and women with genuine stress 

incontinence. Eur Urol 1993; 24(2):226-30. 

Not eligible outcomes 

4807. Wein AJ. Overactive bladder: defining the 

disease. Am J Manag Care 2000 Jul; 6(11 

Suppl):S559-64; discussion S607-19. 

Comment 

4808. Wein AJ. Impact of urinary incontinence after 

stroke: results from a prospective populationbased stroke register. J Urol 2005 Jun; 

173(6):2057. Not eligible outcomes 

4809. Wein AJ. Transvaginal surgery in the 

octogenarian using cadaveric fascia for pelvic 

prolapse and stress incontinence: minimal 

one-year results compared to younger patients. 

J Urol 2005 Sep; 174(3):1009. Case-series 
B-215 

4810. Wein AJ. Antidiuresis: a new concept in 

managing female daytime urinary 

incontinence. J Urol 2005 Jun; 173(6):2054-5. 

Comment 

4811. Wein AJ, Khullar V, Wang JT, et al. 

Achieving continence with antimuscarinic 

therapy for overactive bladder: effects of 

baseline incontinence severity and bladder 

diary duration. BJU Int 2007 Feb; 99(2):360-

3. secondary data analysis 

4812. Weinberger MW, Goodman BM, Carnes M. 

Long-term efficacy of nonsurgical urinary 

incontinence treatment in elderly women. J 

Gerontol A Biol Sci Med Sci 1999 Mar; 

54(3):M117-21. Case-series 

4813. Weinberger MW, Julian TM. Voiding 

dysfunction and incontinence caused by 

uterine retroversion. A case report. J Reprod 

Med 1995 May; 40(5):387-90. Case Reports 

4814. Weinberger MW, Ostergard DR. Long-term 

clinical and urodynamic evaluation of the 

polytetrafluoroethylene suburethral sling for 

treatment of genuine stress incontinence. 

Obstet Gynecol 1995 Jul; 86(1):92-6. Caseseries 

4815. Weinberger MW, Ostergard DR. 

Postoperative catheterization, urinary 

retention, and permanent voiding dysfunction 

after polytetrafluroethylene suburethral sling 

placement. Obstet Gynecol 1996 Jan; 

87(1):50-4. Case-series 

4816. Weinstein DL, Cohen JS, Liu C, et al. 

Duloxetine in the treatment of women with 

stress urinary incontinence: results from 

DESIRE (Duloxetine Efficacy and Safety for 

Incontinence in Racial and Ethnic 

populations). Curr Med Res Opin 2006 Nov; 

22(11):2121-9. Not eligible exposure 

4817. Weir NU, Counsell CE, McDowall M, et al. 

Reliability of the variables in a new set of 

models that predict outcome after stroke. J 

Neurol Neurosurg Psychiatry 2003 Apr; 

74(4):447-51. Not eligible outcomes 

4818. Weiss JP, Blaivas JG, Stember DS, et al. 

Nocturia in adults: etiology and classification. 

Neurourol Urodyn 1998; 17(5):467-72. Not 

eligible outcomes 

4819. Weiss RE, Garden RJ, Cohen EL, et al. 

Covered exstrophy with sequestered colonic 

remnant. J Urol 1993 Jul; 150(1):185-7. Case 

report 

4820. Wells JA, Ouslander JG, Meadows E, et al. 

Urinary incontinence in a geriatric patient 

with a complex neurologic history. J Wound 

Ostomy Continence Nurs 1999 Sep; 

26(5):270-4; discussion 4-5. Case-reports 

4821. Wells T. Conquering incontinence. Geriatr 

Nurs 1990 May-Jun; 11(3):133-5. Comment 

4822. Welz-Barth A, Fusgen I, Melchior HJ. 1999 

rerun of the 1996 German Urinary 

Incontinence Survey: will doctors ever ask? 

World J Urol 2000 Dec; 18(6):436-8. Not 

eligible outcomes 

4823. Wenning GK, Scherfler C, Granata R, et al. 

Time course of symptomatic orthostatic 

hypotension and urinary incontinence in 

patients with postmortem confirmed 

parkinsonian syndromes: a clinicopathological 

study. J Neurol Neurosurg Psychiatry 1999 

Nov; 67(5):620-3. Case-series 

4824. Werbrouck P, Baert L, Binard JE, et al. 

Balloon dilatation of the external urethral 

sphincter: a case study. J Am Paraplegia Soc 

1990 Apr; 13(2):13-4. Case Reports 

4825. Werner M, Najjari L, Schuessler B. 

Transurethral resection of tension-free vaginal 

tape penetrating the urethra. Obstet Gynecol 

2003 Nov; 102(5 Pt 1):1034-6. Case-reports 

4826. Werner M, Schmid DM, Schussler B. Efficacy 

of botulinum-A toxin in the treatment of 

detrusor overactivity incontinence: a 

prospective nonrandomized study. Am J 

Obstet Gynecol 2005 May; 192(5):1735-40. 

Not eligible target population 

4827. West RL, Dwarkasing S, Briel JW, et al. Can 

three-dimensional endoanal ultrasonography 

detect external anal sphincter atrophy? A 

comparison with endoanal magnetic resonance 

imaging. Int J Colorectal Dis 2005 Jul; 

20(4):328-33. Not eligible target population 

4828. West RL, Felt-Bersma RJ, Hansen BE, et al. 

Volume measurements of the anal sphincter 

complex in healthy controls and fecalincontinent patients with a three-dimensional 

reconstruction of endoanal ultrasonography 

images. Dis Colon Rectum 2005 Mar; 

48(3):540-8. Not eligible outcomes 

4829. Westerterp M, Volkers NA, Poolman RW, et 

al. Anal fistulotomy between Skylla and 

Charybdis. Colorectal Dis 2003 Nov; 

5(6):549-51. Case-series 

4830. Westney OL, Bevan-Thomas R, Palmer JL, et 

al. Transurethral collagen injections for male 

intrinsic sphincter deficiency: the University 

of Texas-Houston experience. J Urol 2005 

Sep; 174(3):994-7. Case-series 

4831. Westney OL, Lee JT, McGuire EJ, et al. 

Long-term results of Ingelman-Sundberg 

denervation procedure for urge incontinence 

refractory to medical therapy. J Urol 2002 

Sep; 168(3):1044-7. Case-series 
B-216 

4832. Westney OL, Scott S, Wood C, et al. 

Suburethral sling at the time of radical 

prostatectomy in patients at high risk of 

postoperative incontinence. BJU Int 2006 

Aug; 98(2):308-13. Case-series 

4833. Weston PM, Morgan JD, Hussain J, et al. 

Artificial urinary sphincters around intestinal 

segments--are they safe? Br J Urol 1991 Feb; 

67(2):150-4. Case-series 

4834. Wexner SD, Jorge JM. Colorectal 

physiological tests: use or abuse of 

technology? Eur J Surg 1994 Mar; 

160(3):167-74. Not eligible outcomes 

4835. Wexner SD, Reissman P, Pfeifer J, et al. 

Laparoscopic colorectal surgery: analysis of 

140 cases. Surg Endosc 1996 Feb; 10(2):133-

6. Not eligible level of evidence 

4836. Wheeler JS, Jr., Walter JS, Sibley P. 

Management of incontinent SCI patients with 

penile stimulation: preliminary results. J Am 

Paraplegia Soc 1994 Apr; 17(2):55-9. Caseseries 

4837. Wheeler TL, 2nd, Richter HE, Duke AG, et al. 

Outcomes with porcine graft placement in the 

anterior vaginal compartment in patients who 

undergo high vaginal uterosacral suspension 

and cystocele repair. Am J Obstet Gynecol 

2006 May; 194(5):1486-91. Case-series 

4838. Whishaw DM, Fonda D. Is there a role for 

drug therapy in the treatment of urinary 

incontinence in the elderly? Med J Aust 1994 

Apr 4; 160(7):430-5. Comment 

4839. White H, Holland D. Looking good and 

feeling good: clothes to help promote 

continence. Nurs Times 2001 May 17-23; 

97(20):60-1. Comment 

4840. White M. Spina bifida: the personal and 

financial cost of incontinence. Br J Nurs 1993 

Dec 9-1994 Jan 12; 2(22):1123-4, 6-30; 

discussion 30-2. Case Reports 

4841. Whitebird RR, Bliss DZ, Hase KA, et al. 

Community-based recruitment and enrollment 

for a clinical trial on the sensitive issue of 

fecal incontinence: the Fiber study. Res Nurs 

Health 2006 Jun; 29(3):233-43. No associative 

hypothesis tested 

4842. Whiteside JL, Hijaz A, Imrey PB, et al. 

Reliability and agreement of urodynamics 

interpretations in a female pelvic medicine 

center. Obstet Gynecol 2006 Aug; 108(2):315-

23. Not eligible outcomes 

4843. Whiteside JL, Weber AM, Meyn LA, et al. 

Risk factors for prolapse recurrence after 

vaginal repair. Am J Obstet Gynecol 2004 

Nov; 191(5):1533-8. Not eligible outcomes 

4844. Whittingham K, May S. Cleansing regimens 

for continence care. Prof Nurse 1998 Dec; 

14(3):167-72. Not eligible outcomes 

4845. Widgerow AD. Abdominoplasty following 

colostomy. Ann Plast Surg 1992 Nov; 

29(5):454-6. Case Reports 

4846. Wielink G, Essink-Bot ML, van Kerrebroeck 

PE, et al. Sacral rhizotomies and electrical 

bladder stimulation in spinal cord injury. 2. 

Cost-effectiveness and quality of life analysis. 

Dutch Study Group on Sacral Anterior Root 

Stimulation. Eur Urol 1997; 31(4):441-6. 

Case-series 

4847. Wiesel PH, Norton C, Roy AJ, et al. Gut 

focused behavioural treatment (biofeedback) 

for constipation and faecal incontinence in 

multiple sclerosis. J Neurol Neurosurg 

Psychiatry 2000 Aug; 69(2):240-3. Not 

eligible target population 

4848. Wietek BM, Hinninghofen H, Jehle EC, et al. 

Asymmetric sphincter innervation is 

associated with fecal incontinence after anal 

sphincter trauma during childbirth. Neurourol 

Urodyn 2007; 26(1):134-9. Not eligible 

outcomes 

4849. Wijma J, Tinga DJ, Visser GH. Perineal 

ultrasonography in women with stress 

incontinence and controls: the role of the 

pelvic floor muscles. Gynecol Obstet Invest 

1991; 32(3):176-9. Not eligible outcomes 

4850. Wijma J, Weis Potters AE, de Wolf BT, et al. 

Anatomical and functional changes in the 

lower urinary tract during pregnancy. Bjog 

2001 Jul; 108(7):726-32. Not eligible 

exposure 

4851. Wilbur J, Miller AM, Montgomery A, et al. 

Sociodemographic characteristics, biological 

factors, and symptom reporting in midlife 

women. Menopause 1998 Spring; 5(1):43-51. 

Not eligible level of evidence 

4852. Wilking SV, Sinclair AJ, Dickinson EJ. 

Exploring joint research initiatives: 

opportunities for collaboration between the 

US and the UK. J Am Geriatr Soc 1998 Mar; 

46(3):291-2. Comment 

4853. Wilkins K. Medications and fall-related 

fractures in the elderly. Health Rep 1999 

Summer; 11(1):45-53(Eng); 49-58(Fre). Not 

eligible outcomes 

4854. Wilkinson K. Pakistani women's perceptions 

and experiences of incontinence. Nurs Stand 

2001 Oct 17-23; 16(5):33-9. Case-series 
B-217 

4855. Willams NS, Hallan RI, Koeze TH, et al. 

Construction of a neoanal sphincter by 

transposition of the gracilis muscle and 

prolonged neuromuscular stimulation for the 

treatment of faecal incontinence. Ann R Coll 

Surg Engl 1990 Mar; 72(2):108-13. Caseseries 

4856. Wille S, Mills RD, Studer UE. Absence of 

urethral post-void milking: an additional cause 

for incontinence after radical prostatectomy? 

Eur Urol 2000 Jun; 37(6):665-9. Case-series 

4857. Wille S, Varga Z, von Knobloch R, et al. 

Intussusception of bladder neck improves 

early continence after radical prostatectomy: 

results of a prospective trial. Urology 2005 

Mar; 65(3):524-7. Case-series 

4858. Willener R, Hantikainen V. Individual quality 

of life following radical prostatectomy in men 

with prostate cancer. Urol Nurs 2005 Apr; 

25(2):88-90, 5-100. Not eligible outcomes 

4859. Williams AB, Malouf AJ, Bartram CI, et al. 

Assessment of external anal sphincter 

morphology in idiopathic fecal incontinence 

with endocoil magnetic resonance imaging. 

Dig Dis Sci 2001 Jul; 46(7):1466-71. Not 

eligible outcomes 

4860. Williams AB, Spencer JA, Bartram CI. 

Assessment of third degree tears using threedimensional anal endosonography with 

combined anal manometry: a novel technique. 

Bjog 2002 Jul; 109(7):833-5. Not eligible 

outcomes 

4861. Williams D, Moran S. Use of urinary sheaths 

in male incontinence. Nurs Times 2006 Nov 

21-27; 102(47):42, 4-5. Comment 

4862. Williams ER, Malone PS. The social 

implications of lower urinary tract 

reconstruction performed during childhood. Br 

J Urol 1995 Aug; 76(2):226-30. Not eligible 

exposure 

4863. Williams JG, MacLeod CA, Rothenberger 

DA, et al. Seton treatment of high anal 

fistulae. Br J Surg 1991 Oct; 78(10):1159-61. 

Case-series 

4864. Williams JG, Rothenberger DA, Madoff RD, 

et al. Treatment of rectal prolapse in the 

elderly by perineal rectosigmoidectomy. Dis 

Colon Rectum 1992 Sep; 35(9):830-4. Caseseries 

4865. Williams JG, Wong WD, Jensen L, et al. 

Incontinence and rectal prolapse: a 

prospective manometric study. Dis Colon 

Rectum 1991 Mar; 34(3):209-16. Case-series 

4866. Williams K. Good practice guidance for 

continence services. Nurs Times 2000 Aug 3; 

96(31 Suppl):23-4. Guidance 

4867. Williams KS, Crichton NJ, Roe B. 

Disseminating research evidence. A controlled 

trial in continence care. J Adv Nurs 1997 Apr; 

25(4):691-8. Not eligible outcomes 

4868. Williams ME, Richman J, Scatliff J. A 67-

year-old woman with a progressive gait 

disturbance. J Am Geriatr Soc 1996 Jul; 

44(7):843-6. Case report 

4869. Williams N, Barlow J, Hobson A, et al. 

Manometric asymmetry in the anal canal in 

controls and patients with fecal incontinence. 

Dis Colon Rectum 1995 Dec; 38(12):1275-80. 

Question 4 

4870. Williams NS, Ogunbiyi OA, Scott SM, et al. 

Rectal augmentation and stimulated gracilis 

anal neosphincter: a new approach in the 

management of fecal urgency and 

incontinence. Dis Colon Rectum 2001 Feb; 

44(2):192-8. Case- Reports 

4871. Williams NS, Patel J, George BD, et al. 

Development of an electrically stimulated 

neoanal sphincter. Lancet 1991 Nov 9; 

338(8776):1166-9. Case-series 

4872. Williams R. Promoting continence following 

head injury. Br J Nurs 1992 Jun 25-Jul 8; 

1(5):236-7, 9-40. Case Reports 

4873. Williams T. Nursing initiative pinpointed 

problem. N Z Nurs J 1993 Feb; 86(1):14. 

4874. Williamson ME, Lewis WG, Miller AS, et al. 

Clinical and physiological evaluation of 

anorectal eversion during restorative 

proctocolectomy. Br J Surg 1995 Oct; 

82(10):1391-4. Case-series 

4875. Willis J. Continence: a case for home delivery 

services. Nurs Times 1998 Nov 25-Dec 1; 

94(47):64-6. Case Reports 

4876. Willis S, Faridi A, Schelzig S, et al. Childbirth 

and incontinence: a prospective study on anal 

sphincter morphology and function before and 

early after vaginal delivery. Langenbecks 

Arch Surg 2002 Jun; 387(2):101-7. Caseseries 

4877. Wilmshurst JM, Kelly R, Borzyskowski M. 

Presentation and outcome of sacral agenesis: 

20 years' experience. Dev Med Child Neurol 

1999 Dec; 41(12):806-12. Not eligible target 

population 

4878. Wilson L, Brown JS, Shin GP, et al. Annual 

direct cost of urinary incontinence. Obstet 

Gynecol 2001 Sep; 98(3):398-406. Secondary 

data analysis 

4879. Wilson M. Male external collecting devices: 

management of a difficult case. Urol Nurs 

1993 Dec; 13(4):130-1. Case Reports 
B-218 

4880. Wilson M. The impact of faecal incontinence 

on the quality of life. Br J Nurs 2007 Feb 22-

Mar 7; 16(4):204-7. No associative hypothesis 

tested 

4881. Wilson S, Quek ML, Ginsberg DA. 

Transurethral injection of bulking agents for 

stress urinary incontinence following 

orthotopic neobladder reconstruction in 

women. J Urol 2004 Jul; 172(1):244-6. Caseseries 

4882. Wilson TS, Zimmern PE. Tailor-made 

incontinence care. Match type of incontinence 

to resident assessment for optimal treatment. 

Part 2. Contemp Longterm Care 2002 Sep; 

25(9):18, 20. Comment 

4883. Wilson TS, Zimmern PE. Urinary 

incontinence in elderly women. Contemp 

Longterm Care 2002 Aug; 25(8):18-20. 

Review 

4884. Winde G, Reers B, Nottberg H, et al. Clinical 

and functional results of abdominal rectopexy 

with absorbable mesh-graft for treatment of 

complete rectal prolapse. Eur J Surg 1993 

May; 159(5):301-5. No associative hypothesis 

tested 

4885. Winters JC, Appell RA, Rackley RR. 

Urodynamic findings in postprostatectomy 

incontinence. Neurourol Urodyn 1998; 

17(5):493-8. Case-series 

4886. Wise TN. Psychosocial side effects of 

sildenafil therapy for erectile dysfunction. J 

Sex Marital Ther 1999 Apr-Jun; 25(2):145-50. 

Case Reports 

4887. Wiseman PA, Malone-Lee J, Rai GS. 

Terodiline with bladder retraining for treating 

detrusor instability in elderly people. BMJ 

1991 Apr 27; 302(6783):994-6. Not eligible 

exposure 

4888. Wollin J, Bennie M, Leech C, et al. Multiple 

sclerosis and continence issues: an exploratory 

study. Br J Nurs 2005 Apr 28-May 11; 

14(8):439-40, 42, 44-6. Case-series 

4889. Wolters M, Methfessel HD, Goepel C, et al. 

Computer-assisted virtual urethral pressure 

profile in the assessment of female genuine 

stress incontinence. Obstet Gynecol 2002 Jan; 

99(1):69-74. Not eligible level of evidence 

4890. Wong EY. Uterine didelphys and occult spinal 

dysraphism: an unusual case. Dev Med Child 

Neurol 1998 Feb; 40(2):124-5. Case report 

4891. Wong L. Incontinence has different meanings 

for different people. Aust J Adv Nurs 1995 

Spring; 13(1):6-15. Not eligible outcomes 

4892. Wong MY, Harmanli OH, Agar M, et al. 

Collagen content of nonsupport tissue in 

pelvic organ prolapse and stress urinary 

incontinence. Am J Obstet Gynecol 2003 Dec; 

189(6):1597-9; discussion 9-600. Not eligible 

outcomes 

4893. Wong WD, Jensen LL, Bartolo DC, et al. 

Artificial anal sphincter. Dis Colon Rectum 

1996 Dec; 39(12):1345-51. Case-series 

4894. Wong WS, Chinn DO, Chinn M, et al. 

Cryosurgery as a treatment for prostate 

carcinoma: results and complications. Cancer 

1997 Mar 1; 79(5):963-74. Case-series 

4895. Woo HH, Rosario DJ, Chapple CR. Stone 

formation on permanent suture material used 

previously in colposuspension. Br J Urol 1995 

Jul; 76(1):139-40. Case Reports 

4896. Woo J, Ho SC, Lau J, et al. The prevalence of 

depressive symptoms and predisposing factors 

in an elderly Chinese population. Acta 

Psychiatr Scand 1994 Jan; 89(1):8-13. Not 

eligible outcomes 

4897. Wood DN, Allen SE, Hussain M, et al. Stomal 

complications of ileal conduits are 

significantly higher when formed in women 

with intractable urinary incontinence. J Urol 

2004 Dec; 172(6 Pt 1):2300-3. Not eligible 

target population 

4898. Woodhouse CR. Reconstruction of the lower 

urinary tract for neurogenic bladder: lessons 

from the adolescent age group. Br J Urol 1992 

Jun; 69(6):589-93. Not eligible target 

population 

4899. Woodhouse CR, Christofides M. Modified 

ureterosigmoidostomy (Mainz II)--technique 

and early results. Br J Urol 1998 Feb; 

81(2):247-52. Case-series 

4900. Woodhouse CR, Gordon EM. The Mitrofanoff 

principle for urethral failure. Br J Urol 1994 

Jan; 73(1):55-60. Not eligible target 

population 

4901. Woodhouse CR, MacNeily AE. The 

Mitrofanoff principle: expanding upon a 

versatile technique. Br J Urol 1994 Oct; 

74(4):447-53. Case-series 

4902. Woodman PJ, Davis GD. The relationship of 

the in-situ advancing vaginal wall sling to 

vaginal epithelial inclusion cyst. Int 

Urogynecol J Pelvic Floor Dysfunct 2000; 

11(2):124-6. Case Reports 

4903. Woodman PJ, Misko CA, Fischer JR. The use 

of short-form quality of life questionnaires to 

measure the impact of imipramine on women 

with urge incontinence. Int Urogynecol J 

Pelvic Floor Dysfunct 2001; 12(5):312-5; 

discussion 5-6. Not eligible target population 
B-219 

4904. Woods D, Dobranowski J, Orovan WL, et al. 

The Koch pouch: radiographic evaluation of 

the orthotopic and cutaneous forms. Can 

Assoc Radiol J 1991 Apr; 42(2):119-26. Caseseries 

4905. Woods R, Voyvodic F, Schloithe AC, et al. 

Anal sphincter tears in patients with rectal 

prolapse and faecal incontinence. Colorectal 

Dis 2003 Nov; 5(6):544-8. Case-series 

4906. Wozniak-Petrofsky J. Urinary incontinence in 

the elderly: not a normal part of aging. Urol 

Nurs 1993 Mar; 13(1):12-6. Comment 

4907. Wraige E, Borzyskowski M. Investigation of 

daytime wetting: when is spinal cord imaging 

indicated? Arch Dis Child 2002 Aug; 

87(2):151-5. Not eligible target population 

4908. Wren FJ, Reese CT, Decter RM. Durability of 

the Malone antegrade continence enema in 

pregnancy. Urology 2003 Mar; 61(3):644. 

Case-reports 

4909. Wright EJ, Iselin CE, Carr LK, et al. 

Pubovaginal sling using cadaveric allograft 

fascia for the treatment of intrinsic sphincter 

deficiency. J Urol 1998 Sep; 160(3 Pt 1):759-

62. Case-series 

4910. Wright L. The efficacy of bowel management 

in the adult with spina bifida. Eur J Pediatr 

Surg 2002 Dec; 12 Suppl 1:S41-3. Comment 

4911. Wszolek ZK, Pfeiffer RF, Bhatt MH, et al. 

Rapidly progressive autosomal dominant 

parkinsonism and dementia with pallidoponto-nigral degeneration. Ann Neurol 1992 

Sep; 32(3):312-20. Case Reports 

4912. Wu EQ, Birnbaum H, Marynchenko M, et al. 

Employees with overactive bladder: work loss 

burden. J Occup Environ Med 2005 May; 

47(5):439-46. Not eligible outcomes 

4913. Wu J, Baguley IJ. Urinary retention in a 

general rehabilitation unit: prevalence, clinical 

outcome, and the role of screening. Arch Phys 

Med Rehabil 2005 Sep; 86(9):1772-7. Not 

eligible outcomes 

4914. Wydra D, Emerich J, Ciach K, et al. The role 

of pelvic exenteration for treatment of pelvic 

malignancy--a nine-year experience. Eur J 

Gynaecol Oncol 2005; 26(4):418-22. Caseseries 

4915. Wydra D, Emerich J, Sawicki S, et al. Major 

complications following exenteration in cases 

of pelvic malignancy: a 10-year experience. 

World J Gastroenterol 2006 Feb 21; 

12(7):1115-9. Case-series 

4916. Wyman JF. Managing urinary incontinence 

with bladder training: a case study. J ET Nurs 

1993 May-Jun; 20(3):121-6. Case Reports 

4917. Wyman JF, Bliss DZ, Dougherty MC, et al. 

Shaping future directions for incontinence 

research in aging adults: executive summary. 

Nurs Res 2004 Nov-Dec; 53(6 Suppl):S1-10. 

Comment 

4918. Wyman JF, Elswick RK, Jr., Ory MG, et al. 

Influence of functional, urological, and 

environmental characteristics on urinary 

incontinence in community-dwelling older 

women. Nurs Res 1993 Sep-Oct; 42(5):270-5. 

Not eligible target population 

4919. Wyndaele JJ, Maes D. Clean intermittent selfcatheterization: a 12-year followup. J Urol 

1990 May; 143(5):906-8. Case-series 

4920. Wynne JM, Myles JL, Jones I, et al. Disturbed 

anal sphincter function following vaginal 

delivery. Gut 1996 Jul; 39(1):120-4. Not 

eligible level of evidence 

4921. Xiao YH, Liu GL. Manometric asymmetry of 

the anal sphincter: anatomic evidence and 

clinical application. Chin Med J (Engl) 2005 

Feb 5; 118(3):210-4. Not eligible target 

population 

4922. Xu Z, Fu Q. Bulbocavernosus muscle flap in 

the repair of complicated vesicovaginal 

fistula. Int J Urol 2005 Dec; 12(12):1037-40. 

Case-series 

4923. Yakut M, Kaymakcioglu N, Simsek A, et al. 

Surgical treatment of rectal prolapse. A 

retrospective analysis of 94 cases. Int Surg 

1998 Jan-Mar; 83(1):53-5. Case-series 

4924. Yalcin I, Bump RC. The effect of previous 

treatment experience and incontinence 

severity on the placebo response of stress 

urinary incontinence. Am J Obstet Gynecol 

2004 Jul; 191(1):194-7. Not eligible exposure 

4925. Yalcin I, Patrick DL, Summers K, et al. 

Minimal clinically important differences in 

Incontinence Quality-of-Life scores in stress 

urinary incontinence. Urology 2006 Jun; 

67(6):1304-8. Not eligible outcomes 

4926. Yalcin O, Isikoglu M, Beji NK. Results of 

TVT operations alone and combined with 

other vaginal surgical procedures. Arch 

Gynecol Obstet 2004 Jan; 269(2):96-8. Caseseries 

4927. Yalcin OT, Hassa H, Ozalp S. Effectiveness 

of ultrasonographic parameters for 

documenting the severity of anatomic stress 

incontinence. Acta Obstet Gynecol Scand 

2000 May; 79(5):421-6. Not eligible outcomes 

4928. Yalcin OT, Hassa H, Ozalp S, et al. Results of 

the anti-incontinence operations and Kegel 

exercises in patients with type II anatomic 

stress incontinence. Acta Obstet Gynecol 

Scand 1998 Mar; 77(3):341-6. Case-series 
B-220 

4929. Yalcin OT, Hassa H, Tanir M. A new 

ultrasonographic method for evaluation of the 

results of anti-incontinence operations. Acta 

Obstet Gynecol Scand 2002 Feb; 81(2):151-6. 

Case-series 

4930. Yalcin OT, Yildirim A, Hassa H. The effects 

of severe cystocele on urogynecologic 

symptoms and findings. Acta Obstet Gynecol 

Scand 2001 May; 80(5):423-7. Case-series 

4931. Yamada T, Hayashi T, Kamata S, et al. New 

hammock hypothesis-based method for the 

treatment of stress urinary incontinence: the 

first 29 urethral supports with a small fascial 

patch. Int J Urol 2005 Sep; 12(9):806-9. Caseseries 

4932. Yamada T, Ichiyanagi N, Kamata S, et al. 

Need for sling surgery in patients with large 

cystoceles and masked stress urinary 

incontinence. Int J Urol 2001 Nov; 8(11):599-

603. Case-series 

4933. Yamada T, Kamata S, Nagahama K, et al. 

Polytetrafluoroethylene patch sling for type 2 

or type 3 stress urinary incontinence. Int J 

Urol 2001 Dec; 8(12):675-80. Not eligible 

exposure 

4934. Yamada T, Mizuo T, Kawakami S, et al. 

Application of transrectal ultrasonography in 

modified Stamey procedure for stress urinary 

incontinence. J Urol 1991 Dec; 146(6):1555-8. 

Case-series 

4935. Yamada Y, Honda N, Nakamura K, et al. 

Vesicourethral anastomotic suture placement 

during radical prostatectomy using Maniceps. 

Urol Int 2003; 70(3):181-5. Case-series 

4936. Yamana T, Oya M, Komatsu J, et al. 

Preoperative anal sphincter high pressure 

zone, maximum tolerable volume, and anal 

mucosal electrosensitivity predict early 

postoperative defecatory function after low 

anterior resection for rectal cancer. Dis Colon 

Rectum 1999 Sep; 42(9):1145-51. Case-series 

4937. Yamana T, Takahashi T, Iwadare J. Clinical 

and physiologic outcomes after transvaginal 

rectocele repair. Dis Colon Rectum 2006 May; 

49(5):661-7. Case-series 

4938. Yamanishi T, Yasuda K, Sakakibara R, et al. 

Detrusor overactivity and penile erection in 

patients with lower lumbar spine lesions. Eur 

Urol 1998 Oct; 34(4):360-4. Case-series 

4939. Yamanishi T, Yasuda K, Suda S, et al. Effect 

of functional continuous magnetic stimulation 

for urinary incontinence. J Urol 2000 Feb; 

163(2):456-9. Not eligible target population 

4940. Yan A, Anne M, Karine A, et al. Cystocele 

repair by a synthetic vaginal mesh secured 

anteriorly through the obturator foramen. Eur 

J Obstet Gynecol Reprod Biol 2004 Jul 15; 

115(1):90-4. Case-series 

4941. Yang CC, Stiens SA. Antegrade continence 

enema for the treatment of neurogenic 

constipation and fecal incontinence after 

spinal cord injury. Arch Phys Med Rehabil 

2000 May; 81(5):683-5. Case Reports 

4942. Yang JM. Factors affecting 

urethrocystographic parameters in urinary 

continent women. J Clin Ultrasound 1996 Jun; 

24(5):249-55. Not eligible outcomes 

4943. Yang JM, Huang WC. Discrimination of 

bladder disorders in female lower urinary tract 

symptoms on ultrasonographic 

cystourethrography. J Ultrasound Med 2002 

Nov; 21(11):1249-55. Not eligible outcomes 

4944. Yang JM, Yang SH, Huang WC. Dynamic 

morphological changes in the anterior vaginal 

wall before and after laparoscopic Burch 

colposuspension in primary urodynamic stress 

incontinence. Ultrasound Obstet Gynecol 

2005 Mar; 25(3):289-95. Case-series 

4945. Yang JM, Yang SH, Huang WC. A surgical 

technique to adjust bladder neck suspension in 

laparoscopic Burch colposuspension. J Minim 

Invasive Gynecol 2006 Jul-Aug; 13(4):289-

95. Case-series 

4946. Yang T, Liu Z, Liu Y. Electroacupuncture at 

ciliao and huiyang for treating neuropathic 

incontinence of defecation and urination in 30 

cases. J Tradit Chin Med 2003 Mar; 23(1):53-

4. Case Reports 

4947. Yang YK, Wexner SD. Anal pressure 

vectography is of no apparent benefit for 

sphincter evaluation. Int J Colorectal Dis 1994 

May; 9(2):92-5. Case-series 

4948. Yeni E, Unal D, Verit A, et al. An adult 

female epispadias without exstrophy was 

presented with urinary incontinence: a case 

report. Int Urogynecol J Pelvic Floor Dysfunct 

2004 May-Jun; 15(3):212-3. Case Reports 

4949. Yeoh E, Sun WM, Russo A, et al. A 

retrospective study of the effects of pelvic 

irradiation for gynecological cancer on 

anorectal function. Int J Radiat Oncol Biol 

Phys 1996 Jul 15; 35(5):1003-10. Case-series 

4950. Yeoh EE, Botten R, Russo A, et al. Chronic 

effects of therapeutic irradiation for localized 

prostatic carcinoma on anorectal function. Int 

J Radiat Oncol Biol Phys 2000 Jul 1; 

47(4):915-24. Case-series 
B-221 

4951. Yeoh EE, Holloway RH, Fraser RJ, et al. 

Anorectal dysfunction increases with time 

following radiation therapy for carcinoma of 

the prostate. Am J Gastroenterol 2004 Feb; 

99(2):361-9. Case-series 

4952. Yeoh EK, Russo A, Botten R, et al. Acute 

effects of therapeutic irradiation for prostatic 

carcinoma on anorectal function. Gut 1998 

Jul; 43(1):123-7. Case-series 

4953. Yerkes EB, Cain MP, King S, et al. The 

Malone antegrade continence enema 

procedure: quality of life and family 

perspective. J Urol 2003 Jan; 169(1):320-3. 

Not eligible target population 

4954. Yerkes EB, Rink RC, Cain MP, et al. Use of a 

Monti channel for administration of antegrade 

continence enemas. J Urol 2002 Oct; 168(4 Pt 

2):1883-5; discussion 5. Not eligible target 

population 

4955. Yerkes EB, Rink RC, King S, et al. Tap water 

and the Malone antegrade continence enema: 

a safe combination? J Urol 2001 Oct; 

166(4):1476-8. Not eligible target population 

4956. Yeung CK, Lund L. Laparoscopic cecostomy 

for anterior ectopic anus with constipation: a 

new and technical proposal. Eur J Pediatr Surg 

2000 Aug; 10(4):276-7. Case Reports 

4957. Yeung CK, Sihoe JD, Sit FK, et al. 

Characteristics of primary nocturnal enuresis 

in adults: an epidemiological study. BJU Int 

2004 Feb; 93(3):341-5. Not eligible outcomes 

4958. Yim SY, Yoon SH, Lee IY, et al. A 

comparison of bowel care patterns in patients 

with spinal cord injury: upper motor neuron 

bowel vs lower motor neuron bowel. Spinal 

Cord 2001 Apr; 39(4):204-7. Case-series 

4959. Yip B, Barrett RC, Coller JA, et al. Pudendal 

nerve terminal motor latency testing: assessing 

the educational learning curve: can we teach 

our own? Dis Colon Rectum 2002 Feb; 

45(2):184-7. Not eligible exposure 

4960. Yip B, Barrett RC, Coller JA, et al. Linear 

pressure profiles and symmetric findings in 

the stimulated gracilis muscle. Dis Colon 

Rectum 2003 Jan; 46(1):77-80. Case-series 

4961. Yip SK, Chung TK. Treatment-seeking 

behavior in Hong Kong Chinese women with 

urinary symptoms. Int Urogynecol J Pelvic 

Floor Dysfunct 2003 Feb; 14(1):27-30; 

discussion Not eligible level of evidence 

4962. Yip SK, Fung K, Pang MW, et al. A study of 

female urinary tract infection caused by 

urodynamic investigation. Am J Obstet 

Gynecol 2004 May; 190(5):1234-40. Not 

eligible outcomes 

4963. Yip SK, Leung TY, Chan CK. Hematuria and 

clot retention after Burch colposuspension and 

Cystofix suprapubic catheterization: 

suprapubic cystotomy as an alternative 

suprapubic drainage method. Int Urogynecol J 

Pelvic Floor Dysfunct 1998; 9(2):122-4. Case 

Reports 

4964. Yip SK, Pang MW. Tension-free vaginal tape 

sling procedure for the treatment of stress 

urinary incontinence in Hong Kong women 

with and without pelvic organ prolapse: 1-year 

outcome study. Hong Kong Med J 2006 Feb; 

12(1):15-20. Not eligible target population 

4965. Yohannes P, Khan A, Francis K, et al. Robotassisted Bricker ileoureteral anastomosis 

during intracorporeal laparoscopic ileal 

conduit urinary diversion for 

prostatocutaneous fistula: case report. J 

Endourol 2004 Apr; 18(3):269-72. Case 

Reports 

4966. Yokoo A, Hirose T, Mikuma N, et al. Ileal 

neobladder for bladder substitution after 

radical cystectomy. Int J Urol 1998 May; 

5(3):219-24. Case-series 

4967. Yokoyama E. Contigen Bard Collagen 

implant: the Japanese experience. Int J Urol 

1995 Apr; 2 Suppl 1:11-5; discussion 6-8. Not 

eligible target population 

4968. Yokoyama T, Fujita O, Nishiguchi J, et al. 

Extracorporeal magnetic innervation treatment 

for urinary incontinence. Int J Urol 2004 Aug; 

11(8):602-6. Not eligible target population 

4969. Yokoyama T, Inoue M, Fujita O, et al. 

Preliminary results of the effect of 

extracorporeal magnetic stimulation on 

urinary incontinence after radical 

prostatectomy: a pilot study. Urol Int 2005; 

74(3):224-8. Case-series 

4970. Yoo JH, Hasegawa H, Ishii Y, et al. Longterm outcome of per anum intersphincteric 

rectal dissection with direct coloanal 

anastomosis for lower rectal cancer. 

Colorectal Dis 2005 Sep; 7(5):434-40. Caseseries 

4971. Yoshimura N, Nagahama Y, Ueda T, et al. 

Paroxysmal urinary incontinence associated 

with multiple sclerosis. Urol Int 1997; 

59(3):197-9. Case- Reports 

4972. Yoshioka K, Keighley MR. The position of 

the patient does not adversely influence the 

results of the most clinically important 

measurements of anorectal function. Int J 

Colorectal Dis 1995; 10(1):47-8. Not eligible 

exposure 
B-222 

4973. Young CJ, Mathur MN, Eyers AA, et al. 

Successful overlapping anal sphincter repair: 

relationship to patient age, neuropathy, and 

colostomy formation. Dis Colon Rectum 1998 

Mar; 41(3):344-9. Case-series 

4974. Young MD, Weizer AZ, Silverstein AD, et al. 

Urinary continence and quality of life in the 

first year after radical perineal prostatectomy. 

J Urol 2003 Dec; 170(6 Pt 1):2374-8. Caseseries 

4975. Young SB, Howard AE, Baker SP. Mersilene 

mesh sling: short- and long-term clinical and 

urodynamic outcomes. Am J Obstet Gynecol 

2001 Jul; 185(1):32-40. Not eligible target 

population 

4976. Youngson HA, Alderman N. Fear of 

incontinence and its effects on a communitybased rehabilitation programme after severe 

brain injury: successful remediation of escape 

behaviour using behaviour modification. Brain 

Inj 1994 Jan; 8(1):23-36. Case- Reports 

4977. Youssef AH, Fath-Alla M, El-Kassaby AW. 

Perineal subcutaneous dartos pedicled flap as 

a new technique for repairing urethrorectal 

fistula. J Urol 1999 May; 161(5):1498-500. 

Not eligible target population 

4978. Yu DS. Gelatin packing of intracortical tract 

after percutaneous nephrostomy lithotripsy for 

decreasing bleeding and urine leakage. J Chin 

Med Assoc 2006 Apr; 69(4):162-5. Caseseries 

4979. Yu LC, Rohner TJ, Kaltreider DL, et al. 

Profile of urinary incontinent elderly in longterm care institutions. J Am Geriatr Soc 1990 

Apr; 38(4):433-9. Not eligible target 

population 

4980. Yu YF, Nichol MB, Yu AP, et al. Persistence 

and adherence of medications for chronic 

overactive bladder/urinary incontinence in the 

california medicaid program. Value Health 

2005 Jul-Aug; 8(4):495-505. Not eligible 

outcomes 

4981. Yusuf SW, Booth SA, Mishra RM. Falls and 

urinary incontinence in a 66-year-old woman. 

Lancet 1996 Jun 22; 347(9017):1738. Case 

report 

4982. Zahn CM, Siddique S, Hernandez S, et al. 

Anatomic comparison of two transobturator 

tape procedures. Obstet Gynecol 2007 Mar; 

109(3):701-6. Not eligible target population 

4983. Zanoschi C, Carauleanu A. The use of the 

supra-pubic fibrous complex in isthmic 

hysteropexies. Rev Med Chir Soc Med Nat 

Iasi 2003 Jul-Sep; 107(3):627-32. Case-series 

4984. Zaragoza MR. Expanded indications for the 

pubovaginal sling: treatment of type 2 or 3 

stress incontinence. J Urol 1996 Nov; 

156(5):1620-2. Case-series 

4985. Zbar AP, Aslam M, Gold DM, et al. 

Parameters of the rectoanal inhibitory reflex in 

patients with idiopathic fecal incontinence and 

chronic constipation. Dis Colon Rectum 1998 

Feb; 41(2):200-8. Not eligible outcomes 

4986. Zbar AP, Beer-Gabel M, Chiappa AC, et al. 

Fecal incontinence after minor anorectal 

surgery. Dis Colon Rectum 2001 Nov; 

44(11):1610-9; discussion 9-23. Case-series 

4987. Zbar AP, Kmiot WA, Aslam M, et al. Use of 

vector volume manometry and endoanal 

magnetic resonance imaging in the adult 

female for assessment of anal sphincter 

dysfunction. Dis Colon Rectum 1999 Nov; 

42(11):1411-8. Not eligible exposure 

4988. Zehrer CL, Newman DK, Grove GL, et al. 

Assessment of diaper-clogging potential of 

petrolatum moisture barriers. Ostomy Wound 

Manage 2005 Dec; 51(12):54-8. Not eligible 

outcomes 

4989. Zeidman LA, Melen O, Gottardi-Littell N, et 

al. Susac syndrome with transient inverted 

vision. Neurology 2004 Aug 10; 63(3):591. 

Case Reports 

4990. Zelefsky MJ, Aschkenasy E, Kelsen S, et al. 

Tolerance and early outcome results of 

postprostatectomy three-dimensional 

conformal radiotherapy. Int J Radiat Oncol 

Biol Phys 1997 Sep 1; 39(2):327-33. Caseseries 

4991. Zemack G, Romner B. Adjustable valves in 

normal-pressure hydrocephalus: a 

retrospective study of 218 patients. 

Neurosurgery 2002 Dec; 51(6):1392-400; 

discussion 400-2. Not eligible target 

population 

4992. Zermann DH, Ishigooka M, Wunderlich H, et 

al. A study of pelvic floor function pre- and 

postradical prostatectomy using clinical 

neurourological investigations, urodynamics 

and electromyography. Eur Urol 2000 Jan; 

37(1):72-8. Case-series 

4993. Zermann DH, Kutzenberger J, Sauerwein D, 

et al. Penile prosthetic surgery in 

neurologically impaired patients: long-term 

followup. J Urol 2006 Mar; 175(3 Pt 1):1041-

4; discussion 4. Not eligible target population 

4994. Zetterstrom J, Lopez A, Holmstrom B, et al. 

Obstetric sphincter tears and anal 

incontinence: an observational follow-up 

study. Acta Obstet Gynecol Scand 2003 Oct; 

82(10):921-8. Case-series 
B-223 

4995. Zetterstrom J, Mellgren A, Jensen LL, et al. 

Effect of delivery on anal sphincter 

morphology and function. Dis Colon Rectum 

1999 Oct; 42(10):1253-60. Case-series 

4996. Zetterstrom JP, Mellgren A, Madoff RD, et al. 

Perineal body measurement improves 

evaluation of anterior sphincter lesions during 

endoanal ultrasonography. Dis Colon Rectum 

1998 Jun; 41(6):705-13. Not eligible outcomes 

4997. Z'Graggen K, Maurer CA, Birrer S, et al. A 

new surgical concept for rectal replacement 

after low anterior resection: the transverse 

coloplasty pouch. Ann Surg 2001 Dec; 

234(6):780-5; discussion 5-7. Not eligible 

target population 

4998. Zhengwei Y, Weilin W, Yuzuo B, et al. Longterm outcomes of individualized biofeedback 

training based on the underlying dysfunction 

for patients with imperforate anus. J Pediatr 

Surg 2005 Mar; 40(3):555-61. Not eligible 

target population 

4999. Zhu L, Lang J, Chen J, et al. Study on nerve 

fiber density in anterior vaginal epithelium for 

stress urinary incontinence. Int Urogynecol J 

Pelvic Floor Dysfunct 2004 Jul-Aug; 

15(4):272-5. Not eligible outcomes 

5000. Zhu L, Lang J, Feng R, et al. Estrogen 

receptor in pelvic floor tissues in patients with 

stress urinary incontinence. Int Urogynecol J 

Pelvic Floor Dysfunct 2004 Sep-Oct; 

15(5):340-3. Not eligible outcomes 

5001. Zhu L, Lang JH, Chen J, et al. Morphologic 

study on levator ani muscle in patients with 

pelvic organ prolapse and stress urinary 

incontinence. Int Urogynecol J Pelvic Floor 

Dysfunct 2005 Sep-Oct; 16(5):401-4. Not 

eligible outcomes 

5002. Zhu L, Lang JH, Li Y, et al. Postoperative 

evaluation of tension-free vaginal tape 

procedure. Chin Med Sci J 2005 Jun; 

20(2):116-8. Case-series 

5003. Zietman AL, Sacco D, Skowronski U, et al. 

Organ conservation in invasive bladder cancer 

by transurethral resection, chemotherapy and 

radiation: results of a urodynamic and quality 

of life study on long-term survivors. J Urol 

2003 Nov; 170(5):1772-6. Case-series 

5004. Zimakoff J, Stickler DJ, Pontoppidan B, et al. 

Bladder management and urinary tract 

infections in Danish hospitals, nursing homes, 

and home care: a national prevalence study. 

Infect Control Hosp Epidemiol 1996 Apr; 

17(4):215-21. Not eligible outcomes 

5005. Zimmaro Bliss D, Larson SJ, Burr JK, et al. 

Reliability of a stool consistency classification 

system. J Wound Ostomy Continence Nurs 

2001 Nov; 28(6):305-13. Not eligible 

outcomes 

5006. Zimmaro Bliss D, Zehrer C, Savik K, et al. 

Incontinence-associated skin damage in 

nursing home residents: a secondary analysis 

of a prospective, multicenter study. Ostomy 

Wound Manage 2006 Dec; 52(12):46-55. Not 

eligible outcomes 

5007. Zincke H, Oesterling JE, Blute ML, et al. 

Long-term (15 years) results after radical 

prostatectomy for clinically localized (stage 

T2c or lower) prostate cancer. J Urol 1994 

Nov; 152(5 Pt 2):1850-7. Not eligible level of 

evidence 

5008. Zinner N, Gittelman M, Harris R, et al. 

Trospium chloride improves overactive 

bladder symptoms: a multicenter phase III 

trial. J Urol 2004 Jun; 171(6 Pt 1):2311-5, 

quiz 435. Not eligible exposure 

5009. Zinner N, Harnett M, Sabounjian L, et al. The 

overactive bladder-symptom composite score: 

a composite symptom score of toilet voids, 

urgency severity and urge urinary 

incontinence in patients with overactive 

bladder. J Urol 2005 May; 173(5):1639-43. 

Not eligible exposure 

5010. Zinner N, Susset J, Gittelman M, et al. 

Efficacy, tolerability and safety of darifenacin, 

an M(3) selective receptor antagonist: an 

investigation of warning time in patients with 

OAB. Int J Clin Pract 2006 Jan; 60(1):119-26. 

Not eligible exposure 

5011. Zinner N, Tuttle J, Marks L. Efficacy and 

tolerability of darifenacin, a muscarinic M3 

selective receptor antagonist (M3 SRA), 

compared with oxybutynin in the treatment of 

patients with overactive bladder. World J Urol 

2005 Sep; 23(4):248-52. Not eligible exposure 

5012. Zinner NR, Mattiasson A, Stanton SL. 

Efficacy, safety, and tolerability of extendedrelease once-daily tolterodine treatment for 

overactive bladder in older versus younger 

patients. J Am Geriatr Soc 2002 May; 

50(5):799-807. Not eligible exposure 

5013. Zivkovic F, Tamussino K, Pieber D, et al. 

Body mass index and outcome of incontinence 

surgery. Obstet Gynecol 1999 May; 93(5 Pt 

1):753-6. Case-series 

5014. Zorcolo L, Covotta L, Bartolo DC. Outcome 

of anterior sphincter repair for obstetric injury: 

comparison of early and late results. Dis 

Colon Rectum 2005 Mar; 48(3):524-31. Caseseries 
B-224 

5015. Zorn BH, Montgomery H, Pieper K, et al. 

Urinary incontinence and depression. J Urol 

1999 Jul; 162(1):82-4. Not eligible outcomes 

5016. Zubke W, Becker S, Kramer B, et al. 

Persistent urinary retention after tension-free 

vaginal tape: a new surgical solution. Eur J 

Obstet Gynecol Reprod Biol 2004 Jul 15; 

115(1):95-8. Case Reports 

5017. Zullo MA, Plotti F, Bellati F, et al. 

Transurethral polydimethylsiloxane 

implantation: a valid option for the treatment 

of stress urinary incontinence due to intrinsic 

sphincter deficiency without urethral 

hypermobility. J Urol 2005 Mar; 173(3):898-

902. Case-series 

5018. Zvosec DL, Smith SW, McCutcheon JR, et al. 

Adverse events, including death, associated 

with the use of 1,4-butanediol. N Engl J Med 

2001 Jan 11; 344(2):87-94. Case Reports 

5019. Zweig S, Lawhorne L, Post R. Factors 

predicting mortality in rural elderly 

hospitalized for pneumonia. J Fam Pract 1990 

Feb; 30(2):153-9. Not eligible outcomes 

5020. Zwergel U, Wullich B, Lindenmeir U, et al. 

Long-term results following transurethral 

resection of the prostate. Eur Urol 1998; 

33(5):476-80. Not eligible level of evidence 
D-1 

Appendix D: Technical Expert Panel Members and Affiliation 

TEP Member Affiliation 

Linda Brubaker, M.D. Clinical and Translational Research 

Loyola University Medical Center 

Tomas L. Griebling, M.D. Department of Urology 

The University of Kansas 

Robert Madoff, M.D. Colon and Rectal Surgery 

University of Minnesota Medical School 

Richard Nelson, M.D. Department of General Surgery 

Northern General Hospital, Sheffield, UK 

Joseph Ouslander, M.D. Division of Geriatric Medicine and Gerontology 

Wesley Woods Center of Emory University 

Neil Resnick, M.D. Department of Medicine 

University of Pittsburgh Medical Center 

Carolyn Sampselle, Ph.D, R.N.C. School of Nursing 

University of Michigan 

David Thom, M.D., Ph.D. Family and Community Medicine 

San Francisco General Hospital 

Joanne Townsend, R.N., B.A. (Hons) 

Post Grad Cert HSR 

Urogynaecology Nurse Specialist 

University Hospitals of Leicester, Leicester, UK 

E-1 

Appendix E. Data Abstraction Forms 

Prevalence and incidence of urinary incontinence in the community 

and long-term care settings 

Abstraction Form 

(Complete for each study) 

Number of the study in the database (PubMed ID, Cochrane accession number, ISBN)_________ 

First author_________ 

Year of publication________ 

Purpose/aim of study 

Design of the study (check one) 

 prospective cohort 

 retrospective cohort 

 cross-sectional 

 descriptive study 

 case-control 

 case-series 

 randomized controlled clinical trial 

 not randomized clinical interventions 

 ecologic 

Adjustment for confounding factors: _________________ 

Population variables (independent variables) 

Data source for population variables (define) 

Survey____________ 

Administrative data base__________ 

Population based______________ 

Clinic based_________ 

Other__________ 

Settings 

Community (general population)____________ 

Long term care settings_____________________ 

Nursing home____________________________________ 

Long term care hospital____________________________ 

Location 

Residence _________ 

Country __________ 

Region (State, Province, Census region)__________ 

Urban_________________ 

Rural__________________ 

Time 

Year of the publication_____________ 

Year to collect the data (Range)___________ 

Subjects 

Race 

African Continental Ancestry Group, %_________ 

Asian Continental Ancestry Group, %_________ 

European Continental Ancestry Group, %_________ 
E-2 

Ethnicity 

Caucasians, %____________ 

African Americans, %________ 

Arabs, %___________ 

Asian Americans, %__________ 

Hispanic Americans, %_______ 

Gender________ 

Males, %_____ 

Females, %_____ 

Age: 

Mean age, years______ Standard deviation_________ 

Age intervals:________ 

Health status 

Sample size:__________ 

Inclusion criteria:___________ 

Exclusion criteria:__________ 

Incontinence variables 

Methods to assess incontinence: 

Self report_______ 

Medical diagnosis_______ 

Medical procedure_______ 

Data source to measure incontinence: 

Time of followup from the diagnosed incontinence in months____________ 

Urinary Incontinence (Incidence, Prevalence) 

Define ____________ 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Length________ 

Bothersomeness_____ 

Type of Incontinence (Incidence. Prevalence) 

Define___________ 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Frequency__________ 

Length________ 

Bothersomeness_____ 
E-3 

Subject Age, Gender, Race, 

Ethnicity 

Prevalence (%) 

of Incontinence 

Prevalence (%) 

of Incontinence 

Prevalence (%) of 

Incontinence 

Race Definition overall 

and by type 

Severity of urinary 

incontinence 

Bothersomeness 

African Continental Ancestry Group 

Asian Continental Ancestry Group 

European Continental Ancestry Group 

Ethnicity 

Caucasians 

African Americans 

Arabs 

Asian Americans 

Hispanic Americans 

Gender 

Males 

Females 

Age groups 

Level of evidence of the individual study (check one) 

Observational studies 

 I-2A Well-designed cohort (prospective) study with concurrent controls 

 I-2B Well-designed cohort (prospective) study with historical controls 

 II-2C Well-designed cohort (retrospective) study with concurrent controls 

 II-3 Well-designed case-controlled (retrospective) study 

 III Large differences from comparisons between times and/or places 

 IY Opinion of respected authorities based on clinical experience 
E-4 

Prevalence and incidence of fecal and combined incontinence in the 

community and long-term care settings 

Abstraction Form 

(Complete for each study) 

Number of the study in the database (PubMed ID, Cochrane accession number, ISBN)_________ 

First author_________ 

Year of publication________ 

Purpose/aim of study 

Design of the study (check one) 

 prospective cohort 

 retrospective cohort 

 cross-sectional 

 descriptive study 

 case-control 

 case-series 

 randomized controlled clinical trial 

 not randomized clinical interventions 

 ecologic 

Adjustment for confounding factors: _________________ 

Population variables (independent variables) 

Data source for population variables (define) 

Survey____________ 

Administrative data base__________ 

Population based______________ 

Clinic based_________ 

Other__________ 

Settings 

Community (general population)____________ 

Long term care settings_____________________ 

Nursing home____________________________________ 

Long term care hospital____________________________ 

Location 

Residence _________ 

Country __________ 

Region (State, Province, Census region)__________ 

Urban_________________ 

Rural__________________ 

Time 

Year of the publication_____________ 

Year to collect the data (Range)___________ 

Subjects 

Race 

African Continental Ancestry Group, %_________ 

Asian Continental Ancestry Group, %_________ 

European Continental Ancestry Group, %_________ 

Ethnicity 

Caucasians, %____________ 
E-5 

African Americans, %________ 

Arabs, %___________ 

Asian Americans, %__________ 

Hispanic Americans, %_______ 

Gender________ 

Males, %_____ 

Females, %_____ 

Age: 

Mean age, years______ Standard deviation_________ 

Age intervals:________ 

Health status 

Sample size:__________ 

Inclusion criteria:___________ 

Exclusion criteria:__________ 

Incontinence variables 

Methods to assess incontinence: 

Self report_______ 

Medical diagnosis_______ 

Medical procedure_______ 

Data source to measure incontinence: 

Time of followup from the diagnosed incontinence in months____________ 

Fecal Incontinence (Incidence, Prevalence) 

Define ____________ 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Length________ 

Bothersomeness_____ 

Combined Incontinence (Incidence. Prevalence) 

Define___________ 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Frequency__________ 

Length________ 

Bothersomeness_____ 
E-6 

Subject Age, Gender, Race, 

Ethnicity 

Prevalence (%) 

of Incontinence 

Prevalence (%) 

of Incontinence 

Prevalence (%) of 

Incontinence 

Race Definition overall Severity of fecal incontinence Bothersomeness 

African Continental Ancestry Group 

Asian Continental Ancestry Group 

European Continental Ancestry Group 

Ethnicity 

Caucasians 

African Americans 

Arabs 

Asian Americans 

Hispanic Americans 

Gender 

Males 

Females 

Age groups 

Level of evidence of the individual study (check one) 

Observational studies 

 I-2A Well-designed cohort (prospective) study with concurrent controls 

 I-2B Well-designed cohort (prospective) study with historical controls 

 II-2C Well-designed cohort (retrospective) study with concurrent controls 

 II-3 Well-designed case-controlled (retrospective) study 

 III Large differences from comparisons between times and/or places 

 IY Opinion of respected authorities based on clinical experience 
E-7 

Independent contributions of risk factors for fecal and combined 

Incontinence 

Abstraction Form 

(Complete for each study) 

Number of the study in the database (PubMed ID, Cochrane accession number, ISBN)_________ 

First author_______ ___ 

Year of the publication________ 

Purpose/aim of study___________ 

Design of the study (check one) 

 prospective cohort 

 retrospective cohort 

 cross-sectional 

 descriptive study 

 case-control 

 case-series 

 randomized controlled clinical trial 

 not randomized clinical interventions 

 ecologic 

Adjustment for confounding factors: _________________ 

Population variables 

Data source for population variables (define) 

Survey____________ 

Administrative data base__________ 

Population based______________ 

Clinic based_________ 

Other__________ 

Settings 

Community (general population)____________ 

Long term care settings_____________________ 

Nursing home____________________________________ 

Long term care hospital____________________________ 

Location 

Residence: _________ 

Country __________ 

Region (State, Province, Census region)__________ 

Subjects 

Race 

African Continental Ancestry Group, %_________ 

Asian Continental Ancestry Group, %_________ 

European Continental Ancestry Group, %_________ 

Ethnicity 

Caucasians, %____________ 

African Americans, %________ 

Arabs, %___________ 

Asian Americans, %__________ 

Hispanic Americans, %_______ 
E-8 

Gender 

Males, %_____ 

Females, %_____ 

Age 

Mean age, years______ Standard deviation_________ 

Age intervals:________ 

Health status 

Sample size_____________ 

Inclusion criteria:___________ 

Exclusion criteria:__________ 

Risk factors (independent variables) 

Data source for variables (define) __________ 

Frailty 

Unintentional weight loss (10 pounds or more in a year) _____________ 

General feeling of exhaustion _______________ 

Weakness (as measured by grip strength)________________ 

Slow walking speed________________ 

Low levels of physical activity_________________ 

Prostate disorders 

⁪Define _____________ 

Prostatic enlargement, benign ________ 

Urethral stricture_________ 

Bladder neck contracture_________ 

Prostate cancer__________ 

Prostatectomy, radical__________ 

Prostatectomy, laparoscopic_______ 

TURP____________ 

Sexual abuse, torture, sodomy ___________________ 

Anal sexual intercourse_________________ 

Pregnancy and Postpartum period 

Define________ 

Semester or pregnancy______ 

Complications of Pregnancy_______ 

Labor, Obstetric____________ 

Menopause 

Define__________ 

Years of amenorrhea______________ 

Hysterectomy_______________ 

Dementia 

Define ___________ 

Levels of decline_______ 

Functional status_______ 

ADL______ 

CPS______ 

Depression 

Define__________ 

Depressive Disorder__________ 

Depression, Postpartum________ 

Depressive Disorder, Major_______ 
E-9 

Psychiatric disorders 

Define____________ 

Functional status_______ 

ADL______ 

CPS______ 

Diabetes 

Diabetes Mellitus, Type 2________ 

Compensation (HbA1c)__________ 

Diabetes Mellitus, Type 1________ 

Compensation (HbA1c)__________ 

Obesity 

Define___________ 

class I (BMI 30-34.9)___________ 

class II (BMI 35-39.9)____________ 

class III (BMI 40 and above)________ 

Abdominal Obesity 

Define__________ 

Waist Circumference >102 cm(men) >88cm (women)_________ 

Waist-Hip Ratio >0.9 (men) >0.8(women)__________ 

Diet 

Define___________ 

Caffeine intake________ 

Alcohol intake________ 

Liquid Intake_______ 

Calories intake______ 

Saturated fat intake______ 

Salt Intake___________ 

Dietary fiber intake_______ 

Nutritional deficits____________ 

Malnutrition________________ 

Fiber-free tube-feeding formulas_______ 

Irritable Bowel Syndrome 

Length of the diseases_________ 

Severity of the disease_________ 

Diarrhea 

Define______ 

Length of the diseases_________ 

Severity of the disease_________ 

Constipation 

Define___________ 

Length of the diseases_________ 

Severity of the disease_________ 

Inflammatory Bowel Diseases 

Length of the diseases_________ 

Severity of the disease_________ 

Radiation to pelvis or radiation enteritis____________ 

Fecal impaction 

Define___________ 

Length of the diseases_________ 

Severity of the disease_________ 
E-10 

Cardiovascular Diseases 

Define __________ 

Length of the diseases_________ 

Arrhythmia_________ 

Congestive heart failure_________ 

Coronary Disease_____________ 

Myocardial infarction___________ 

Hypertension_________________ 

Smoking 

Define____________ 

Length of smoking_________ 

Dose of nicotine per day_______ 

Secondary smoking__________ 

Years after cessation________ 

Smoking related Respiratory Tract Diseases 

Define______________________ 

Length of the diseases_________ 

Lung neoplasm_________ 

Chronic obstructive pulmonary disease___________________ 

Pneumonia__________________ 

Asthma________________ 

Dyspnea____________ 

Gastrointestinal Procedures 

Define________ 

Endoscopy, Gastrointestinal___________ 

Proctocolectomy, Restorative_______________________________ 

Gynecologic Procedures 

Define___________ 

Colposcopy___________________ 

Culdoscopy_____________________ 

Hysteroscopy_______________________ 

Gynecological surgery for pelvic organ prolapse repair__________________ 

Urologic Surgical Procedures 

Define_________ 

Cystectomy_________________ 

Cystoscopy_________________ 

Ureteroscopy________________ 

Urinary Diversion_____________ 

Prostatectomy: Suprapubic_______________ 

 Retropubic________________ 

 Transurethral______________ 

Ultrasound, High-Intensity Focused, Transrectal______________ 

Stroke 

Define_________ 

Type (ischemic)_________ 

Type (Hemorrhagic)_______ 

Plegia, hemi_______ para __________ tetra________ quadri________ 

Spinal Cord Diseases 

Define________ 

Length of the diseases_________ 

Severity (functional status) _________ 

Traumatic injuries_________ 

Vascular diseases________ 

Infections__________ 

Inflammatory/autoimmune processes___________ 
E-11 

Multiple Sclerosis 

Define _________ 

Length of the diseases_________ 

Severity (functional status) _________ 

Parkinson’s Disease 

Length of the diseases_________ 

Severity (functional status) _________ 

Hip Fractures 

Length of the diseases_________ 

Severity (functional status) _________ 

Degenerative Joint Diseases, Osteoarthritis 

Define_________ 

Length of the diseases_________ 

Severity (functional status) _________ 

Rectal Diseases and Surgeries 

Hemorroidectomy ___________ 

Bowel resection______________ 

Anal and recto-vaginal fistula__________ 

Rectal prolapse_____________ 

Acute sphincter trauma, Sphincterotomy, and sphincter repair_____________

Fistulotomy 

Obstetrical and Other Injuries to the Pelvic Floor 

Define ________ 

Parity__________ 

Forcept delivery_________ 

Vacuum extraction________ 

Episiotomy__________ 

Increased Fetal weight_________

Functional impairments (e.g., ADL impairments)____________ 

Mobility status (bedbound, wheelchair bound, assistive device)_____________ 

Drugs________________________ 

Alpha Blocker 

Alzheimer's agent 

Antipsychotic 

Antidepressants 

Antiparkinson agents 

Diuretics 

Sedative/hypnotics 

Skeletal muscle relaxants 

Antineoplastic and antiviral medications 

Laxatives 

Stool softeners 

Nursing home institutionalization_____________ 

Physical restraints_____________ 

Other Risk Factors 

Define________ 

Incontinence (dependent variable) 

Incontinence Variables 

Methods to assess of incontinence: 

Self report_______ 
E-12 

Medical diagnosis_______ 

Medical procedure_______ 

Data source to measure incontinence: 

Time of followup from the diagnosed incontinence in months____________ 

Fecal Incontinence (Incidence, Prevalence) 

Define 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Length________ 

Bothersomeness_____ 

Combined Incontinence (Incidence, Prevalence) 

Define 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Frequency__________ 

Length________ 

Bothersomeness_____ 

Risk Factor Outcome 

Reporting Number 

of Cases for Each 

Level of Risk Factor 

Percentage with Incontinence 

for Each Level of Risk Factor 

Relative Risk, 

95% CI 

Levels of risk 

factor 

Fecal 

Incontinence 

 

Levels of risk 

factor 

Combined 

Incontinence 

Level of evidence of the individual study (check one) 

Interventions: 

 I Well-designed randomized controlled trial 

 II-1A Well-designed controlled trial with pseudo-randomization 

 I-1B Well-designed controlled trial without randomization 

Observational studies 

 I-2A Well-designed cohort (prospective) study with concurrent controls 

 I-2B Well-designed cohort (prospective) study with historical controls 

 II-2C Well-designed cohort (retrospective) study with concurrent controls 

 II-3 Well-designed case-controlled (retrospective) study 

 III Large differences from comparisons between times and/or places 

 IY Opinion of respected authorities based in clinical experience 
E-13 

Evidence to support specific clinical interventions to reduce risk of 

fecal and urinary incontinence 

Abstraction Form 

(Complete for each study) 

Number of the study in the database (PubMed ID, Cochrane accession number, ISBN)_________ 

First author_________ 

Year of the publication _____ 

Purpose/aim of study __________ 

Design of the study (check one) 

 prospective cohort 

 retrospective cohort 

 randomized controlled clinical trial 

 not randomized clinical interventions 

Length of intervention____________ 

Length of follow up______________ 

Population variables (target population) 

Data source for population variables (define) 

Survey____________ 

Administrative data base__________ 

Other__________ 

Settings 

Community (general population)____________ 

Hospital (clinic)________________ 

Long term care settings_____________________ 

Nursing home_______________________ 

Subjects 

Race

African Continental Ancestry Group, %_________ 

Asian Continental Ancestry Group, %_________ 

European Continental Ancestry Group, %_________ 

Ethnicity 

African Americans, %________ 

Arabs, %___________ 

Asian Americans, %__________ 

Hispanic Americans, %_______ 

Gender 

Males, %_____ 

Females, %_____ 

Age_________ 

Health status 

Primary Health Condition, Diagnosis: 

Sample size: 

Inclusion criteria ___________ 

Exclusion criteria __________ 

Loss of follow up _________ 
E-14 

Incontinence (dependent variable) 

1. Provide the definition of urinary and fecal incontinence used in the article. 

2. Provide the data source to measure incontinence. 

3. Mark how the outcome was reported. 

/*Complete with values reported in article with page number in articles where data was extracted for quality control*/ 

/*Add as many lines for categories as necessary*/ 

/*Median is calculated when ranges only reported assuming normal distribution*/ 

/*Increment is analyzed when regression coefficients only reported*/ 

/*Provide means and standard deviation (95%CI) when reported*/ 

Methods to assess urinary incontinence: 

Self report_______ 

Medical diagnosis_______ 

Medical procedure_______ 

Methods to assess fecal incontinence: 

Self report_______ 

Medical diagnosis_______ 

Medical procedure_______ 

Urinary Incontinence, Incidence 

Define 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Length________ 

Bothersomeness_____ 

Urinary Incontinence, Progression 

Define 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Frequency______ 

Urinary Continence 

Define 

Dependent Continence______ 

Independent Continence_________

Fecal Incontinence, Incidence 

Define 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Frequency__________ 

Length________ 

Bothersomeness_____ 

Fecal Incontinence, Progression 

Define 

Symptoms_______ 

Signs_________ 

Acuity________ 

Severity_______ 

Length________ 

Frequency_______ 

Bothersomeness_____ 
E-15 

Fecal Continence 

Define 

Dependent Continence______ 

Independent Continence_________

Clinical Interventions (independent variables) 

Provide the definition of each variable used in the article. 

Health Education 

Define ________ 

Behavioral Therapy 

Define________ 

Education about urinary and fecal tract structure and function 

Development of individualized diaries of daily dietary, physical activities, urinary and fecal habits 

Development of individualized voiding schedules 

Voiding schedules: prompted, timed, habit retraining 

Patterned urge response toileting 

Dose of intervention: 

Length of therapy________ 

Intensity of therapy, section number ________ 

Biofeedback 

Define__________ 

Dose of intervention:

Length of therapy________ 

Intensity of therapy ________ 

Monitoring device________ 

Pelvic Floor Muscle Training 

Define________ 

Dose of intervention: 

Length of training________ 

Intensity of training ________ 

Vaginal Cones 

Define _________ 

Electrical Stimulation 

Define________ 

Dose of intervention: 

Length of therapy________ 

Intensity of therapy ________ 

Urethral "Plugs" and Urethral Pessaries 

Define________ 

Intermittent Catheterization 

Define________ 

Intermittent self-catheterization is performed by the patient himself/herself 

Intermittent catheterization is performed by an attendant (e.g., doctor, nurse, or relative) 

Clean intermittent catheterization: use of a clean technique 

Aseptic intermittent catheterization: use of a sterile technique 

Indwelling Catheterization 

Define ________ 

Dose of intervention: 

Length of therapy________ 

Intensity/frequency of therapy ________ 
E-16 

Detrol (tolterodine tartrate) 

Define________ 

Dose of intervention: 

Length of therapy________ 

Dose ________ 

Ditropan 

Define ________ 

Dose of intervention: 

Length of therapy________ 

Dose ________ 

Sanctura (trospium chloride) 

Define________ 

Dose of intervention: 

Length of therapy________ 

Dose ________ 

Enablex (darifenacin) 

Define________ 

Dose of intervention: 

Length of therapy________ 

Dose ________ 

Vesicare (solifenacin succinate) 

Define________ 

Dose of intervention: 

Length of therapy________ 

Dose ________ 

Weight Loss 

Define ________ 

Dose of intervention: 

Length of therapy________ 

Intensity of therapy ________ 

Smoking Cessation 

Define ________ 

Diet Therapy 

Define________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 

Magnetic Stimulation 

Define________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 

Elective Caesarian Delivery 

Define _______ 

Direct Neuron Modulation of the Sacral Spinal Cord 

Define ________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 

Urethropexy 

Define________ 
E-17 

Laparoscopic and Open Burch Retropubic Urethropexies 

Define ________ 

Abdominal Sacrocolpopexy 

Define ________ 

Urethral Bulking Procedures 

Define________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 

Anterior Colporrhaphy (anterior repair) 

Define________ 

Posterior Colporrhaphy (posterior repair) 

Define________ 

Radiofrequency Therapy to the Anal Canal 

Define ________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 

Artificial Bowel Sphincter 

Define________ 

Overlapping Sphincteroplasty 

Define ________ 

Dynamic Graciloplasty 

Define________ 

Other Surgical Procedures 

Define__________________ 

Botulinum Toxin Injections 

Define ________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 

Hormone Replacement Therapy 

Define________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 

Topical Estrogen Therapy 

Define________ 

Dose of intervention: 

Length of therapy________ 

Intensity (dose) of therapy ________ 
E-18 

Intervention Control Outcomes 

Definition 

Outcome Level 

in Active Group 

Outcome 

Level in 

Control 

Group 

Rate 

in 

Active 

Group 

Rate in 

Control 

Group 

Relative 

Risk, 95% 

CI 

 Urinary 

Incontinence

 

 Fecal Incontinence 

 Combined 

Incontinence 

 

Quality of the studies: 

Intention to treat: 

 Yes No not stated but all subjected included in analysis 

Masking of treatment status: 

Double blind 

Single blind 

Open label 

Randomization regime____________ 

Adequate: computer-generated random numbers or random numbers tables 

Inadequate: alternation, case record numbers, birth dates, or days of the week 

Adequacy of randomization____________ 

Baseline data not reported____________ 

Baseline data confirmed the adequacy of randomization_________ 

Allocation concealment __________ 

Not reported___________ 

Adequate__________ 

Not adequate__________ 

Adequate approaches to concealment of allocation: 

Centralized or pharmacy-controlled randomization 

Serially-numbered identical containers 

On-site computer based system with a randomization sequence that is not readable until allocation 

Inferior approaches to concealment of allocation: 

Use of alternation 

Case record numbers 

Birth dates or days of the week 

Open random numbers lists 

Serially numbered envelopes (even sealed opaque envelopes can be subject to manipulation) 

Justification for sample size_________ 

Level of evidence of the individual study (check one) 

Interventions: 

 I Well-designed randomized controlled trial 

 II-1A Well-designed controlled trial with pseudo-randomization 

 I-1B Well-designed controlled trial without randomization 

Observational studies 

 I-2A Well-designed cohort (prospective) study with concurrent controls 

 I-2B Well-designed cohort (prospective) study with historical controls 

 II-2C Well-designed cohort (retrospective) study with concurrent controls 

 II-3 Well-designed case-controlled (retrospective) study 

 III Large differences from comparisons between times and/or places 

 IY Opinion of respected authorities based in clinical experience 
Strategies to improve the identification of persons at risk and patients 

who have fecal and urinary incontinence 

Abstraction Form 

(Complete for each study) 

Number of the study in the database (PubMed ID, Cochrane accession number, ISBN)_________ 

First author________ 

Year of the publication__________ 

Purpose/aim of study__________ 

Design of the study (check one) 

 prospective cohort 

 retrospective cohort 

 cross-sectional 

 descriptive study 

 case-control 

 case-series 

 randomized controlled clinical trial 

 not randomized clinical interventions 

 ecologic 

Population variables (target population) 

Data source for population variables (define) 

Survey____________ 

Administrative data base__________ 

Other__________ 

Settings: 

Community (general population)___________ 

Hospital (clinic)________________ 

Long term care settings _____________________ 

Nursing home________________ 

Location: 

Country __________ 

Urban 

Rural 

Subjects: 

Race 

Define 

African Continental Ancestry Group, %_________ 

Asian Continental Ancestry Group, %_________ 

European Continental Ancestry Group, %_________ 

Ethnicity 

Define 

African Americans, %________ 

Arabs, %___________ 

Asian Americans, %__________ 

Hispanic Americans, %_______ 

Gender 

Males, %_____ 

Females, %_____ 
E-20 

Age: 

Mean age, years______ Standard deviation_________ 

Age intervals:________ 

Health status 

Primary Health Condition, Diagnosis 

Sample size: 

Sampling strategy: 

Random 

Self-selected 

Inclusion criteria:___________ 

Incontinence (dependent variable) 

Definition of incontinence 

Urinary___________ 

Fecal_____________ 

Combined___________ 

“Gold standard” to detect urinary incontinence used in the article_________ 

Multichannel urodynamics cut points of continence 

- Maximal urethral pressure (MUP)_________ 

- Functional urethral length (FUL)_________ 

- Maximal cystometric capacity (MCC)_______ 

- Abdominal leak point pressure (ALPP)________ 

Index diagnostic tests for urinary incontinence: 

Define______________ 

Cut points of continence____________ 

Clinical history 

 Nature 

 Duration 

 Symptoms and their severity 

 Symptom bothersomeness or impact 

 Functional and mental status 

 Medical, surgical and gynecological history 

 Exacerbating factors: diet, fluid, and medications 

Physical examination, general 

 Pelvic, Abdominal 

 Rectal 

 Neurological 

 Body mass index 

Pelvic floor muscle assessment 

Diagnostic tests for urinary incontinence: 

 Provocation stress test_____________ 

 Frequency volume chart____________________ 

 Post-void residual volume (PVR)____________ 

 Distal Urethral Electrical Conductance test____________ 

 Pad tests______________ 

 Paper towel test____________ 

 Ultrasound______________ 

 Q-Tip test_________________ 

Screening programs (clinic based, MDS based) 

Define____________________________ 

Clinician education programs with and without individual consultation 

Scales_______________ 

Define____________________ 
E-21 

For the each test provide comparison with “gold standard”: 

True positives_________ 

False positives_________ 

False negatives________ 

True negatives 

Sensitivity, % 

Specificity, % 

Reliability: 

Cronbach alpha 

Kappa statistics 

Correlation coefficients 

Inter-observer variability______________ 

Absolute values of the tests in patients with urinary incontinence and in controls:_____________________________ 

“Gold standard” to detect Fecal Incontinence used in the article_________ 

Index diagnostic tests for fecal incontinence: 

Define______________ 

Cut points of continence____________ 

Clinical history 

 Nature ,type, frequency, symptoms consistency, amount of leakage_________ 

 Duration ___________ 

 Symptoms: Urgency, flatus and their severity____________ 

 Functional and mental status_______________________ 

 Medical, surgical and gynecological history____________ 

 Exacerbating factors: diet, fluid, and medications__________ 

 Alleviating factors___________________________ 

Physical examination, general

 Pelvic, Abdominal___________________________

 Rectal_____________________________________ 

 Neurological ________________________________ 

 Body mass index____________________________ 

 Pelvic floor muscle assessment________________ 

Anal manometry ____________ 

Endoanal ultrasound __________ 

Cinedefography ______________ 

Pudendal nerve terminal motor ___________ 

Single-fiber electromyography____________ 

Screening programs (clinic based, MDS based) ________________ 

Clinician education programs with and without individual consultation ______________________ 

Stool diary_________________ 

Scales______________ 

For the each test provide comparison with “gold standard”: 

True positives_________ 

False positives_________ 

False negatives________ 

True negatives 

Sensitivity, % 

Specificity, % 

Reliability: 

Cronbach alpha 

Kappa statistics 

Correlation coefficients 
E-22 

“Gold standard” to detect combined Incontinence used in the article_________ 

Index diagnostic tests for combined incontinence: 

Define______________ 

Cut points of continence____________ 

For the each test provide comparison with “gold standard”: 

True positives_________ 

False positives_________ 

False negatives________ 

True negatives 

Sensitivity, % 

Specificity, % 

Level of evidence of the individual study (check one) 

Interventions: 

 I Well-designed randomized controlled trial 

 II-1A Well-designed controlled trial with pseudo-randomization 

 I-1B Well-designed controlled trial without randomization 

Observational studies 

 I-2A Well-designed cohort (prospective) study with concurrent controls 

 I-2B Well-designed cohort (prospective) study with historical controls 

 II-2C Well-designed cohort (retrospective) study with concurrent controls 

 II-3 Well-designed case-controlled (retrospective) study 

 III Large differences from comparisons between times and/or places 

 IY Opinion of respected authorities based in clinical experience 
F1 

Appendix F. Evidence Tables Contents Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in the commu F1a. Incidence of urinary incontinence in adults......................................................................................................................

 F1b. Risk factors for urinary incontinence in adults .................................................................................................................

 F1c. Prevalence of urinary incontinence in adults.................................................................................................................... F1d. Prevalence and incidence of fecal incontinence in adults................................................................................................ F1e. Prevalence of combined urinary and fecal incontinence..................................................................................................

 F1f. Risk factors for fecal incontinence.................................................................................................................................... F1g.Evidence tables of the association between risk factors and prevalence of fecal incontinence in adults in the community a

long-term care settings ............................................................................................................................................................

Table F2. Prevalence of UI in community dwelling men by country, type, and definition of UI (the results of individual studies) ............

Table F3. Prevalence of UI in American males by type and time period of involuntary loss of urine (the results of individual studies) ...Table F4. Prevalence of UI by severity in age groups of the American men (the results from individual studies) ...................................Table F5. Severity of FI in LTC facilities ..................................................................................................................................................Table F6. Prevalence of FI in community dwelling women by type of incontinence.................................................................................

Table F7. Prevalence of FI in community dwelling women by severity of incontinence...........................................................................

Table F8. Prevalence of FI in community dwelling adults (men and women) ..........................................................................................

Table F9. Prevalence of FI in community dwelling adults (men and women) by severity ........................................................................

Table F10. Prevalence of FI in community dwelling adults by race ...........................................................................................................Table F11. Association between age and UI in women .............................................................................................................................Table F12 Association between race and prevalent UI in women ............................................................................................................

FigureF1. Prevalent UI in Asian women compared to Caucasian women ...............................................................................................

Table F13. Association between body mass index and UI in females .......................................................................................................

Table F14. Association between behavioral and environmental factors and UI in women ........................................................................

Table F15. Association between dietary intake and UI in women..............................................................................................................

Table F16 Association between smoking and UI in women......................................................................................................................

Table F17. Association between cognitive status, depression, dependency, and UI in women ................................................................Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-delivery)........

Table F19. Association between hormonal status and prevalent UI in females.........................................................................................

Table F20. Association between prevalent UI and hysterectomy ..............................................................................................................Table F21. Association between prevalent UI and gynecological factors ..................................................................................................

Table F22. Association between urinary symptoms and prevalent UI in women .......................................................................................Table F23. Association between urinary tract infection and prevalent UI in women ..................................................................................Table F24. Association between glucose metabolism and UI....................................................................................................................Table F25. Association between neurological diseases and UI in women.................................................................................................

Table F26. Association between health status, comorbidities, and UI in women.......................................................................................Table F27. Association between gastrointestinal symptoms, surgery, and UI in females..........................................................................

Table F28 Association between pharmacological agents and UI in women .............................................................................................

Table F29. Association between hormone use and UI in women ..............................................................................................................

Table F30. Prevalence of UI among males with risk factors ......................................................................................................................Table F31. Prevalence and incidence of UI in males with prostate cancer................................................................................................

Table F32. Prevalence or incidence of UI after treatments for prostate cancer .........................................................................................
F2 

Table F33. Prevalence and severity of post-prostatectomy UI ..................................................................................................................

Table F34. Association between race and FI.............................................................................................................................................Table F35. Prevalence of FI in community dwelling adults by diet, body mass index, and the presence of diabetes................................Table F36. Association between severity of FI and BMI ............................................................................................................................

Table F37. Association between physical activity and FI...........................................................................................................................

Table F38. Prevalence of FI in patients with cancer ..................................................................................................................................

Table F39. Prevalence of FI in community dwelling adults after stroke .....................................................................................................Table F40. Prevalence of fecal incontinence in patients with neurological disease...................................................................................Table F41. Association between FI and pressure ulcers in residents of nursing homes............................................................................

Table F42. Association between FI and gastrointestinal conditions in residents of nursing homes...........................................................Table F43. Association between type and severity of FI and gastrointestinal conditions...........................................................................

Table F44. Prevalence of FI after gastro-intestinal surgery .......................................................................................................................Table F45. Association between FI and surgical procedures ....................................................................................................................Table F46. Association between fecal incontinence and drug administration............................................................................................

Table F47. Prevalence of FI in men with prostate diseases ......................................................................................................................Table F48. Association between FI and abortion in women ......................................................................................................................

Table F49. Association between FI and menopause.................................................................................................................................

Table F50. Prevalence of FI in patients with prolapse and in women with UI ............................................................................................

Table F51. Association between FI and prolapse in women......................................................................................................................

Table F52. Association between FI and UI in residents of nursing homes ................................................................................................

Table F53. Association between severity of FI and UI...............................................................................................................................

Table F54. Prevalence of FI related to pregnancy and birth ......................................................................................................................

Table F55. Incidence and severity of FI related to pregnancy and birth ....................................................................................................Table F56. Association between fetal characteristics and FI .....................................................................................................................

Table F57. Association between FI and mode of delivery .........................................................................................................................

Table F58. Effects of implementation of evidence based guidelines on urinary incontinence in residents of nursing homes....................

Table F59. Comparative effectiveness of implementation of evidence-based guidelines on urinary incontinence in residents of nursing 

Table F60. Effects of conservative management programs on urinary incontinence in females, residents of nursing homes...................

Table F61. Comparative effectiveness of conservative management programs on urinary incontinence in females, residents of nursing 

(events)....................................................................................................................................................................................

Table F62. Comparative effectiveness of conservative management programs on urinary incontinence in 143 females, residents of nurTable F63. Effects of conservative management programs on urinary incontinence in residents of nursing homes .................................

Table F64. Comparative effectiveness of conservative management programs on urinary incontinence in residents of nursing homes (

measures)................................................................................................................................................................................

Table F65. Effects of conservative management programs on urinary incontinence in patients admitted for rehabilitation following acut

unilateral hemispheric stroke ...................................................................................................................................................

Table F66. Comparative effectiveness of conservative management programs on urinary incontinence in patients admitted for rehabilit

following acute unilateral hemispheric stroke ..........................................................................................................................

Table F67. Effects of implementation of evidence based guidelines on urinary incontinence in adults .....................................................

Table F68. Comparative effectiveness of evidence based guidelines on urinary incontinence in adults, self reported severity and impac

urinary incontinence.................................................................................................................................................................

Table F69. Effects of conservative management programs on urinary incontinence in community-dwelling adults ..................................

Table F70. Comparative effectiveness of conservative management programs on urinary incontinence in adults (events) .....................Table F71. Comparative effectiveness of combined conservative management programs on urinary incontinence in females (events)..
F3 

Table F72. Comparative effectiveness of combined conservative management programs on urinary incontinence in females, self repor

severity and impact on life .......................................................................................................................................................

Table F73. Comparative effectiveness of conservative management programs on urinary incontinence in adults, self reported severity 

quality of life.............................................................................................................................................................................

Table F74. Comparative effectiveness of educational intervention on urinary incontinence in adults (events) .........................................

Table F75. Effects of dietary and other lifestyle interventions on risk and progression of urinary incontinence in adults .........................

Table F76. Effects of weight reduction on improvement in urinary continence in females.........................................................................

Table F77. Effect of dietary intervention on urinary incontinence in females (severity measures).............................................................

Table F78. Effects of diet and weight management on urinary incontinence in females (events)..............................................................Table F79. Effects of dietary and other lifestyle modifications on perceived urinary incontinence in males and females from the commu

(severity measures) .................................................................................................................................................................

Table F80. Effects of behavioral interventions on female urinary incontinence related to pregnancy and birth.........................................

Table F81. Effects of conservative management on female urinary incontinence related to pregnancy and birth (events).......................

Table F82. Effects of conservative management on female urinary incontinence related to pregnancy and birth (self reported severity a

impact on life) ..........................................................................................................................................................................

Table F83. Effects of behavioral interventions on female urinary incontinence related to pregnancy and births (events) ........................

Table F84. Effects of behavioral intervention on urinary incontinence related to pregnancy and birth (urodynamic outcomes) ................

Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females ..........................

Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females ....................................

Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary continence aft

treatment, from highest to lowest)............................................................................................................................................

Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate of impro

in urinary continence after active treatments, from highest to lowest) .....................................................................................

Table F89. Effects of bladder training and pelvic muscle floor exercises on progression of urinary incontinence in females (events)......Table F90. Behavioral interventions on risk and progression of stress urinary incontinence in males with prostate diseases ..................

Table F91. Effects of behavioral interventions on urinary continence in males (events) (table sorted by rate of continence in the active 

from highest to lowest..............................................................................................................................................................

Table F92. Effects of behavioral interventions on progression of urinary incontinence in males (events) .................................................

Table F93. Behavioral clinical interventions on urinary incontinence in adults ..........................................................................................

Table F94. Effects of behavioral interventions on urinary incontinence in adults (events).........................................................................Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measures) .......Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in females (objec

severity measures) ..................................................................................................................................................................

Table F97. Effects of behavioral interventions on perceived urinary incontinence in males (severity measures)......................................Table F98. Effects of behavioral interventions on pad test in males (severity measures) .......................................................................

Table F99. Effects of behavioral interventions on perceived urinary incontinence in males and females from the community (severity 

measures)................................................................................................................................................................................

Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults ......................................................................Table F101. Effects of physiotherapy on urinary continence in females (events) (table sorted by rate of continence after active treatmen

highest to lowest).....................................................................................................................................................................

Table F102. Effects of electrical stimulation and neuromodulation on improvement of urinary incontinence in females (events) (table sor

rate of improvement after active treatment, from highest to lowest) ........................................................................................

Table F103. Effects of stimulation therapy on urinary incontinence in females (events)..............................................................................Table F104. Effects of electrical stimulation or neuromodulation therapy on urinary continence in adults (events) (sorted by rate of contin

after active treatment, from highest to lowest) .........................................................................................................................
F4 

Table F105 Effects of electrical stimulation and neuromodulation therapy on improvement of urinary incontinence (events) (table sorted 

of improvement after active treatment, from highest to lowest) ...............................................................................................

Table F106. Effects of electrical stimulation or neuromodulation on perceived urinary incontinence in females (severity measures).........

Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urodynamic 

evaluations) .............................................................................................................................................................................

Table F108. Effects of electrical stimulation or neuromodulation therapy on self reported severity of urinary incontinence in adults .........Table F109. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in adults (urodynamic evaluations).......Table F110. Effects of devices on risk and progression of incontinence in females ....................................................................................Table F111. Effects of medical devices on female urinary incontinence (events rate..................................................................................Table F112. Effects of medical devices on self reported severity of urinary incontinence, quality of life, and objective instrumental measu

severity (continuous variables) ................................................................................................................................................

Table F113. Effects of medical devices on urinary incontinence in community-dwelling males...................................................................

Table F114. Clinical improvement in urinary incontinence in 57 males after inserted sphincter stent .........................................................

Table F115. Effects of devices on urinary incontinence in males (severity measures)................................................................................Table F116. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontinence in femTable F117. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontinence in fem

(events)....................................................................................................................................................................................

Table F118. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on severity of urinary incontinTable F119. Effects of obstetric interventions on incidence and progression of urinary incontinence in females ........................................

Table F120. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (events) ..........................

Table F121. Effects of obstetric interventions on progression of urinary incontinence in females (instrumental severity measures) ..........

Table F122. Effects of hysterectomy on incidence and progression of urinary incontinence in females......................................................

Table F123. Effects of hysterectomy on incidence and progression of urinary incontinence in females (events)........................................

Table F124. Effects of hysterectomy on self reported and objectively measured severity of urinary incontinence......................................

Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females .........................................Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of urinary co

after active treatment, from highest to lowest) .........................................................................................................................

Table F127. Effects of vaginal tapes and sling procedures on improvement of urinary incontinence in women (events) (table sorted by ra

improvement after active treatment, from highest to lowest) ...................................................................................................

Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) .................Table F129. Effects of vaginal tapes and sling procedures on perceived urinary incontinence in females (severity measures) .................

Table F130. Effects of vaginal tapes and sling procedures on urinary incontinence in females (severity measures)..................................

Table F131. Surgical interventions on risk and progression of incontinence in women...............................................................................

Table F132. Effects of surgical interventions on improvement of urinary incontinence in females (events) (table sorted by rate of improve

after active group treatment, from highest to lowest)...............................................................................................................

Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events).....................................Table F134. Effect of surgical interventions on self reported severity of urinary incontinence in females....................................................Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures)..................................Table F136. Effects of radiotherapy on urinary incontinence in adults with adenocarcinoma of the rectum................................................

Table F137. Effects of radiotherapy on urinary incontinence in 597 adults (38% women) adenocarcinoma of the rectum (events) ...........Table F138. Clinical interventions to reduce risk and progression of urinary incontinence in males with urologic diseases........................Table F139. Effects of clinical intervention on urinary continence in males (events) (sorted by rate of urinary continence after active trea

from highest to lowest).............................................................................................................................................................

Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence after active 

treatment, from lowest to highest)............................................................................................................................................
F5 

Table F141. Effect of surgical intervention on perceived urinary incontinence in males (severity measures)..............................................

Table F142. Effect of surgical interventions on progression of urinary incontinence in males (urodynamic measures)...............................

Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women......................................

Table F144. Effects local estrogen therapy on progression of urinary incontinence in women....................................................................

Table F145. Effects of hormone therapy on urinary continence in females (events) (sorted by the rate of continence after the active trea

from highest to lowest).............................................................................................................................................................

Table F146. Effects of hormone therapy on improvement of urinary incontinence in females (events) (sorted by rate of improvement in 

continence after active treatment, from the highest to the lowest)...........................................................................................

Table F147. Effects of hormone therapy on risk of urinary incontinence in females (events) (sorted by rate of outcome after active treatm

from lowest to highest).............................................................................................................................................................

Table F148. Effects of hormone therapy on progression of urinary incontinence in females (events) (sorted by rate of progression after t

active treatment, from lowest to highest) .................................................................................................................................

Table F149. Effects of hormone therapy on perceived urinary incontinence in females (severity measures)..............................................

Table F150. Effects of hormone therapy on urinary incontinence in females (severity measures) ..............................................................

Table F151. Clinical interventions on fecal incontinence in long-term care setting......................................................................................

F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults....................................................

Table F152. Comparative effectiveness of conservative management of fecal incontinence in residents of nursing homes (severity meas

Table F153. Comparative effectiveness of pharmacological intervention on progression of fecal incontinence in residents of long-term c

Table F154. Comparative effectiveness of individualized evidence-based conservative management on self-reported severity of fecal 

incontinence in patients after stroke ........................................................................................................................................

Table F155. Comparative effectiveness of individualized evidence-based conservative management on quality of life .............................

Table F156. Relative risk of fecal incontinence outcomes, number needed to treat to prevent one event, and number of avoided (excess

events per 1,000 treated after individualized evidence-based conservative management ......................................................

Table F157. Comparative effectiveness of dietary interventions on progression of fecal incontinence in adults (event rate.......................

Table F158. Comparative effectiveness of dietary interventions on progression of fecal incontinence in adults (severity measures).........

Table F159. Comparative effectiveness of conservative management programs on postnatal fecal incontinence in females ....................

Table F160. Relative risk of fecal incontinence outcomes, number needed to treat to prevent one event, and number of avoided (excess

events per 1,000 treated after conservative management programs on postnatal fecal incontinence in females ...................

Table F161. Comparative effectiveness self administered perineal massage on prevention of fecal incontinence in females....................

Table F162. Comparative effectiveness of behavioral interventions on prevention of fecal incontinence in females (cases of continence 

Table F163. Comparative effectiveness of behavioral interventions on instrumental outcomes in females.................................................Table F164. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in females (events rate) Table F165. Comparative effectiveness of behavioral intervention on prevention of fecal incontinence in adults (cases of continence rep

Table F166. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence adults (events rate) ......

Table F167. Clinical behavioral interventions that resulted in improvement in fecal incontinence in more than 40% of subjects................Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (severity score 

measures and instrumental outcomes)....................................................................................................................................

Table F169. Comparative effectiveness of behavioral interventions on objective instrumental outcomes, only significant differences show

Table F170. Clinical behavioral interventions that resulted in more than 40% difference in outcome levels compared to standard care....

Table F171. Comparative effectiveness of electrical stimulation on fecal incontinence in adults (events)...................................................Table F172. Relative effectiveness and attributable events of electrical stimulation on fecal incontinence in adults...................................

Table F173. The effect of electrical stimulation on quality of life of fecal incontinence in adults..................................................................

Table F174. Effects of electrical stimulation on progression of fecal incontinence in adults (anal manometry outcomes)...........................

Table F175. Comparative effectiveness of Botulinum toxin on fecal incontinence (events rate) .................................................................
F6 

Table F176. Comparative effectiveness of pharmacological interventions on progression of fecal incontinence (severity measures and 

instrumental outcomes) ...........................................................................................................................................................

Table F177. Comparative effectiveness of Loperamide vs. placebo on fecal incontinence (events rate)....................................................Table F178. Comparative effectiveness of pharmacological interventions on fecal incontinence (events rate)...........................................

Table F179. Medications that resulted in fecal continence in more than 50% of subjects ...........................................................................Table F180. Medications that changed self-reported scores of fecal incontinence by more than 20% compared to the control interventio

Table F181. Comparative effectiveness of end-to-end technique vs. overlapping repair of obstetric anal sphincter lacerations (clinical ev

Table F182. Comparative effectiveness of different techniques to repair anal sphincter (clinical events) ...................................................

Table F183. Comparative effectiveness of different techniques to repair anal sphincter (instrumental outcomes)......................................

Table F184. Comparative effectiveness of end-to-end technique vs. overlapping repair of obstetric anal sphincter lacerations (severity m

an instrumental outcomes) ......................................................................................................................................................

Table F185. Comparative effectiveness of clinical interventions to reduce fecal incontinence after obstetric trauma (clinical events)........

Table F186. Comparative effectiveness of clinical interventions to reduce fecal incontinence after obstetric trauma (severity measures a

instrumental outcomes) ...........................................................................................................................................................

Table F187. Comparative effectiveness of surgical interventions on fecal incontinence in females (events) ..............................................

Table F188. Comparative effectiveness of surgical interventions on fecal continence in females (events).................................................Table F189. Comparative effectiveness of surgical interventions of progression of fecal incontinence in females (events)........................

Table F190. Comparative effectiveness of surgical interventions on self-reported severity of fecal incontinence in females......................

Table F191. Comparative effectiveness of surgical interventions on progression of fecal incontinence (instrumental outcomes) ..............Table F192. Comparative effectiveness of radiotherapy for prostate cancer on fecal incontinence ............................................................

Table F193. The changes in self-reported fecal incontinence after radiotherapy of prostate cancer in 166 males compared to active surv

Table F194. Bowel management in 87 patients with spinal cord injury (29% females) and symptoms of neurogenic bowel dysfunction ...

Table F195. Comparative effectiveness of surgical interventions on fecal incontinence in patients with hemorrhoid disease (events) ......

Table F196. Comparative effectiveness of surgical interventions on progression of fecal incontinence in patients with hemorrhoid diseas

(events)....................................................................................................................................................................................

Table F197. Comparative effectiveness of surgical interventions on fecal incontinence in patients with hemorrhoid disease (self-reported 

severity scores and instrumental outcomes)............................................................................................................................

Table F198. Comparative effectiveness of clinical interventions in patients with colo-rectal diseases to reduce risk of fecal incontinence 

Table F199. Comparative effectiveness of clinical interventions in patients with rectal diseases to reduce risk of fecal incontinence (self-

severity scores and instrumental outcomes)............................................................................................................................

Table F200. Comparative effectiveness of surgical interventions on fecal incontinence in patients with rectal prolapse (events) ..............

Table F201. Effect of surgical procedures on severity of fecal incontinence ...............................................................................................Table F202. Comparative effectiveness of surgical interventions on anal sphincter to prevent incidence of fecal incontinence in adults (e

Table F203. Comparative effectiveness of surgical interventions on anal sphincter to prevent progression of fecal incontinence in adults 

reported severity scores) .........................................................................................................................................................

Table F204. Comparative effectiveness of surgical interventions on anal sphincter to prevent perceived progression of fecal incontinenc

adults (self-reported severity scores and instrumental outcomes)...........................................................................................

Table F205. Fecal continence and pad use of 1,85 patients operated on for chronic ulcerative colitis at 1, 5, 10, 15,and 20 years of follo

Table F206. Functional outcome of 1,885 patients operated on for chronic ulcerative colitis by time period of operation...........................Table F207. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (self-reported severity scores

Table F208. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (instrumental outcomes .......

Table F209. Evidence tables of diagnostic values of the tests to identify UI and FI in adults ......................................................................

Table F210. Recommended questionnaires for UI and lower urinary tract symptoms/overactive bladder (adapted from the Symptom and 

of Life Committee of the International Consultation on Incontinence)......................................................................................
F7 

Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the Symptom and Quality of L

Committee of the International Consultation on Incontinence..................................................................................................

Table F212. Association between sample size of studies and diagnostic values of tests............................................................................Table F213. Scales that provided the largest positive likelihood ratio to detect UI ......................................................................................Figure F2. Association between sample size and sensitivity (%) of clinical history versus multichannel urodynamics to detect stress UI Figure F3. Association between sample size and positive predictive value (%) of clinical history versus multichannel urodynamics to d

stress U ...................................................................................................................................................................................

Table F214. Diagnostic value of different tests to detect persons at risk and patients with UI.....................................................................

Table F215. Diagnostic value of different tests compared to multichannel urodynamics to detect UI in adults ...........................................

Table F216. Number needed to screen and number of tests to detect 1 case of UI in men .......................................................................Table F217. Recommended questionnaires for symptoms and quality of life impact of anal incontinence (adapted from the Symptom an

Quality of Life Committee of the International Consultation on Incontinence)..........................................................................

Table F218 . Questionnaires with rigorous validity, reliability, and responsiveness highly recommended by the Symptom and Quality of L

Committee of the International Consultation on Incontinence for anal incontinence................................................................

References for Appendix F ...........................................................................................................................................................................
F8 

Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Townsend, 20071Prospective cohort Adjusted by: Age, BMI, Weight, Race Parity, Smoking, Oral contraceptive use, Menopausal status, Hormone use, Hysterectomy, Diabetes, Physical activity, Diuretic use Level of evidence: II-2A 

Female nurses selected using data from the Nurses Health Study II which is updated biennially. Response rate: Approximately 88% Data source: Self-reported mailed questionnaires. Incontinence was defined as, “Leaked or lost control of urine in the last 12 months.” 

Age: 37-54 (Mean: 46.1) 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: USA 

Incident incontinence: 

(2 years) 13.60% 

Altman, 20062Prospective, observational cohort study with 10-year followup Adjusted for maternal age and parity Level of evidence: 11-2A 

304 primiparous women who had a vaginal delivery over a 10-week period in 1995 and completed a bladder function questionnaire 

Excluded: Elective or acute cesarean delivery; inadequate knowledge of Swedish language; dual pregnancy UI Measurement: Survey using selfadministered questionnaire 

• Do you experience sudden desires to 

void urine that are difficult to hold back?

• Do you experience involuntary loss of 

urine at physical activities? 

UI Severity Definition • Mild SUI defined as <1/week 

Moderate-severe SUI defined as UI >1/week or daily

Swedish women with mean age at index delivery 29.9 ± 4.1 years 

Adjusted for age and parity, oddwith index delivery: • 6 months: RR 2.2, 95% CI: 0.9• 9 months: RR 1.8, 95% CI: 1.6• 5 years: RR 4.1, 95% CI: 3.1-• 10 years: RR 3.9, 95% CI: 1.1

Adjusted by maternal age and psevere SUI after first delivery wMean incidence rates 10-year pdelivery, respectively: # of cases per 1,000 person yea• Mild SUI: 5 vs. 30 • Moderate-severe SUI: 2 vs. 10 

Edwards, 20063Prospective cohort study Level of analysis: II-2A 

361/460 patients (78.5% response rate) consecutively admitted with ischemic stroke hospitalized between 1999-2000 Inclusion criteria: community residence, absence of serious 

Adults ages 22-90 years with a mean age 65,5 (SD 15.2), USA (Missouri) Age: 

• Continent: 64.6 (SD 15.2) 

(n=301) 

• UI group was older (P <.001) • UI more common in women th• Individuals continent at 6 mon

functioning significantly better survivors; more independent icommunication, and cognition 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F9 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

cognitive or language deficits, no prestroke UI, and met ICD-9 criteria for ischemic stroke Telephone interview 6 months poststroke UI Measurement: Classified as 

incontinent if FIM bladder management item ≤5 (e.g., experience loss of 

bladder control at least 1x/month) 

• Incontinent: 70.1 (SD 

(14.8) (n=59) 

Gender: • 160 (47%) male; 137 

(46%) continent and 23 (40%) incontinent 

• 201 (53%) female; 165 

(54%) continent and 35 (60%) incontinent 

Race: • 181 (50%) white • 79 (50%) AfricanAmerican 

<.0001) 

• Individuals continent at 6 mon

independent in ADLs measure

SF-12 scores • Continent vs. Incontinent 

o Physical health: 45.6 (SD 6

.18) 

o Mental health: 43.9 (SD 7.8

.0001) 

Engh, 20064Case-control Not adjusted Level of evidence: II-2A 

835/1,022 women (81.7% response rate) ages 40-52 years who underwent uterine surgery with ovaries preserved between 1997-2002 Excluded: preoperative urinary symptoms; 6 or more vaginal deliveries, followup time <2 years, uterine size >9 weeks or uterine weight >120g, previous UI surgery and/or concomitant prolapse surgery 

Types of surgery, n 

• Total hysterectomy 

(abdominal/laproscopic) n=198/116 

• Subtotal hysterectomy 

(abdominal/laproscopic) n=163/86 

• Total hysterectomy 

(vaginal/laproscopic assisted vaginal) n=265/7 

Control group: women undergoing endometrial destruction (ablation, balloon treatment) n=187 Questionnaire 

Women with mean age 44.9 years, Sweden 

De novo UI by type of surgery a

• Total abdominal/laproscopic h

o 236 (75.2%) no symptoms o 43 (13.7%) SUI o 10 (3.2%) UUI 

• Subtotal abdominal/laproscop

o 186 (74.7%) no symptoms o 36 (14.5%) SUI o 12 (4.8%) UUI 

• Total vaginal/laproscopically a

o 210 (77.2%) no symptoms o 39 (14.3%) SUI o 11 (4.0%) UUI 

• Endometrial destruction (cont

o 138 (73.8%) no symptoms o 26 (13.9%) SUI o 7 (3.7%) UUI 

• No significant differences note
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F10 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Glazener, 20065Cross-sectional Adjusted Level of evidence: 

3,405/4,537 (75.1% response rate) of women responding they had singleton births delivered over 1 year between 1994-1995 (3489/4555 responded to survey) Excluded: Twin pregnancies Conducted in 3 countries Mailed survey 

UI Measurement: A positive response 

to one or more of the following questions: 

• At present, do you ever lose any urine 

when you don’t mean to? 

• In the last month, how often has this 

happened on average? 

• Do you wear a pad for this? 

Women mean age 26.7 years (SD 5.3), Scotland, New Zealand, and England 

UI onset during index pregnancUI onset after 3 months index p

McGrother, 20066Prospective cohort study with 1-year followup Adjusted for age and ADL; separate models adjusted for general and specific morbidities and parity Level of evidence: 11-2A 

12,570/19,241 (65.3% response rate) community-dwelling women drawn from 108 general practices (71% of all practices) 

Mailed questionnaire at baseline and 1 year UI Measurement: SUI: leakage upon 

laughing, coughing, or exercise ≥monthly 

Included OAB but could not differentiate those with OAB with urge incontinence from those with OAB without urge incontinence 

Women aged ≥40 years (range 40-98), UK Median age: 58 and 56 years 

Incident rate at 1-year: 3.6% SU

van Brummen, 20067Prospective cohort study No adjustment for confounding factors Level of evidence: II-2A Note: van Brummen, 20068had similar sample but recruited from fewer 

Consecutive recruitment of nulliparous pregnant women with single, low-risk pregnancy between 12 and 18 weeks gestation recruited from 10 midwifery practices from January 2002 to July 2003 

Exclusion criteria: previous urogynaecological surgery, urogynaecological malformations, 

Women with a mean age of 30.4 (SF 0.19); Netherlands 

Bothersome SUI:: 

• 53 (15.4%) at 36 weeks • 36 (10.5%) at 1 year after chi

Moderately or greatly bothersom

• 58 (16.9%) at 36 weeks • 51 (14.8%) at 1 year after chi
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F11 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

midwifery practices over same time period 

diabetes mellitus, or neurological disorders; good knowledge of Dutch language; pregnancy within 1 year after index pregnancy 

344/954 of those invited and not pregnant with 1 year postpartum (37.1% response rate) 344/904 of those eligible (38.1% response rate) Self-report questionnaire at 12, 24, and 36 weeks gestation, and 3 and 12 months after delivery UI Measurement:

Using questions from the UDI, 

• SUI was defined as: Do you 

experience urine leakage related to physical activity, coughing, or sneezing? 

• UUI: Do you experience urine 

leakage related to the feeling of urgency? 

Defined symptom bother using item levels and total scores from UDI Baseline continence status unknown 

Wehrberger, 20069Prospective cohort study with mean duration of follow-up of 6.5 years Adjusted for confounding factors Level of evidence: II-2A 

441/925 women (47.7% response rate) who completed a free examination in 1998 or 1999 

Mailed questionnaire UI Measurement: BFLUTS: Have you 

leaked any urine at all during past 4 weeks? 

Women ages 20-84 years; Austrian 

Study described as incidence bcalculated numbers (see preval

Cumulative incidence of any UI • 3.9% annually • 25.6% By age and frequency, cumulat(n, n with UI, cumulative incidenfrequency ≥1 time/week, cumula

• 20-39 years: 8/54 (14.8%, 2.3

0.6%) 

• 40-49 years: 18/70, 25.7%, 4.

2.2%) 

• 50-59 years: 22/92, 23.6%, 3.

1.7%) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F12 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

• 60-69 years, 11/46, 23.9%, 3.

2.3% 

• 70+ years: 18/38, 47.3%, 7.3%

5.3% 

• Total = 77/300, 25.6%, 3.9%; Frequency of UI: • ≤1 time/week: 44% • 2-3 times/week: 28% • 1 time/day: 15% • More often: 13% UI severity: • Enough to make underwear/p• Enough to make underwear/p• Enough to wet outer clothes: 5• Urine runs down legs onto flooImpact of UI: • 14% not at all • 40% a little • 29% moderate • 17% significant UI type: • 34% SUI • 13% UUI • 53% MUI 

Andersson,200410Population based study II-3 

3/2000, Life and Health questionnaire sent to 70,000 residents randomly selected. In Orebro, pop of 274,000, one of the five counties that participated in above study, a special section on UI was given to a sample of 15,360 residents Questionnaire mailed to home comprising 12 questions on UI as a supplement to a large public health survey on health and general livingSample of 15,360 residents aged 18-79yrs of Orebro, Sweden; 

7680 females 7680 males 

age categories 18-34 53.9% 35-49 60.3 50-64 69.6 65-79 72.2 Swedish population 

Only prevalence rates given – s
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F13 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Response rate was 64.5% Used defs from ICS 

Stats on wts and calibration and found results were the same 

Bogner, 200411Population based longitudinal survey II-2B 

Used ECA (Epi Catchment Area) program sample to select from 3,481 community dwelling adults who were initially living in East Baltimore in 1981. 1,920 were contacted (73% of original cohort). Study sample included 822 persons ≥50 years, who completed info on UI. After exclusions for missing data, the final sample was 747. Age ≥65 over sampled GHQ used and self report on UI. UI = “Have you ever had any difficulty in controlling your water, losing your urine or having trouble getting to the bathroom on time?” If any uncontrolled urine loss was reported within the 12mos before the interview, persons were classified as having UI. 

Mean age: 67.2 64% were women 72.3% White – mean age 68.2+/- 11 27.7% AA – mean age 64.5 +/-10  White AA diabetes 14.3 16.9 heart trouble 27.4 26.6 arthritis 51.1 56.5 stroke 8.2 7.3 cancer 14.4 6.3 

MME 27.6+-2.6  25.6+-3.6 ADL impaired 1.9% 3.9% (AA and Whites ≥50years 

at followup interview 1993-1996) 

Corcos, 200412Prospective cohort No control mentioned 

Population ≥35 years, stratified by 

census of metro area and by gender. 7,487 persons were sample base. 53.7% response rate. 3249 interviews were final sample. Investigators developed standardized questionnaire to ascertain OAB and SUI and impact on QoL. 

Computer assisted telephone interviews conducted in 2 steps: an initial questionnaire to evaluate presence of OAB followed by detailed questionnaire to complete assessment. 

48.2% men; mean age=52 51.8% women; mean age=50.9 

82.4% younger than 65 and 17.6% older Montreal, Toronto, Vancouver and Edmonton, Canada 

Dallosso,200413Prospective longitudinal study 

Part of the Leicestershire MRC Incontinence Study. This study focused on women living in the community in UK 

Baseline data compared to those who provided FFQ data – 

Incidence rate over 1 yr of f/u w

Highest in perimenopausal grouelderly (80+) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F14 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

II=2B age ≥40. Of a random sample of 20,244 

women drawn, 12,565 returned the questionnaire (65% response rate). 

FFQ sent to 10,852 of above sample, 1st Postal questionnaire mailed Oct 

1998 and completed by 7,046 women(response rate 65%). 2nd postal 

questionnaire mailed Oct 1999 and completed by 6,424 women (91% response rate). 

Excluded women living in residential or nursing homes and those of South Asian origin who make up 5.3% of Leicestershire pop > 40years. Used ICS definitions 

Median age 57 vs. 61 Rating of health poorer in baseline after adjusting for age (OR: 1.66; 95% CI 1.51-1.82) More long term health problems in baseline (OR 1.14; 95% CI, 1.05-1.25) No difference in reporting SUI (OR: 1.02; CI 95%, .92-1.13) 

 Incidence at 1 year fol Total N SUI case40-49 1,242 9.3 50-59 1,272 7.2 60-69 1,108 7.6 70-79 756 8.3 80+ 214 12.6 

Dallosso, 200314Longitudinal, Prospective cohort II – 2B 

7,046 women at baseline with follow up collected from 6,426 1 year later, age ≥40 living at home, part of the 

Leicestershire MRC Incontinence Study on prevalence and incidence including men and women begun 10/98 with followup in 10/99 

Postal survey with usual definitions of SI. OAB defined by ICS and for this study as one or both of the sxs urge leakage and urgency. Subgroups of OAB and SI Excluded nursing home or residential pts and SI at baseline was excluded from analysis of onset of S.( 19,239 eligible women; 65.3% returned N= 12,565, 6,426 in this study) 

Age 40-49 - 26% 50-59 27.4% 60-69 23.3% 70-79 17.1% >80 6.2% 

BMI Acceptable 48.4% Underwt 7% Overwt 31.4% Obese 13.3% Smoking Never 54.3 Exsmoker 30.3 Current 15.2 United Kingdom 

Prevalence of OAB increased wchange with SI 

1 yr f/u there were 492 new casof SI giving incidence rates of 9Being overwt or obese were boincreased risk of SUI (OR: 1.421.91; 95% CI, 1.38-2.63) respec

Deliveliotis, 200415Prospective cohort II-2A 

283 of 441 pts enrolled; 105/142pts tx with RRP for prostate cancer, 98/151pts tx with TURP for BPH, 80/148 healthy men as control completed surveys Used AUA Sx Index, UCLA Prostate 

Greek men Mean ages 67.4 range 55-75 group 1 70.3 range 58-74 group 2 72.4 range 62-82 control 

 RRP TURP Pretx post p pretx Urinary function 85.1 80.2 .121 71.2 Urinary Bother 85.1 70.6 .021 65.1 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F15 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Cancer Index; Rand 36-Item Health Survey and BMSFI translated into Greek Patient outcomes 2 years post tx compared to pretx status at 2 weeks prior to tx Investigators felt poor returns due to length of questionnaires and the number of them 

HRQOL post tx RRP TURP Control Physical functioning 81.5 78.1 82.3 

AUA SI 11.1 8.6 .812 24.2 UI every day 2% 9% .002 12% RRP had trend towards worse usurgery but diff not significant. UI in control group was 5.78% 

Grodstein, 200416Prospective cohort II-2A Confounded for stroke and physical limitations and results were the same in both analysis 

Nurse Health Study from 1996-2000 females, Cohort of 39,436 women 50-75 years Questionnaire mailed in 1996 to 39,436 post menopausal women who had no leaking of urine and were followed for 4 years Incident cases of occasion UI defined as leaking 1-3 times/month; frequent ≥1/week Excluded premenopausal women or users of estrogen creams, or reported leaking in 1996 

Mean age; 61 for current HRT use; 64 for never used. BMI for never used HRT was 27, current use BMI = 47, past BMI = 47. Smokers @45% all. HRT use:  Never Current Past Cauc 98 97 98 AfrA 1 1 1 Hisp 0 1 0 Asian 1 1 1 Hysterectomy  16 47 40 

5,060 incident cases of occasiocases of frequent UI 

Average incidence rate of 3.2% year respectively 

Hagglund, 2004174 year followup cohort study II-2A 

145 incontinent and 193 continent women 22-50 years in 2000 follow up, who participated in 1995 study on prevalence. Response rate 73% 248/338 Among the 248 responders as followup, 118 reported UI and 130 reported being continent. Changes in type of UI measured using DIS “do you have problem with involuntary loss of urine?” 

Sweden At 4 year followup in 2000 118 w

incontinent. Of these, 95/118 ha130 women were continent. Of remained continent. 

Incidence rate from 1996-2000 mean annual incidence rate of 4Persistence of UI – this group creported UI daily, 34% reported monthly and 22% reported seld
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F16 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Haltbakk, 200418Prospective cohort no control mentioned historical control 

480 Norwegian men at St. Olavs Hospital, Trondheim Norway. Tentative dx of BPH made on 612 patients and from this pool, sample analyzed was 480 (78%). ICS LUTS questionnaire (ICS-BPH) between 1997-2000. IPSS, SPI and SISI used also. UI defined as any involuntary leakage of urine. 

Mean age of patients was 67 years, SD 10.6 years; median 69 years range 39-91 years 

15% mild sxs 54% moderate sxs 31% severe sxs mean age in incontinent group was 68 years 

Holroyd-Leduc, 200419Population based Prospective cohort Confounders – sex, age, sex, race, smoking, alcohol, BMI, sensory impairment, comorbid disease, depression, cognitive function and baseline dependency. II-2A 

6,506 of 7,447 subjects ≥70 in the 

Asset and Health Dynamics Among the Oldest Old study who had complete info on continence status at baseline. 3 groups- 5,872 nursing home, 5,521 ADL decline and 5,509 IADL decline as outcomes 

Subjects interviewed in 1993 and 1995 Blacks, Hispanics and Florida residents were over sampled Overall response rate was 80% UI measured “next question might not be easy to talk about, but it is very impt for research on health and aging, during the last 12 mos, have you lost any amount of urine beyond your control?” 

Mean age =/- SD = 77 (range 69-103) 63% female 86% white 

Median number of baseline comorbid medical conditions was 2 10% received help ≥1 ADLs; 23% were receiving help in ≥1 IADLS at baseline Patients with UI had more comorbidities (p=.001), higher rate of visual impairment (35% vs. 22.4% p <.001) and hearing impairment (39.7% vs. 30.5% p<.001) More functionally impaired at baseline Community dwelling in US 

Hunskaar, 200420Cross national study, Prospective No control group 

Postal survey mailed to 29,500 households in 4 countries – France, Germany, UK and Spain age >/= 18yrs 58.1% response rate. Women with UI 

included in analysis = 5,976 (35% of study pop) Definitions used by ICS; sxs in last 30 days and in last 7 days 

Mean age France – 44.8 Germany – 59 UK – 45 Spain – 64 All – 58 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F17 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Jackson, 200421

Cross sectional analysis, longitudinal study 

II-2A 

1,584 white and black women 70-79 years at 2 clinical sites in Pittsburg and Memphis. 1,558 answered the questions Limited enrollment to those who reported no difficulty walking quarter mile, climbing 10 steps or performing ADLs Questionnaires – in the past 12 mos, have you leaked even a small amt of urine? How often have you leaked? 

Smoking Alcohol Depression Diabetes BMI Parity Hysterectomy Oral estrogen use COPD Stroke Arthritis Age Race 

Jackson, 200422population based Prospective cohort; also randomly selected from HMO diabetes registry II-2A 

1,017 post menopausal US women a 55-75 years enrolled in HMO and followed for 2 years (1998-2002) inclusion criteria were no natural menstrual cycle in past 12 months (oral estrogen or vaginal estrogen users were excluded), resided in Washington state. Exclusion factors were residential nursing care, restriction to wheel chair, dementia or severe psych disorder, indwelling catheter or intermittent urinary catheter, end stage renal disease requiring dialysis, active malignancy other than skin cancer and chronic antibiotic use. Acute cystitis in past 90 days exclusionary. Postvoid residual bladder volume measured using portable ultrasound device. 12 month f/u done by 87% and 24mo f/u by 81%. Primary study outcome was sx cystitis 

Risk factor (%) Crude HR (95% CI) Complete sample 1,017 Age (years) 55-59-32% 1.0 60-69- 42% 1.3 (0.8–2.2) 70-75- 26% 1.6 (0.9–2.9) Ethnicity White- 87% 1.0 Other-12 % 0.6 (0.3–1.2) General health score from SF-36 76-100(51%) 1.0 51-75(37%) 2.0 (1.2-3.3) 0-50 (12%) 2.6 (1.3-4.8) Smoking history Never (55%) 1.0 Former (39%) 0.9 (0.5-1.4) Current (6%) 0.1 (0.02-0.8) Diabetes at baseline No (79%) 1.0 Yes (21%) 1.9 (1.1-3.1) Diabetes treatment type Not diabetic (79%) 1.0 Diet/pill (17%) 1.2 (0.7-2.0) Insulin (4%) 4.7 (2.2-10.3) Accidental leakage of urine 

Incidence of UTI was .07 per peIndependent predictors of infectdiabetes (hazard ratio [HR]=3.4[CI]: 1.7 to 7.0) and a lifetime hiinfection(HR for six or more infe13.6). Borderline associations inestrogen cream use in the last m1.0 to 3.4), a history of kidney sto 3.7), and asymptomatic bacte95% CI: 0.9 to 3.5).
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F18 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

in last year No (34%) 1.0 Yes (66%) 1.6 (0.9-2.7) Type of urinary incontinence in last month None 1.0 Stress only 0.9 (0.5–1.8) Urge only 1.7 (0.8–3.6) Mixed 1.4 (0.9-2.4) Postvoid residual bladder volume, ml <50ml (79%) 1.0 50-100ml (10%) 1.1 (0.5–2.2) >100ml (10%) 1.6 (0.8–3.2) History of hysterectomy No (69%) 1.0 Yes (31%) 1.2 (0.8-2.0) History of kidney stones No (90%) 11.0 Yes (5%) 2.4 (1.2-4.9) History of bladder or urinary surgery No (90%) 1.0 Yes (10%) 1.6 (0.9-3.0) Parity (N of full-term pregnancies) 0-(14%) 1.0 1-3-(63%) 1.3 (0.7-2.5) >4-(23%) 2.2 (1.1-4.3)

Johnson, 200423Long term cohort, Prospective study of RRP vs. Radiotherapy II-2B 

Men from the Prostate Cancer Outcomes Study dx with primary prostate cancer between Oct 1994-Oct 1995 Residents of LA, King County Washington, states of CT, NM, U,T 60-89 years in King County and younger >90 in others. 

1,433 men RRP 642 men received radiotherapy RRP group – wt % by race  NHW AA Hisp Arthritis:  33.3 38.6 35.8 Diabetes: 

Wt % for men with RRP  NHW ALevel of urinary control baseline Total control 87.9 8Occ leakage 8.8 9Freq leakage 2.1 2 P = .6 months 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F19 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Self questionnaire at 6, 12, 24 and 60 mos after diagnosis and medical record review at 12 and 60 mos. 11,137 men identified in registries; 5,672 randomly selected, letters sent to 4,736(83.5%) of selected cases. Total of 3,533 men(62.3%) completed 6 and 12mo were included in f/u cohort. 1433 men had RRP completed 6mos 1178 did 24 mos (82.2%) 1109 did 60mos (77.4%) For Radiotherapy – urinary problems not reported Questionnaire also translated into Spanish and interview conducted in Spanish when necessary. 

 11.1 29.5 17.2 COPD:  7.5 6.6 5.4 HF: 4.9 2.1 4.4 CVA: 2.6 2.5 3.3 HTN: 37.3 54 37.5 MI: 7.9 4 4.2 

Age at dx <60 27.5 38.6 23.4 60-64 26.8 26.1 30 65-75 41.9 32.9 45.5 ≥75 3.8 2.4 1 

total control 22.7 2occ leakage 52.1 4freq 22.6 2p = .12 months total control 33.1 3occ leakage 50.2 5freq 15.6 9 p= .24 months total control 38.2 4occ leakage 50.2 4freq 9.8 1p = .60 months total control 30.8 4occ leakage 53.7 3freq 14.3 1p = .

*definitions of occasional and fr

Lagergren, 200424National, longitudinal, multipurpose study in Sweden (SNAC). Study consisted of two parts – population part and the care/service part. II-2A 

65-79years old = 12%, >80years = 6% Of a total pop of 17,044, 8,627 ≥65 

years were targeted and 7,518 sampled from 2001-March 2004. 

16-25% of SNAC received public care F/u every 6 years starting at age 66 Combo of interviews and questionnaires 

Men 3,052 Women 4,465 Total 7,518 

Avg age 85 compared to national avg age 83 Skane, Karlskrona, Kungshomen and Nordanstig, Sweden 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F20 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Liebling, 200425Prospective study 

393 UK women with term singleton, cephalic pregnancies who required op delivery at full dilatation between 2/1999-2/2000 from a cohort of 10,106 deliveries Postal questionnaires at 6wks and 1yr study conducted at St. Michael’s Hospital, Bristol, UK Only instrumental vaginal deliveries performed in surgery as the definition of difficult vaginal operative delivery. 

Instrumental C-section OR(95% CI)  (184) (209) Primi 78% 79%  1.09(.67-1.77) Age>35 14% 9% Nonwhite 7% 5% BMI>30 7% 15%  .44(.22-.86) 

25% attempted with forceps 51% ventouse 24% ventouse and forceps 59% rotational del attempted 

Incidence of urinary sxs (at leasUI) after delivery was reported bgroup, respectively, at 6 weeks year.  6 weeks  Instr. delivery c-section UI 16.2% 2.7% OR 7.8 (2.58-23.55) 

Difficulty holding on to urine  9.6% 2.7% OR 3.59 (1.22-10.54) 

McGrother, 200426Cross sectional and longitudinal II – 2B 

162,533 prevalence study and 39,602 incidence study subjects ≥40 years Response rate 60 and 63% respectively and 79% at follow up Excluded people living in institutional settings Response rate at 1 year: 79.8% women (n=12,036) 77.6% men (n=7,823) UI Measurement: Daytime or evening 

urine leakage 

Almost dry: minimal Damp: moderate Wet: severe Profound: soaked 

15% age ≥ 65 yrs 85.5% white 44.9% employed 91.8% good health Mean age 57 54% women U.K. 

Annual incidence rates: 6.3% in combined 

In women: 8.8% overall: 8.4% 4years; 8.5% 60-69 years: 9.4% years In men: 3.8% overall; 2.2% 40-44.0% 60-69 years; 7.1% 70-79 yPeriod prevalence was: modera16.1%; storage disorder, 28.5%on QoL, 30.4%, healthcare nee20.4%. Remission rates substantially gOver a year, 20.4% of people arequirement in terms of seeking more help for storage sxs. In men: 3.8% overall; 2.2% 40-44.0% 60-609 years; 7.1% 70-79 Weekly wetting prevalence was residential care than in the comWomen:  Overall: 5.5% minimal 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F21 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

3.9% moderate 4.0% severe 0.8% profound  Minimal leaka13.3% 40-49 years 13.5% 50-59 years 11.1% 60-69 years 8.6% 70-79 years 6.3% ≥80 years  Moderate lea7.7% 40-49 years 7.9% 50-59 years 7.0% 60-69 years 6.4% 70-79 years 6.8% ≥80 years  Severe leaka9.8% 40-49 years 11.7% 50-59 years 12.0% 60-69 years 13.2% 70-79 years 17.0% ≥80 years  Profound leak2.0% 40-49 years 2.9% 50-59 years 3.3% 60-69 years 4.2% 70-79 years 9.6% ≥80 years 

Neumann, 200427Prospective study II-2A 

Study group – 549 women who had hysterectomy during 1/1/98-12/31/2000 born after 1939 Background group – 144 women, born between 1940-1965, who had non-GYN surgery. Exclue nulliparae Questionnaire sent 9- 45 mos postop SI as involuntary leakage during effort, Urge as leakage with a sense of 

Caucasian Women: 12% hysterectomy – 33% of these had abdominal, 55% had vaginal Denmark. 

Pre urinary sxs in relation to mo Supracer Tot  53 51 % of N listed Sig SI 17 17 Sig Urge 13 3 Bothersome SI  17 12 Both. urge 13 3  Supracer Tot  53 1 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F22 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

urgency, sig UI was defined as involuntary leakage at least once a week, bothersome UI as sig incontinence and use of devices, decreased social ability or having hygienic problem with incon. Questionnaires returned by 82% in study group, 76% in background group 

% of N listed sig SI 36 26 sig urge 19 11 Bothersome SI 28 19 Both. Urge 11 7 

Østbye, 200428

Population-based with 5 and 10-year follow-up 

8,949 adults aged 65 and over who were participants in the Canadian Study of Health and Aging: 

Age at baseline: Women: 65-74: 2,159 (40.6%) 75-842,254 (42.4%) 85+: 909 (11%), 

Men: 65-74: 1,722 (58.9%) 75-84: 1,455 (40.2%) 85+: 397 (11%) Race/ethnicity: not reported Residence: Canada 

Cumulative 5-year incidence: Women: 14.3% ages 65-74 years 20.5% ages 75-84 years 24.3% ages 85+ years 

Men: 8.6% ages 65-74 years 12.3% ages 75-84 years 23.2% ages 85+ years Remission at 5 and 10 years: 37% and 40% women 29% and 38% men 

Ozerdogan, 200429

Cross sectional study, Prospective 

II-2A 

625 women living in Turkey ≥20years 

from 4 different cities of Turkey Questionnaire and I-QOL: Rare – UI less than once a month Reg – UI more than twice per month Serious – continuous use of sanitary protection SI and Urge defined as usual definitions 

Age distribution 20-29 – 26.4% 30-39 – 22.6 40-49 – 18.7 50-59 – 13.4 60-69 – 11/7 ≥70 – 7.2 Illiteracy rate 9.4% 1 in 4 resided in rural area 1 in 5 had ≥4 births and 

most were vaginal deliveries (25%) 50% BMI >25 25% smokers Recurrent UTIs 19% Diabetes 6.6% COPD – 7.5% 

Neurological disorders 11.2% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F23 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Schytt, 200430Prospective, longitudinal cohort II-2A 

After childbirth 5,550 women from 593 clinics booked appts during recruitment time. Of 4,500 eligible, 3,191 consented, 3,061completed 1st , 2,762 

completed 2nd, and 2,563 completed 3rd 

questionnaire. 2,450 completed all 3 with 2,390 total after exclusion. Selected data from a National Swedish survey investigating physical and psychological assessment of childbirth (May and Sept 1999 and January 2000 antepartal visits) 3 questionnaires; 1st at baseline, 2nd

mailed 6-8 weeks after the birth and 3rd

1 year after birth. Women were asked to recall any sxs of UI during and postpregnancy. 

Excluded miscarriages, non-Swedish speaking, and women at nonparticipating clinics, delivery of twins 

Avg gestation answering 1st quest – 16 weeks, 2nd – 

10 weeks post, 3rd – 1 year 

and 2 weeks. 

Avg age at recruit – 29.5 years Primiparas – 44% Multiparas – 56%  79.2% had vaginal delivery 13.4% had c-section 

de Tayrac, 200431Case control, retrospective study II-3 

French women – study pop 717 who had Dargent and Rudigoz technique 449 did not respond 365 (50.9%) returned questionnaires 51 excluded leaving 314 women 117 pts who had a vaginal hysterectomy for menorrhagia from Jan 1991 to Dec 2001 control group of 116 pt who had conservative tx 197 had hyster for pelvic pain and 117 for menorrhagia Self report questionnaire 

 Vaginal hyst. Control Age 51.4 50.9 Parity 2.1 2.2 Menopause  43.5% 47.4% Smoking 17.9% 17.2% Drink >2 L/d  7.7% 9.5% Hx of uro sxs  0 0 

Hu, 200332Retrospective longitudinal study. Level of evidence: 

Subject selection: 12,079 patients who underwent radical prostatectomy were identified in the claims data of a 5% national random sample of beneficiaries from the CMMS. 

Men aged >65 years 

USA 

The 3-year incontinence rate deto 4% in 1995. 

On multivariate analysis nonwhincreased risk for in hospital com
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F24 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Study done to ascertain whether radical prostatectomy outcomes improved after the diffusion of surgical innovations during the last decade. 

CI 1.17 to 1.55) 

Kolominsky-Rabas, 2003 (7715059) Population-based, longitudinal survey 

Adjusted by age, continence 

status, disability, stroke type, dependency and setting prior to stroke, independence 

752 adults with first-ever stroke and no UI prior to stroke were prospectively identified from the Erlangen Stroke Project. Of these, 586 had information on UI presence prior to stroke (84%) 

55% female 45% male 

Mean age of those without UI at Day 7: 68.1 and those with UI: 74.7) Race/ethnicity: not identified Residence: Bavaria, Germany 

35.3% UI incidence at day 7 28% full incontinence 7% partial incontinence 

24% UI at 12 months 12% full incontinence 12% partial incontinence Significant differences between UI at day 7: Age: 74.7 vs. 68.1 (P =.001) Age group: < 65 years: 17% vs. 36%; 75-84 years: 40% vs. 26%(P =.001) Female gender: 59% vs. 51%, Cerebral infarction: 78% vs. 91hemorrhage: 8% vs. 20%; subavs. 0%; undefined type (no CT sDisability at day 7: Very severe disabled: 80% vs. Severe disabled: 8% vs. 9%; Mmoderate disabled: 5% vs. 43%30%, P =.001 Living situation before stroke: Independent at home: 67% vs. 21% vs. 9%; institution: 8% vs. P=.001 Comorbidity before stroke: Diabetes: 29% vs. 23%, P = NS Hypertension: 62% vs. 63%, P Cardiac risk factors: 56% vs. 4
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F25 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Long, 200333

Prospective/Observational 

II-2 

Patients admitted from June 1999 to June 2001 with various indications for hysterectomy were evaluated. 22 patients were postmenopausal and had received hormone replacement therapy. 54 excluded due to: (i) the presence of peculiar pelvic mass (anterior wall or low-lying uterine myoma >5cm diameter) (n = 10); (ii) conversion to laparotomy (n = 3); (iii) intraoperative bladder rupture (n = 4); (iv) diabetes mellitus type 2 (n = 10); (v) combined colposuspension or TVT procedure (n = 12); and (vi) incomplete medical records (n = 15). Data pertaining to 151 women was therefore assessed for this study. 

Women 

Age: Range 35 to 61 years Mean: 45 years; Parity ranged from 0 to 6, with a median of 3. Taiwan 

Incidence of UI Post-op 

SUI Pre-op: 29.1% Post-op: 15.2 UUI Pre-op: 7.3% Post-op: 7.9% 

Yip, 200334

Observational (Cohort) II-2 

Subject selection: 276 nulliparous women were asked to participate; recruited consecutively on day 1 postpartum after a singleton, full term, vaginal delivery. Women with history of UI (including ante-partum stress UI), cesarean delivery, multiple pregnancy, or breech delivery were excluded. Response rate: 148 (53.6%) women answered a telephone interview. Definition: Urinary stress incontinence was defined as ‘‘2 or more episodes of urinary stress incontinence occurring in the past month’’

Women Age range: 23-30yrs 

Hong Kong 

Prevalence UI Women without interval vaginal Women with one interval vagina25.7% of women suffered from 

Kherulff, 200235Prospective cohort with 2-year follow-up Adjusted by age, race, income, and hysterectomy indication Level of evidence: II-2B 

Enrolled women 1,299 undergoing 

hysterectomy for noncancerous conditions from February 1992 to October 1993 at 28 hospitals. (81% response rate) Excluded: <18 years, cancer as indication for hysterectomy Interviews prior, and at 3, 6, 12, 18, and 24 months post-hysterectomy 

Women ages ≥18, with a mean age 43.3 years; Maryland, USA 

65% white 32% black 2% other Maryland Women’s Health Study, USA 

Prior to hysterectomy: 

• 29.5% (n=382) had severe • 35.9% (n=464) had modera• 34.^% (n=447) had mild or 

Preoperatively, UI severity globmonth how much of problem wa

• 16.4% (n=212) big problem • 18.9& (n=245) medium prob
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F26 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

UI Measurement: Urinary Symptom Scale for Women (USSW) adapted from questions in the Main Women’s Health Study; In the past month how often have you dripped or leaked urine? In the past month how often have you had urine drip when you sneezed or coughed? 

• 22.0% (n=285) small proble• 42.8% (n=555) no problem 

Viktrup, 200236Prospective cohort with 5-year follow-up Adjusted by maternal age, parity, gestational age, length of first stage, length of second stage, birth weight, head circumference, anesthesis, delivery method, perineal lesions, perineal injury Level of evidence: II-2A 

Consecutive recruitment of 305 

primiparious women attending obstetric department 91.0% response rate of those who were initially contacted at 

time of delivery, n=278) 

Standard questionnaire sent within 2-5 days after 1st delivery, telephone 3 months later; same questionnaire mailed 5 years later UI Measurement: Asked if they had urinary incontinence; if incontinence was provoked by physical exerting (SUI) or accompanied by strong desire to void (UUI); if they had daily UI; and if UI was a hygienic or social problem (Using ICS definition) 

Women ages 17-41 years (median 26 years); Denmark 

Race not reported 

32% had SUI during pregnancyreported social and hygienic dis

19% reported SUI during 1st pue

social and hygienic discomfort 

6% SUI 3 months after 1st delive

0.3% had social and hygienic d

5 years after first delivery, 30% (17/278) had daily SUI, and 8% hygienic or social discomfort UUI 5 years after first delivery oSUI in 49% of women with SUI of women with SUI during 3-mo

Miles 2001 (14687387) Population-based, longitudinal survey Adjusted by depression, self-reported number of medical conditions, BMI, gender, age, lifetime smoking, ADLs, and IADLs II-2A 

Random sample of 2,660/3,051 Mexican Americans aged 65 years and over who were participants in the Hispanic Established Population for Epidemiologic Studies of the Elderly (HEPESE); 2,025 persons had data at baseline and at the 2-year followup Home interviews UI measured by asking subjects how often they experienced difficulty holding urine. If answered “some,” “most” or “all,” categorized as incontinent 

Mean age at baseline of continent subjects: 71.9 years, and incontinent subjects: 73.6 years 

57% women Mexican-Americans Texas, New Mexico, Colorado, Arizona, and California 

14.1% with prevalent UI at basefollowup: 11.6% with new UI at 2-year fol

Weighted sample of 436,533 peprevalent UI at baseline, and 32at 2-year followup Prevalent UI: ADLs: 1.5 [0.9-2.7] IADLs: 1.0 [0.7-1.5] Walking: 1.6 [1.0-2.4] Balance: 1.0 [0.6-1.6] Chair rises: 1.1 [0.7-1.6] Incident UI: ADLs: 1.3 [0.6-2.6] 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F27 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

IADLs: 1.7 [1.1-2.6] Walking: 2.0 [1.2-3.0] Balance: 2.0 [1.2-3.2] Chair rises: 2.0 [1.3-3.1] 

Møller 200037Population-based with 1-year followup 

2,860 of 4,000 (71.5%) women aged 40-60 years who were originally randomly selected from the Danish Civil Registration System; After 1-year 2,284 (79.9%) completed 1-year follow-up study Mailed questionnaire UI measured by asking subjects about leakage caused by coughing or sneezing, moving, lifting, sleeping, sexual intercourse, urgency, and rest. Stress UI defined as leakage caused by exertion (coughing or sneezing, moving, or lifting) and urge UI as leakage associated with urgency; UI categorized as leakage occurring weekly or more 

21.9% age 40 20.7% aged 45 20.4% aged 50 19.1% aged 55 17.6% aged 60 

Ethnicity: not reported Residence: one rural (Storstrøm) and one urban county (Copenhagen) in Denmark 

Incidence at 1-year: Stress UI: 4.0 [2.3-4.9] Urge UI: 2.7 [2.0-3.4] 

Remission at 1-year: Stress UI: 41.4% [39.2-43.6] Urge UI: 42.0% [39.8-44.1] Progression from baseline: Never at baseline to: 69.0% ne1.4% weekly or more, 0.7% daiSometimes at baseline: 11.8% 7.6% weekly or more, 0.8% daiWeekly or more at baseline: 4.sometimes, 39.9% weekly or mDaily or more: 0.8% never, 20.or more, 47.6% daily or more 

Samuelsson, 200038Prospective cohort Adjusted by: Age Marital status Education Smoking Parity BMI Diabetes Hypertension Asthma Neurological disease Oral contraceptives Hysterectomy Level of evidence: II-2C 

All women scheduled for a gynecological health examination by midwives in primary health care district during 1 year were mailed a questionnaire. Exclusions: pregnant or lactating, a cervical smear in the last year, or mental retardation. Response rate: 77% (n=491) Follow-up: 87.8% (n=382) Data source: Self-reported postal questionnaire. (Also for follow up). UI as yes to, “Do you suffer from involuntary loss of urine?” Stress incontinence as, “leakage during effort,” and urge incontinence as, “leakage with sense of urge.” Mixed incontinence was presence of both. Unspecific 

Age: 20-59 years old. 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Sweden 

292 continent women at baselin252 remained continent 

90 incontinent women at baselin65 remained incontinent Incidence of any degree of UI d(13.7%) Annual incidence of U (any, onc20-29 years: 1.5%, 0.60% 30-39 years: 3.5%, 0.24% 40-49 years: 2.9%, 0.81% 50-59 years: 3.3%, 0.41% 60-69 years: 3.9%, 0.79% Overall: 2.9%, 0.51% Note: if pregnant women were incidence would have been 2.7%incidence rate of weekly or mor
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F28 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

incontinence as, “leakage, but not during effort or with sense of urge.” 

UI frequency of incident cases: Seldom: 70% At least monthly: 12.5% At least weekly: 12.5% Daily: 5.0% 

Number of women developing Ubaseline: None: 25 stress UI, 5 mixed UIUI Stress UI: 18 None, 24 stress Unonspecific Mixed UI: 1 none, 5 stress UI, 2 nonspecific; Urge UI: 0 None, 2 stress UI, 1 Nonspecific Nonspecific: 6 None, 6 stress UNonspecific Characteristics of women who bvs. those who remained contineMaximum birth weight was heavestrogen treatment (P < .01). Vsignificantly different between thcurrent smokers, BMI, parity, deprior episiotomy, poor pelvic floinstruction in pelvic floor exercissymptoms reported number of scystocele, vaginal atrophy, fragmembranes, vaginal pH, and esduring follow-up were not signifwomen rem Remission rate: 27.8% over 5 yremission rate: 5.9% 20-29 years: 10.6^ 30-39 years: 8.5% 40-49 years: 6.4% 50-59 years: 5.7% 60-69 years: 2.7% Remission by frequency of UI a
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F29 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Seldom: 6.6% Monthly: 6.6% Weekly: 3.6% Daily: 0 Remission by UI type at baselinStress UI: 6.8% Urge UI: 0 Mixed UI: 2.7% Unspecified: 6.4% 

Hojberg, 199939Cross-sectional Adjusted by: Age, parity, BMI, smoking, previous abortions, lower abdominal or urological surgery Level of evidence: III 

Subjects were selected from all women attending routine antenatal care from January 1993 to April 1996 at the Department of Obstetrics and Gynecology, Aarhus University Hospital. The subjects were asked to fill out a questionnaire at 16 weeks of gestation. Response rate: 91% (n=7,795) Data source: Self-administered questionnaires. Urinary incontinence was defined as, “Involuntary loss of urine within the last year.” Stress incontinence was defined as, “Involuntary loss of urine during physical exertion.” Urge incontinence was defined as, “involuntary loss of urine associated with a strong desire to void.” Mixed incontinence was defined as, “A combination of stress and urge incontinence.” 

Age: 15-24: 17.3% (n=1,347) 25-29: 41.7% (n=3,253) 30-34: 30.3% (n=2,365) 35+: 10.6% (n=830) 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Denmark 

Prevalence: 

Overall: 8,900/100,000 (8.9%) By Type: Stress incontinence: 5,000/100,Urge incontinence: 700/100,000 Mixed incontinence: 2,400/100,By Severity: 3,000 / 100,000 (3%) (Reported once a week) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F30 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Sgadari, 199740 Subjects were selected using data from 

a cross-national database. The interRAI data-base of nursing home assessments was used, containing information on the countries of Denmark, France, Iceland, Italy, Japan, Sweden, and the USA. The data within the interRAI are population-based for the USA, Denmark, and Iceland. The data from the remaining countries are “likely to be representative, but not as broadly-based.” 

Response rate: Not reported. Data comes from a pre-existing data set. (n=279,191) Data source: Nursing home MDS/Resident Assessment Instrument (RAI). MDS items measuring UI have “been proved to be valid.” A resident was considered incontinent when they had, “any uncontrolled leakage of urine, regardless of amount, that occurred two or more times a week.” 

Age: Denmark:  <75: 15.1%  75-84: 34.8%  85+: 50.1% France:  <75: 25.2%  75-84: 30.5%  85+: 44.3% Iceland:  <75: 11.2%  75-84: 37.3%  85+: 51.5% Italy:  <75: 18.2%  75-84: 42.4%  85+: 39.3% Japan:  <75: 18.6%  75-84: 46.3%  85+: 35.2% Sweden:  <75: 18.3%  75-84: 38.1%  85+: 43.5% USA:  <75: 18.9%  75-84: 33.9%  85+: 47.2% 

Gender: Male and female Denmark:  Male: 23.8%  Female: 76.2% France:  Male: 30.1%  Female: 69.9% Iceland:  Male: 32.9%  Female: 67.1% 

Prevalence of urinary incontinenBy country: 

Denmark: 52,200 / 100,000 (52France: 65,200 / 100,000 (65.2%Iceland: 56,500 / 100,000 (56.5Italy: 54,400 / 100,000 (54.4%) Japan: 42,900 / 100,000 (42.9%Sweden: 61,600 / 100,000 (61.6USA: 46,400 / 100,000 (46.4%) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-a. Incidence of urinary incontinence in adults (continued) 

F31 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Incidence (new cases/year * 

adult population, males and f

Type, Severity, and 

Herzog, 199041Prospective cohort Adjusted by: Age Sex General health status Level of evidence: II-2C 

Subjects were all non-institutionalized persons ≥60 years in a stratified probability sample.Response rate: 66% (n=1,956) 1 year followup: 69% 2 year followup: 72% Data source: At home interviews conducted by interviewers trained at the U of Michigan School of Public Health. Incontinence was defined as, “any uncontrolled urine loss within the 12 months prior to the interview.” 

Age: 60 years and older 

Gender: Male and female Males: 41% Females: 59% Race: Not reported Ethnicity: Not reported Residency: Washtenaw County, Michigan 

 1 year incidence ratMale 9.0% Stress 2.2% Urge 9.1% Mixed 4.9% Other 5.1 Female 22.40% Stress 13.7 Urge 3.6 Mixed 26.8 Other 3.9 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F32 

F1-b. Risk factors for urinary incontinence in adults 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Bluestein, 200742Cross sectional survey II-2A Listed as excluded in endnote 

Random sample of 262 patients from 400 mailed surveys from 1,327 potential patients older than 65 years in urban settings Random sample of 1,327 patients with a response rate 70.5% Excluded dementia 

Patients divided into two groups – robust health or impaired health. The following are totals for both groups out of 262 patients Mean age: 72.8 163 women; 99 men Depression: 59 Memory loss: 82 Weight loss: 58 

 48.5% v

54 reporobust h48 repoimpaire

Boyington, 200743II-3 

1999-2002 CMS MDS Southeastern US region Nursing Homes (AL, FL, GA, KY, NC, SC AND TN.) Repeated measures, two time period design Excluded use of a catheter, admission to NH prior to 1999, age <65 or race other than Caucasian or African American. 95,911 African American and Caucasian patients UI measured at 5 levels (0-4) 

82.4% Caucasians 76.5% women mean age – 82.71 years Cognitive impairment score of 2.06 +/- 1.84 on admission 

Age Gender Education Morbidities: Alzheimer’s, diabetes, stroke, HTN, CHF, Dementia Bed mobility Cognitive and functional status 

8.9% inadmissprevale74.3% (

CaucasincreasadmissAfrican howeveAmericatime po

Danforth, 200744Prospective, observational study Nurse’s Health Study II-2A 

Nurses’ Health Study of women ages 54-79 from 14 US states Prospective analysis from 2000 to 2002 2,355 cases of incident UI self reported from questions “Have you leaked urine in last 12 months or lost control?” Incident frequent incontinence defined as those reporting at least weekly in 2002 Estimated OR Excluded women missing info on 

Mean age 65.9 range 54-79 years Incontinence by race or risk factors not reported 

All multivariable logistic regression models included the following covariates: Race BMI Parity Smoking HRT usage 

2,355 cincreasactivity decreas

15-20% UI comquintile 26% lowof walkilowest q0.88) SUI: 79Urge: 3
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F33 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

incontinence or who reported prevalent incontinence in 2000. Excluded major neurological diseases (stroke) or functional limitations (walking, etc.) 

Mixed: 

Higher associaNo relaother ty

Goldacre, 200745Rate ratios for self harm and depression in a cohort of women admitted for UI, and rate ratios for UI in cohorts of women admitted with self harm or depression compared with a control cohort. II-2C retrospective study with concurrent controls 

NHS women admitted for UI; SUI only from 1979 Oxford record-linkage study (ORLS) from 2 health districts from 1968 (no end date) 6 districts from 1974 (no end date) all districts from 1983 (no end date) In addition, psychiatry data were recorded from 1968-1994. SUI pts only from 1979 on but no end date given. Database had records from these dates until; March 31, 1999 Excluded age <20 or >85 and women who had UI recorded at the same NHS contact episode as self harm or depression 

Total self harm and depression with subsequent UI Self harm 16,882 women 20-44 years had self harm 4,296 women 45-64 years 1,702 women ≥65 

Depression 10,646 women 20-44 years had depression 6,557 women 45-64 years 7,137 women ≥65 

Self harm Depression Age Women 

Risk of high in and sigrecorde

16,882 self har20-44, 4age >65significabefore toverall before Urecord a10,646 20-44, 67,137 6in all th1.51), 11.48(1.2Significinterval depressRR 1.46depress1.35 ansubseq

Huang, 200746II-2A 

Observational study of 6,361 community dwelling women ages 65 and older participating in the Study of Osteoporotic Fractures from 1986-1988 Restricted to patients who gave 

Age: mean age 76.7± 4.7 years All women recruited 

Depression:7% BMI: <25 – 42%; 25-30 – 37%; >30 – 21% History of hysterectomy: 39% 

By visit reported incontindisrupti

No data subseq
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F34 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

data on cognitive, physical function and UI through visit 4 Excluded abnormal cognitive and physical function at baseline Self administered questionnaire “in last 12 months, have you ever leaked urine or lost control?” 

CHF: 3% Parity: 0 births – 20%; 1 birth – 12%; 2 births – 23%; >3 – 45% Diabetes: 6% Stroke: 5% Parkinson: <1% Alcohol use: 3% 

Jacobsen, 200747Prospective study of men II-2A 

All men with localized prostate cancer scheduled for either open retropubic or laparoscopic prostatectomy at University of Alberta between Oct 1999-July 2002 Exclusion: prior pelvic radiotherapy, subjective complaint of incontinence at baseline or neurological impairment known to affect bladder Post evaluation included 24 hour pad test and voiding diary performed at 3 and 12 months. I-PSS completed at 3-6-9-12 months UI defined as total pad weight gain of more than 8gm during 24 hours. To control affect of activity, subjects recorded activity for baseline pad test and repeated this activity as closely as possible for subsequent pad tests. 

RRP compared to LRP at 2 points RRP LRP 1st half LRP 2nd# pts 148 29 28 Age 63.7 62.3 60.9 Mean BMI 28.1 26.87 27.54 % smokers 14.9 10.3 7.1 

RRP LRP Surgery 

Despite patients and 3.5Mean gPost op RRP 

3 month34.9 12 mon8.2 12 mon34.8 

% Incon3 month42 12 mon12.8 

Smither, 200748Prospective consecutive patients No controls 

U.S. men, 203 consecutive patients who underwent radical prostatectomy by a single surgeon. Walsh technique used. Patients instructed in pelvic floor 

Age range 40-72 mean 58 Preop PSA range .3-25.4 mean 7.3 Localized cancer 

RRP Mean p

2 weeks6 weeks18 wee30 wee
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F35 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

exercises preop with no other interventions. No data on compliance reported. Dates of study: 3/98-8/03 1 hour pad test used on post op visits Gram weight of urine loss was recorded and subdivided into 4 groups – minimal loss <1g; mild >1, <10; moderate 10-50g and severe >50g. Post op visits at 2 weeks, 6, 18, 30, 42 and 54 weeks. Did not use patient estimates of pad usage at home No mention if incontinence before surgery 

42 wee54 wee

18 weethe time of patiecontrol, weeks,.minimaand by categor

Waetjen, 200749Prospective cohort II-2A 

Study of Women’s Health Across the Nation (SWAN) 1995-2001 Multidisciplinary cohort study of menopausal transition 7 clinical sites (Boston, Chicago, Detroit, LA, Newark, Pittsburg, Oakland, CA) community based women ages 40-55 years each site recruited one Caucasian group and one minority group – African American, Japanese, Chinese and Hispanic Exclusion: no menstrual period in more than 3 months, hysterectomy and/or bilateral oophorectomy, use of oral contraceptives, estrogens or progestins 

3,302 women at baseline, 599 dropped out or did not complete UI questions (18.1%) baseline mean age: 45.8 Caucasian: 47% African Americans: 28.3 Japanese: 8.5 Hispanic: 8.7 Premenopausal: 46.5 Early perimeno: 53.5 

Race Ethnicity SES Obstetric history Smoking Medication use Educational level Depression Physical activity BMI 

CompaAfrican Japanehad lowfrequenno sign or frequby raciadiabetedepresssupport associaincident interactand botethnicityeducatiprevale– OR = Japane
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F36 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Interview and self administered questionnaire “In the past year, have you ever leaked even a small amount of urine involuntarily?” Defined any incontinence: at least monthly SI: urge to void and can’t reach toilet fast enough Combined less than once a month incidents with “no incontinence” 

.97. Being esmoker increasincontinAmericagroups. Diabetefor prevhighest See sup

Adelmann, 200450Prospective cohort 

Community UI prevalence sample of 910 persons to a 1998-1999 survey enrolled in a Medicaid managed health plan Seven county Minneapolis-St. Paul metro area Age ≥65 Random sample of 910 persons enrolled in Medicaid health plan. Of this the n= 378 that were eligible due to UI. Sample was further limited to persons based on at least one claim for a doctor’s visit and medical chart could be located. n=236 Nursing home abstraction sample was randomly drawn from Medicaid persons for a total of 480 persons. Interviews face to face in residence. Response rate 59%, cooperation rate 90%. Abstraction of medical record at clinics also. 

Characteristics of community and nursing home N=910  Community NH (%) Women 82.1% 79.2 Men 17.9 20.8 Age 65-74 50% 14 75-84 34.9 34.2 85+ 15.1 51.9 Mean 75.9 84.5 Race White 69.4 93.8 Black 14.5 4.6 Other 16.2 1.7 

Race Age Gender 

Prevalesample  UI (%) Total Women Men 

Age 65-74 75-84 85+ Race White Black Other SubgroRace a White Black Other  65-74 75-84 85+ 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F37 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Definition: ever/current UI measured by a yes response to questions about trouble holding urine or leaking urine 

Age am 65-74 75-84 85+ 

Age am 65-74 75-84 85+ Age am 65-74 75-84 85+ Age am 65-74 75-84 85+ MedicacommusampleCommuPast 18 Total Gender Age in y 65-74 75-84 85+ race alsPrevale com past 18 any typ
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F38 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

SI Urge Other Mixed 

Andersson, 200410Population based study II-3 

Swedish population, both men and women ages 18-79 years (Orebro county) in March 2000 Questionnaire mailed to home comprising 12 questions on UI as a supplement to a large public health survey on health and general living. Mailed to 15,360 randomly selected residents out of 274,000 population in this county. Response rate 64.5% Used definitions from ICS Stats on weights and calibration and found results were the same

7,680 females 7,680 males Age categories 18-35 53.9% 35-50 60.3 50-65 69.6 65-80 72.2 Life and Health questionnaire sent to 70,000 residents randomly selected. In Orebro, pop of 274,000, one of the five counties that participated in above study, a special section on UI was given to a sample of 15,360 residents 

Age Gender 

Prevalegender Women Women 18-34 (2); 50-21(8). Total foWomen 

SI total 13% 18-34 – 50-64 – Urge In46%; m18-34 – 50-64 – Women Proportincreas At Women 18-34 35-49 50-64 65-79 Men 18-34 35-49 50-64 65-79  Women 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F39 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Men Duratio<1 1-5 6-10 >10 

Bogner, 200411Population based longitudinal survey II-2B 

ECA (Epi Catchment Area) program was used to sample from Baltimore to include 3,481 persons selected from East Baltimore for this study. Community dwelling adults who were initially living in East Baltimore in 1981. Out of 3,481 persons, 1,920 were contacted (73% of original cohort). Study sample included 822 persons aged ≥50 who 

completed info on UI. After exclusions for missing data, 747 were the final sample. 

African Americans and Whites aged ≥50 at followup interview performed 1993-1996 Age ≥65 were over sampled GHQ used and self report on UI UI = “Have you ever had any difficulty in controlling your water, losing your urine or having trouble getting to the bathroom on time?” If any uncontrolled urine loss was reported within the 12 months before the interview, persons were classified as having UI. 

Mean age of study sample was 67.2 64% were women 72.3% White; mean age 68.2 ± 11 27.7% AA – mean age 64.5 ± 10  White Black Diabetes 14.3 16.9 Heart trouble 27.4 26.6 Arthritis 51.1 56.5 Stroke 8.2 7.3 Cancer 14.4 6.3 

MME 27.6±2.6 25.6±3.6 ADL impaired 1.9% 3.9% 

Age Gender Functional status Cognitive status Chronic medical conditions-diabetes, heart trouble, stroke, arthritis or cancer Race 

22% W13% of 

19.8% ryear pre UI No infoAssociaPsychoCrude  White 1.28 (.7Black 4.22 (1.
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F40 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Corcos, 200412Prospective cohort No control mentioned 

Canadian population ≥35 Stratified by census of metro area and by gender. 7,487 persons were sample base. 53.7% response rate. 3,249 interviews from Montreal, Toronto, Vancouver, and Edmonton were final sample Investigators developed standardized questionnaire to ascertain OAB and SUI and impact on quality of life. Computer assisted telephone interviews conducted in 2 steps: an initial questionnaire evaluate presence of OAB followed by detailed questionnaire completing the assessment. 

48.2% men; mean age 52 51.8% women; mean age 50.9 

82.4% younger than 65 and 17.6% older 

Gender Age 

Wet OAboth me75 year

No corrage and OAB in relation

Dallosso, 200413Prospective longitudinal study II=2B 

Part of the Leicestershire MRC Incontinence Study. This study focused on women living in the community in UK ages ≥40. A random sample of 20,244 women drawn, 12,565 returned the questionnaire (65% response rate). FFQ sent to 10,852 of above sample. 7,46 completed it (response rate 65%) 1st postal questionnaire mailed 

Oct 1998 and completed by 7,046 women. 2nd postal 

questionnaire mailed Oct 1999 and completed by 6,424 women (91% response rate). Excluded women living in residential or nursing homes 

Baseline data compared to those who provided FFQ data. Median age 57 vs. 61. Rating of health poorer in baseline after adjusting for age (OR: 1.66; 95% CI 1.51-1.82). More longterm health problems in baseline (OR 1.14; 95% CI, 1.05-1.25). No difference in reporting SUI (OR: 1.02; CI 95%, .92-1.13) 

BMI Fat intake Vitamin usage Cholesterol and other dietary factors Age 

 Inc % 40-49 50-59 60-69 70-79 80y + 

only sigothers iTotal faOR (951.38(.891.27(.83p=.02 Saturat1.08(.691.08(.7-= .001 Carbs 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F41 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Excluded those of South Asian origin who make up 5.3% of Leicestershire pop over 40 years. Used ICS definitions 

.95(.65-.59(.39-Cholest1.09(.701.34(.88p=.003 after adunchanlonger s

3 vitamVit B12 Zinc Retinol After adassociawhile zi

de Tayrac, 200431Case control, retrospective study II-3 

French women – study population 717 who had Dargent and Rudigoz technique 449 did not respond 365 (50.9%) returned questionnaires 51 excluded leaving 314 women 117 patients who had a vaginal hysterectomy for menorrhagia from Jan 1991 to Dec 2001 control group of 116 patients who had conservative treatment 197 had hysterectomy for pelvic pain and 117 for menorrhagia self report questionnaire 

Vaginal hyst. Control group Age 51.4 50.9 Parity 2.1 2.2 Menopause 43.5% 47.4% Smoking 17.9% 17.2% Drink >2 L/day 7.7% 9.5% History of uro sxs 0 0 

Age Parity Menopausal status Smoking Volume of drink 

Did not report incidence by each of these 

Prevale Freq daNoc: da

UrgencQmo Qwk Qday UI Use of Urge InQmonth Qweek Qday SI Qmonth Qweek Qday Age <6UI Urge In
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F42 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

SI Age >6UI Urge InSI 

Deliveliotis, 200415Prospective cohort II-2A 

283 Greek men from 441 patients enrolled. 105/142 patients treated with RRP for prostate cancer 98/151patients treated with TURP for BPH 80/148 healthy men as control completed surveys used AUA Sx Index, UCLA Prostate Cancer Index; Rand 36-Item Health Survey and BMSFI translated into Greek Patient outcomes 2 years post treatment compared to pretreatment status at 2 weeks prior to treatment investigators felt poor returns due to length of questionnaires and the number of them 

Mean ages 67.4 range 55-75 group 1 70.3 range 58-74 group 2 72.4 range 62-82 control 

HRQOL post treatment RRP TURP Control Physical functioning 81.5 78.1 82.3 

Types of surgery RRP; T

treatmeUrinary 85.1; 80Urinary 85.1; 70

AUA SI 11.1; 8.UI ever2%; 9%RRP haurinary surgery significadeteriorUI in co

Foldspang, 200451Age stratified random samples II-2A 

6,240 and 6,468 women ages 20-59 years analysis based on 1,232 women in combined samples who reported their 1st and last 

childbirth within 13-120 months prior to responding to the questionnaire so minimum followup period after childbirth was 12 months 

Self questionnaire mailed JanMarch 1995 and 1998 67.8% responded 

C-section in 12.2% of 1st childbirths 

Average age: 32.8 years (20-41) 52.1% reported having 2 births or more Mean age at 1st birth = 27.5 years and 29.9 years at 2nd

Average duration since 1st childbirth 

was 5.3 years Denmark 

Mode of delivery # of children 

Characteristic of group analyzed First childbirth(n=1232) With index pregnancy UI; vaginal childbirth vs. cesarean section Without index pregnancy UI; vaginal childbirth vs. cesarean section 

Risk of dependpregnan

Adj2.0 

5.4 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F43 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Vaginal childbirth index pregnancy; UI vs. no UI during index pregnancy Cesarean section; index pregnancy UI vs. no index pregnancy UI Second childbirth(n=642) With index pregnancy UI; vaginal childbirth vs. cesarean section Without index pregnancy UI; vaginal childbirth vs. cesarean section Vaginal childbirth; index pregnancy UI vs. no index pregnancy UI 

Cesarean section; index pregnancy UI vs. no index pregnancy UI 

Childbirth First childbirth (n=1232) index pregnancy UI Vaginal childbirth Second childbirth (n=642) Index pregnancy UI Vaginal childbirth 

8.4 

22.0 

1.8 

2.7 

20.3 

11.9 (7.Mutuallrelative and attrpostparvaginal 

9.2 (

3.6 

12.3 

2.2 

Fritel, 200452Retrospective cohort II-2C 

Women from hospital database of 1st birth women who had not 

delivered fetus >22 weeks 

307/669 primiparous women who delivered in 1996 in vertex 

Table I. Analysis of the differences among responders, women not reached and non-responders concerning potential risk factors for stress urinary incontinence (SUI) Risk factor Responders Not 

Age at 1st delivery 

BMI Birth weight Duration of labor Duration of second stage Mode of delivery 

Table IIyears aSUI Risk facp Age at d
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F44 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

position between 37-41 weeks (274 had moved and 88 did not respond) 45.9% response rate. Excluding the women who did not receive the questionnaire (274), response rate was 77.7% Mailed questionnaire sent 4 weeks after delivery and asked about SUI before, during, and after pregnancy – “Do you have loss of urine during physical exertion, cough or sneeze?” UI categorized slight, mode or severe using Sandvik Index 

reached Non-responders p Age at delivery 29.3 [4.4]; 28.2 [4.4]; 28.9 [4.7] 0.01 BMI (kg/m2): 21.3 [2.9]; 21.1 [2.9]; 21.3 [3.2] 0.62 Birth weight (g): 3240 [384]; 3253 [400]; 3241 [430] 0.92 Labor (hours) 6.2 [2.3]; 6.5 [2.5]; 6.6 [2.3] 0.21 Active 2nd stage (minutes): 11.1 [7.5];10.6 [7.9]; 10.9 [7.9] 0.69 C- section: 10.1 (31);17.5 (48);17.0 (15) 0.03 Forceps: 36.2 (111);31.3 (86); 44.3 (39) 0.08 Third-degree tear: 1.3 (4); 1.1 (3);1.1 (1) 0.97 France 

3rd degree tear at first 

delivery Second delivery since 1996 Urinary leakage before 1st

pregnancy Urinary leakage during 1st

pregnancy 

(48); 36BMI >20.34 Birth we(3); 0.58 Labor ≥(46); 0.0Active 2

16.9 (15C sectioForceps3rd degr

0.35 Leak be<0.0001 Leak du<0.0001 2nd deliv

0.81 Table IVurinary the first Risk facLeakag18.7 3.6Leakag2.5 1.3–Age at t >30 yeLabor ≥Cesare0.1–0.9 Adjustelogistic Accordiregressindepenurine le
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F45 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

pregnan95% co(CI) 3.6during t95% CI of first l95% CI >30 yea(OR 2.4cesareadelivery Table IIyears aSUI Risk fac(n=218) Age at d(48); 36BMI >20.34 Birth we(3) 0.58 Labor ≥(46) 0.0Active 2

16.9 (15C sectioForceps3rd degr

0.35 Leak be<0.0001 Leak du<0.0001 2nd deliv

0.81 Table IVurinary 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F46 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

the first Risk facLeakag18.7 3.6Leakag1.3–4.8 Age at 1.4–4.2 Labor ≥ 3.1 1.7Cesare 0.3 0.1Adjustelogistic 

Grodstein, 200416Prospective cohort II-2A Confounded for stroke and physical limitations and results were the same in both analysis 

Nurse Health Study from 1996-2000 females Questionnaire mailed in 1996 to 39,436 women post menopausal women who had no leaking of urine and were followed for 4 years Incident cases of occasion UI were defined as leaking 1-3 times per month; frequent were at least once per week Excluded premenopausal women or users of estrogen creams, or reported leaking in 1996 

Cohort of 39,436 women ages 50-75 Mean age 61 for current HRT use; 64 for never used BMI for never used HRT was 27 Current use BMI was 47 and past use for BMI was 47 Hormone Use Post Menopause Never Current Past Caucasian 98 97 98 African American 1 1 1 Hispanic 0 1 0 Asian 1 1 1 Smokers @ 45% all Hysterectomy 6 47 40 

Age BMI Smokers Recurrent UTI Diabetes COPD Neurological disorders Parity HRT 

5,060 inoccasio2,495 inUI 

Average per yearespect50-55 ywas 3% HRT 56-60 – 61-65 – 66-70 – 71-75 y

Groutz, 200453Prospective cohort elective C-section without trial of labor vs. vaginal 

363 consecutive primiparae followed for 1 year SUI before pregnancy excluded Non-singleton deliveries, instrumental-assisted vaginal 

Vaginal; Obstructed; Elective C-sec Delivery; labor; c-sec Age: 28±4; 32.5±5.3; 31.7±5.2 

Weight: 

Age Maternal age Weight Height Mode of delivery 

SUI sig– 67±10

and incduring pp=.003. 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F47 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

delivery vs. Csection due to obstructed labor II-2A (if controls are considered types of deliveries) 

deliveries excluded 145 spontaneous vaginal delivery 100 C-section following obstructed labor with mean cervical dilation of 8.7 

± 1.6cm 

118 elective C section 

Interviewed one year PP SUI – involuntary leakage with cough, sneeze, etc Regular UI as defined by involuntary excretion or leakage of urine in inappropriate places or times twice or more a month, regardless of quantity loss 

60

±9; 62.5

±11.6; 63

±13 

Height: 164+/-6/6; 162

±5.6; 164

±6.7 

Gestation age: 39.7; 40.2 ; 38.8 Birth weight: 3,251; 3,450; 3,260 Israeli women delivered at Tel Aviv Sourasky Medical Center 

Duratio

second longer (had PP without 121 vs.

Older m32 yearweight prevalepregnanincontin

Hagglund, 2004174 year followup cohort study II-2A 

145 incontinent and 193 continent women in year 2000, who had participated in 1995 prevalence study. Response rate 73% (248/338) Of 248 responders at followup, 118 reported UI and 130 reported being continent. Changes in type of UI measured using DIS “do you have problem with involuntary loss of urine?” 

Swedish women Age; 22-50 years Women 

incidenc22-30 31-40 41-50 Women 22-30 31-40 41-50 

Haltbakk, 200418Prospective cohort no control mentioned ? historical control 

480 Norwegian men at St. Olavs Hospital, Trondheim Norway. Tentative diagnosis of BPH made on 612 patients and from this pool, sample analyzed was 480 (78%). ICS LUTS questionnaire (ICSBPH) between 1997-2000. IPSS, SPI and SISI used also. UI defined as any involuntary leakage of urine. 

Mean age of patients was 67 years, SD 10.6 years; median 69 years range 39-91 years 

15% mild symptoms 54% moderate symptoms 31% severe symptoms Mean age in incontinent group was 68 years 

Age 3/4 of m

problemand 31% sleeping 

issues rwere remen anwould btheir cupersisteIncontin64% ha
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F48 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

22% for 6% for ≥

remaini

Holroyd-Leduc, 200419Population based Prospective cohort Confounders – sex, age, socioeconomic status, race, smoking, alcohol, BMI, sensory impairment, comorbid disease, depression, cognitive function and baseline dependency. II-2A 

6,506 of 7,447 subjects ages ≥70 

in the Asset and Health Dynamics Among the Oldest Old study who had complete info on continence status were baseline –outcomes 3 groups- 5,872 nursing home, 5,521 ADL decline and 5,509 IADL decline as outcomes 

Subjects interviewed in 1993 and 1995 Blacks, Hispanics, and Florida residents were over sampled Overall response rate was 80% UI measured “next question might not be easy to talk about, but it is very important for research on health & aging, during the last 12 months, have you lost any amount of urine beyond your control?” 

Mean age ≤SD = 77 (range 69-103) 

63% female 86% White 

Median number of baseline comorbid medical conditions was 2 10% received help with 1 or more ADLs and 23% were receiving help in 1 or more IADLS at baseline Patients with UI had more comorbidities (p=.001), higher rate of visual impairment (35% vs. 22.4% p <.001) and hearing impairment (39.7% vs. 30.5% p<.001) Community dwelling in U.S. 

Age Sex SES Race Smoking/alcohol BMI Sensory impairment Comorbidity Cognitive scores Depression ADL IADL 

UI and (95%CIDeath: Nursing 2.04) ADL de1.68) IADL de1.63) 

More fubaseline 

Hunskaar, 200420Cross national study, Prospective No control group 

Postal survey mailed to 29,500 households in 4 countries. 58.1% response rate 5,976 women with UI included in analysis (35%) Definitions used by ICS; symptoms in last 30 days and in last 7 days 

Age ≥18 years France – 44.8 Germany – 59 UK – 45 Spain – 64 All – 58 

Age Ethnic background 

No new Only prcountry 

Jackson, 200422Population based Prospective cohort; also randomly selected 

1,017 post menopausal U.S. women ages 55-75 enrolled in HMO and followed for 2 years (1998-2002) inclusion criteria were no natural menstrual cycle 

Frequency of Exposures at Enrollment and University Risk of Symptomatic Urinary Tract Infection Characteristic (%) Hazard ratio Washington State, USA 

Smoking Alcohol Depression Diabetes BMI 

Incidenperson Indepeninfectiodiabete
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F49 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

from HMO diabetes registry II-2A 

in past 12 months. Exclusion: oral estrogen or vaginal estrogen, residential nursing care, restriction to wheel chair, dementia or severe psych disorder, indwelling catheter or intermittent urinary catheter, end stage renal disease requiring dialysis, active malignancy other than skin cancer, chronic antibiotic use, acute cystitis in past 90 days. Post void residual bladder volume measured using portable ultrasound device 12 month followup done by 87% and 24 month followup by 81% Primary study outcome was sx cystitis 

Parity Hysterectomy Oral estrogen use COPD Stroke Arthritis Age Race Urinary tract infection Vaginal estrogen use 

Race and arthritis were associated with SI and Urge. Current oral estrogen use and arthritis were associated with 1.5 to 2 fold higher odds of SI and Urge See table 4 

[HR]_3.[CI]: 1.7 history infectioinfectio13.6). Bincluded estrogemonth (3.4), a h(HR_1.and asybaseline to 3.5). 27% wh14% bla

(95% CCompleAge (ye55-59 60-69 70-75 EthnicitWhite Other Genera36‡ 76-100 51-75 0-50 SmokinNever Former Current DiabeteNo Yes Diabete
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F50 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Not dia Diet or  Insulin Accidenyear No Yes Type of last moNone Stress o174 Urge¶ o106 Stress a324 Postvoi<50ml r 50-100m >100ml  History No Yes History No Yes History surgery No Yes Parity (pregnan0 1-3 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F51 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

≥4 

Johnson, 200423Long-term cohort, Prospective study of RRP vs. radiotherapy II-2B 

Men from the Prostate Cancer Outcomes Study diagnosis with primary prostate cancer between Oct 1994-Oct 1995 Residents of LA, King County Washington, states of Connecticut, NM, UT. Between ages of 60-89 years in King County and younger than 90 in others. Self questionnaire at 6, 12, 24 and 60 months after diagnosis and medical record review at 12 and 60 months. 11,137 men identified in registries; 5,672 randomly selected, letters sent to 4,736 (83.5%) of selected cases. Total of 3,533 men (62.3%) completed 6 and 12 months were included in f/u cohort. 1,433 men had RRP completed 6 months 1,178 did 24 months (82.2%) 1,109 did 60 months (77.4%) For radiotherapy – urinary problems not reported Questionnaire also translated into Spanish and interview conducted in Spanish when necessary. 

1,433 men RRP 642 men received radiotherapy 

RRP group – wt % by race  NHW AA Hispanic Arthritis 33.3 38.6 35.8 Diabetes 11.1 29.5 17.2 COPD 7.5 6.6 5.4 HF 4.9 2.1 4.4 CVA 2.6 2.5 3.3 HTN 37.3 54 37.5 MI 7.9 4 4.2 Age at dx <60 27.5 38.6 23.4 60-64 26.8 26.1 30 65-75 41.9 32.9 45.5 >/=75 3.8 2.4 1 

Prostate cancer RRD Radiation therapy 

Wt % fo Level obaseline Total coOcc leaFreq leaP = 6 monthtotal coocc leafreq p = 12 montotal coocc leafreq p= 24 montotal coocc leafreq p = 60 montotal coocc leafreq p = 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F52 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Lagergren, 200424National, longitudinal, multipurpose study in Sweden (SNAC). Study consisted of two parts – population part and the care/service part. II-2A 

Swedish men and women ≥65 

years starting in 3/2001-3/2004. 12% in SNAC is 65-79 years old, 6% >80 years 

Total pop of SNAC 17,044; baseline 8,627 targeted persons/ 7,518 sampled 16-25% of SNAC received public care Followup every 6 years starting at 66 years Combo of interviews and questionnaires 

Functionally disabled – 37% Average PADL – 6.9 Severe cognitive impairment (Berger 2-6)- 27% Severe mobility restrictions – 51% 

Men 3,052 Women 4,465 Total 7,518 Skane, Karlskrona, Kungshomen and Nordanstig, Sweden Average age 85 compared to average age in Sweden 83 

Men 3,052 Women 4,465 Total 7,518 Avg age 85 compared to avg age in Sweden 83 Residency 

PrevaleSevere OrdinarSpecial Total 3

Liebling, 200425Prospective study 

393 UK women with term singleton, cephalic pregnancies who required op delivery at full dilatation between 2/1999-2/2000 from a cohort of 10,106 deliveries Postal questionnaires at 6 weeks and 1 year study conducted at St. Michael’s Hospital, Bristol, UK Only instrumental vaginal deliveries performed in surgery as the definition of difficult vaginal operative delivery. 

Instrumental; C-section; OR (95% CI)  (184) (209) Primi: 78%; 79%;1.09(.67-1.77) Age >35: 14%; 9% Nonwhite: 7%; 5% BMI >30: 7%; 15%; .44; (.22-.86) 

25% attempted with forceps 51% were ventouse 24% both ventouse and forceps rotational delivery attempted in 59% 

Mode of delivery Age Parity 

Women group wUI more adjuste23.6) anOR 3.1 

Multipafactor foUI at 1 of 2.39 At 6 we UI OR 7.8At 1 yea OR 3.12Difficult At 6 we10.54) At 1 yea
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F53 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

McGrother, 200426Cross sectional and longitudinal II – 2B 

United Kingdom women AND men 162,533 prevalence study and 39,602 incidence study people age ≥40 years Response rate 60 and 63% respectively and 79% at followup Excluded people living in institutional settings 

15% age ≥65 years 85.5% White 44.9% employed 91.8% good health Mean age: 57 54% women 

Gender Female 

disordehighest urgencynocturia 

Neumann, 200427Prospective study II-2A 

Study group – 549 Denmark women who had hysterectomy from 1/1/98-12/31/2000 born after 1939 Background group – 144 women who had non-GYN surgery born between 1940-1965 who had lap chole in Denmark. Nulliparae were excluded. Questionnaire sent 9- 45 months postop SI was involuntary leakage during effort, urge as leakage with a sense of urgency, significant UI was defined as involuntary leakage at least once a week, bothersome UI as significant incontinence and use of devices, decreased social ability or having hygienic problem with incontinence. Questionnaires returned by 82% in study group, 76% in background group 

All women were Caucasian In study group 12% hysterectomy – 33% of these had abdominal, 55% vaginal 

BMI BMI ass

significade novo .15 p<.01-2% of variable

BMI assand afteand r=.2
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F54 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Ozerdogan, 200429Cross sectional study, Prospective II-2A 

625 women living in Turkey ages 20 and over 4 different cities of Turkey. Questionnaire and I-QOL; Rare – UI less than once a month Reg – UI more than twice per month Serious – continuous use of sanitary protection. SI and urge defined as usual definitions 

Age distribution 20-29 – 26.4% 30-39 – 22.6 40-49 – 18.7 50-59 – 13.4 60-69 – 11/7 ≥70 – 7.2 illiteracy rate 9.4% 1 out of 4 resided in rural area 1 in 5 gave birth at least 4 or more times and most were vaginal deliveries (25%) 

Age BMI Smokers Diabetes 

UI was advancincreas40% in 

Hysterefor MI aBMI (ODiabete8.73 Neuro (RUTIs (8.88) 50% BMrecurre6.6%, Cdisorde

Schytt, 200430Prospective, longitudinal cohort II-2A 

Swedish women after childbirth at 593 clinics in Sweden. 5,550 women booked appointments during recruitment time, 4,500 eligible, 3,191 consented, and 3,061 completed 1stquestionnaire, 2,762 completed 2nd, and 2,563 completed 3rd. 

Total 2,450 completed all three. Study sample was 2,390 women after exclusion factors also. 

Selected data from a National Swedish survey investigating physical and psychological assessment of childbirth May and Sept 1999 and January 2000 antepartal visits Three questionnaires 1st at baseline, 2nd mailed 6-8 

weeks after the birth and 3rd 1 

year after birth. Women were 

Average gestation answering 1st

quest – 16 weeks, 2nd – 10 weeks 

post, 3rd – 1 year and 2 weeks. Average age at recruit – 29.5 years Primiparas – 44% Multiparas – 56%  79.2% had vaginal delivery 13.4% had C-section 

Age Parity Education Mode of delivery Smoking 

Strongeyear in multi, wand PPobesity pregnan

Within tthe moswere U(RR 2.4weeks P3.3), mu1.1-1.5)1.1-1.9) the third CI 1.2-1
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F55 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

asked to recall any symptoms of UI during the pregnancy and post. Excluded miscarriages, nonSwedish speaking, and women from nonparticipating clinics, delivery of twins 

Stenzelius, 200454Cross-sectional Adjusted by: Age, Gender, Quality of life, Occupation, Economy, Living condition, Need of help, Satisfaction with children contact, and problems with Communication, Mobility, Elimination, Digestion, Breathing and circulation Psychosocial problems Other type of pain Level of evidence: III

Subjects were selected and mailed a questionnaire from a randomized, age-stratified sample of persons ≥75 years 

living in a southern part of Sweden. Response rate: 52.8% (n=4,277) 

Data source: Self-reported postal questionnaire Incontinence as a yes to the question, “Have you had problems controlling urine in the last 3 months?” 

Age: 75 and above Mean: 83.7 (SD: 5.69) 

Gender: Male and Female Male: 38.4% Female: 61.6% Race: Not reported Ethnicity: Not reported Residency: Community dwelling and special accommodations residents in Southern Sweden. 

Risk Factor Sex (0=women, 1=men) Difficult talking Memory problems Difficulty walking Mobility limitation Oedema in legs Other urinary symptoms Diarhoea Dizziness Protracted coughing Fatigue 

OR 

0.68 1.25 

1.7 

1.63 1.23 1.32 1.37 0.66 1.26 1.33 1.21 

Vandoninck, 200455Age stratified Prospective cohort for men in the original study. Mentions sampling weights upon the 

Dutch women from Urepik (Uro Epi in Europe and Korea)study in the community In 1999, a national postal questionnaire survey 1,460 spouses of 1,771 men. 1,071 returned- 73% response rate 

Mean age 57 (29-79) 34% minimal UI 12% severe Mean parity 2.6 13.5% women were childless During the past month: % How often have you leaked urine? 0 Never 54.5 

Age Parity 

No relaparity oUI; only graph in 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F56 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

ratio of # of women in each age group in the sample to # of women in the age group in population. ?Prospective cohort, no controls 

UI assessed by total score on short UI specific questionnaire – 3 groups – no symptoms score 0-2; minimal 3-6 and severe 7-14. In addition self reported UI calculated conforming to ICS standard definitions. “Do you ever have involuntary urine loss?” QOL also used 

1 Not more than once a week  19.6 2 More than one but less than three times a week 10.0 3 More than three times a week  6.0 4 Nearly always 8.6 If you experienced urine loss, how much did you leak? 0 I never leak 50.2 1 Some drops 32.2 2 A small stream 11.4 3 Protection material or clothes soaking wet 4.9 4 Leaking through pads or clothes  0.3 How often do you use protection material 0 Never 68.1 1 Occasionally 21.4 2 Nearly always 3.9 3 Always 5.8 Did you lose urine on coughing or sneezing? 0 Never 31.1 1 Occasionally 45.0 2 Nearly always 13.5 3 Always 9.3 

Arya, 200156

Prospective Observational II-2 

Subject selection: 315 consecutive primiparous women delivering by forceps (n = 90), vacuum (n = 75), or spontaneously (n = 150). Followup for urinary incontinence was done at 2 weeks, 3 months, and 1 year after delivery. The labor room logs were screened every morning by a research nurse to identify patients who met the 

Women ≥18years 

USA 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F57 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

eligibility criteria for the study. Inclusion criteria: primiparity, vaginal route for delivery, age, gestational age ≥37 weeks, and accessibility by telephone. Exclusion criteria: history of urinary incontinence before or during pregnancy, delivery by cesarean section, known diabetes or neurologic disease, and non- English speaking. Definition: Urinary incontinence was defined as the presence of urine loss of any amount that had occurred on at least 2 occasions.

Sherburn, 200157

Cross-sectional and Longitudinal phases III 

Subject selection: 2 parts: (1) a 

cross-sectional phase involving a population-based sample of 1,897 Australian-born women who participated in the baseline interview; (2) a 7-year follow-up phase, assessing a 373 women (premenopausal at 1 year followup) from the cross-sectional study. Eligibility for longitudinal study: menstruation in previous 3 months, an intact uterus, at least one ovary, and not currently taking oral contraceptives or HRT. Response rate: of original cohort, 779 met these criteria and 438 (56%) agreed to be interviewed in the first year of the longitudinal study. 

Women 45-55 years. Australia 

Multivariate analysis found that urinary incontinence patients were significantly more likely than those without incontinence to have higher body mass index (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.15, 1.95), have had gynecologic surgery (OR 2.17, 95% CI 1.42, 3.32), report urinary tract infections (OR 4.75, 95% CI 2.28, 9.90), diarrhea or constipation (OR 1.95, 95% CI 1.27, 3.00), and have had three or more children (OR 1.47, 95% CI 1.06, 2.05). 

During phase, 35%. Whystereup perio
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F58 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Van Kessel, 200158

Retrospective Observational II-2 Adjustment for factors including mode of delivery, age in years, and duration of enrollment 

Subject selection: The study was conducted at a managed care organization with over 500,000 enrollees. All women who had given birth between 1982 and 1986 and who were continuously enrolled until 1998 were identified with the patient computerized data file. From this cohort, a random sample of women with SUI was selected. 43,288 mother-baby pairs were identified within the computerized database. A random, case-controlled sample of 85 cases and 88 controls was identified 

Women 22.6-52.9 years USA 

After adjustment factors, the risk for SUI associated with duration of second stage of labor was 1.10 (95% Cl 0.90-1.28; 

P = .5) 

There was no significant difference in mode of delivery between cases and controls with one exception; 10.7% of the cases underwent forceps delivery compared with only 1.1% of controls (odds ratio, 10.4; 95% confidence interval, 1.17-93.4; 

P = .04)

Larrieu, 200459

Cross-sectional III 

Data from the Three-City (3C) study; a collaborative research program from a cohort of 9,294 community-dwellers ≥65 years. Subjects living at home were randomly sampled from electoral rolls. Included 8,966 subjects after excluding 328 subjects with missing BMI. 

Men and Women ≥65 years 

3566 men (39.8%); Mean age: 74.2 y (SD=5.6, not different according to sex) France 

BMI The uni

quite fre(20.4%significaseverelin other P<0.00

Viktrup, 199260

Observational II-2 

305 primiparas interviewed repeatedly about stress incontinence before and during pregnancy and after delivery over 6 month period. Definition: ICS

Women 17-41years Denmark 

Pregnancy SUI 

Before During After pr

Van Kuijk, 200161

Observational (cohort) II-2 

Subject selection: All patients with first-time, unilateral hemispheric stroke admitted from August 1994 to August 1997 for a post-acute inpatient rehabilitation 

Men and Women Age: Men: Mean, 62+-11.5; Range, 32-83yrs Women: 

 Inciden

OverallWomenMen: 39
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F59 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

program. Exclusion criteria: non-ischemic stroke, history of previous stroke, evidence of brainstem lesions or bilateral signs on examination, diabetes mellitus, use of anticholinergic medication, history of urinary incontinence, previous urologic surgery, indwelling or intermittent catheterization not regarded as incontinent because of stroke. Definition: Urinary incontinence as any form of involuntary urinary loss. Only urinary incontinence ≤6 months post stroke, considered to be from stroke. 

Mean, 62+ - 12.7 years; Range, 30 - 83 years Netherlands 

The incincontinpersons confide48/1,00

Schmidbauer, 200162

Cross-sectional III 

Subject selection: Analysis of ~2,500 participants in a health screening project in the area of Vienna, using Bristol LUTS incontinence questionnaire and (a) medical history; (b) a physical investigation; (c) sociodemographic parameters (smoking, eating and drinking habits), and (d) urine and blood study including 14 parameters. The parameters collected during this health investigation were correlated to the presence of urinary incontinence to identify potential risk factors for urinary incontinence. Definition: UI was defined as any involuntary loss of urine within the past four weeks. 

Age: Men (49.7+-13.6 years), Women (48.6+-13 years) Austria 

Parity showed a strong correlation to UI. c 26.3% reported episodes of urinary incontinence in the past 4 weeks. Other factors, age (r = 0.22), BMI (r = 0.20), urgency (r = 0.16), feeling of incomplete bladder emptying (r = 0.21), previous urogynecological surgery and fasting blood glucose correlated significantly to UI., 5% of men were incontinent, age (r = 0.12), urgency (r = 0.16), nocturia (r = 0.16), feeling of incomplete emptying (r = 0.16), reduced uroflow (r = 0.18) and previous 

In wom16.5% rpercent(one ch33.3% (57.7% (
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F60 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

prostatectomy (r = 0.11) correlated to the presence of UI. Smoking habits and education level revealed no association in either sex. 

Hu, 200463Observational II-2 

Subject selection: women at Group Health Cooperative of Puget Sound (GHC), a staffmodel health maintenance 

organization with approximately450,000 members in western Washington State. Study subjects with a recent diagnosis of acute UTI. Women were then randomly selected from GHC enrollment 

files to serve as control subjects, matched to cases by date of birth

(within 2 years). 

Women aged 55-75 years USA 

Acute UTI Case su

controls 

incontinadjuste2.10) antypical q

few dro1.71; 95

Infrequeincontinwere noincreas

Bradley, 200564Cross-sectional Adjusted by: Age, BMI, Parity, Smoking, Alcohol use, Coffee, Exercise, Education, Prior surgery, Angina, Hypothyroidism, Hypertension, Asthma, Pelvic floor symptoms Level of evidence: III

Women with intact uterus enrolled in the Women’s Health Initiative Hormone Therapy trial. Response rate: 88% (n=297) Data source: Self-reported written validated questionnaire Incontinence as, “Urinary leaking at least once in the last 3 months.” 

Age: Mean: 68.2 (SD: 5.6) 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Midwest, USA

Risk factor Age Body mass index 

UI DifficulbladdeFeeling incompbladdeWeak stream Intermurinary Vaginaperineato defeFeeling incompmovemUrgencUrge u
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F61 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Exercise (>weekly) Coffee drinking Smoking 

leaking Intermurinary Urinary Fecal uDifficulbladdeWeak stream Pelvic Fecal u

O’Donnell, 200565

Observational II-2 

Subject selection: In 2001, a 13 item questionnaire was mailed to a representative sample of 29,500 community-dwelling women to determine the prevalence, type and treatment behavior of women with UI. Within 2 months of the initial survey a more detailed selfcompletion questionnaire was mailed to a randomly selected sub-sample of 2,953 women identified as having UI from the initial survey. Follow-up included questions on general health status, quality of life and helpseeking behavior, characteristics of UI, and women's attitudes to health care in general and UI specifically. Response rate: 58% in the initial and 535 in the second. Definition: UI was defined as any 

Women ≥18 years with UI 

France, Germany, Spain and the UK. 

UI and women's attitudes were found to be associated with helpseeking after adjusting for age, UI duration and frequency, and ‘bother’ of UI; factors traditionally associated with helpseeking. After adjustment for these factors, willingness to take long-term medication and having spoken to others about UI were found to be strong predictors of helpseeking in all four countries. 

Initial suSUI France: GermanSpain: 3UK: 41% Total: 3UUI France: GermanSpain: 2UK: 16% Total: 2MUI France: GermanSpain: 2UK: 34% Total: 3FollowuSUI France: German
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F62 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

leakage or involuntary loss of urine, conforming to the standards recommended by the ICS. For the purpose of this study this definition was restricted to an incidence during the last 30 days. 

Spain: 4UK: 44% Total: 4UUI France: GermanSpain: UK: 10% Total: 1MUI France: GermanSpain: 3UK: 42% Total: 4

Samuelsson,2000 66Cross-sectional Adjusted by:, Age Parity, Weight Smoking Type of delivery Co-morbidity Hormonal use Surgical history Pelvic floor muscle strength Genital prolapse Level of evidence: III 

Subjects were selected from women aged 20-59 who were invited in for their gynecological health examination. The exam is conducted every third year for women in Sweden. Response rate: 76% (n=487) Data source: Self-reported postal questionnaire Incontinence was defined as a positive response to, “Do you suffer from involuntary loss of urine?” 

Age: 20-59 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Urban area in MidSweden 

Age years 20–29 years 30–39 years 40–49 years 50–59 years Parity 0 deliveries 1 delivery 2 deliveries >3 deliveries Smoking habits Never smoked Former smoker Current smoker Weight 45–58 kg 59–70 kg 71–105 kg ERT use No Yes 

1 

4.18 7.21 9.52 

1 

3.92 5.24 8.59 

1 

1.28 1.78 

1 

0.87 1.13 

1 

4.89 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F63 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Type of delivery Vaginal Section Episiotomy No episiotomy Episiotomy Maximum birth weight (g) <3199 3200 – 3924 >3925 Type of genital prolapse Loss of urethrovesical crease Rectocele Cystocele Uterine prolapse Degree of prolapse None Not to introitus To introitus # of prolapse componentsNone One Two Three Four Age (years) 20-29 30-39 40-49 50-59 Parity 0 deliveries 1 delivery 2 deliveries 3 deliveries or more Smoking habits Never smoked 

Prevale

42.2 30.8 45.2 35.7 35.5 44.7 43.8 53.2 55.3 58.1 

72 

18.7 47.9 62.5 18.7 

31 

59.6 66.7 

100 

Adjuste

1 

2.31 

2.2 

3.47 

1 

1.38 1.84 2.71 

1 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F64 

Author Sample 

Subject Selection, Response 

Rate, Data Source, 

Measurement Methods 

(survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency Levels of Risk Factors 

In

Inco

Type, 

Former smoker Current smoker Pelvic floor muscle strength (scores) 4 3 2 1 Presence of cystocele and/or absence of urethrovesical crease No Yes ERT use No Yes 

1.42 1.86 

1 

1.51 2.56 3.44 

1 

2.49 

1 

2.91 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F65 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Adelmann, 200450Prospective cohort 

Community UI prevalence sample of 910 persons to a 1998-1999 survey enrolled in a Medicaid managed health plan Seven county Minneapolis-St. Paul metro area Age ≥65 Random sample of 910 persons enrolled in Medicaid health plan. Of this the n= 378 that were eligible due to UI. Sample was further limited to persons based on at least one claim for a doctor’s visit and medical chart could be located. n=236 Nursing home abstraction sample was randomly drawn from Medicaid persons for a total of 480 persons. Interviews face to face in residence. Response rate 59%, cooperation rate 90%. Abstraction of medical record at clinics also. Definition: ever/current UI measured by a yes response to questions about trouble holding urine or leaking urine 

Characteristics of community and nursing home N=910  Community NH (%) Women 82.1% 79.2 Men 17.9 20.8 

Age 65-74 50% 14 75-84 34.9 34.2 85+ 15.1 51.9 Mean 75.9 84.5 Race White 69.4 93.8 Black 14.5 4.6 Other 16.2 1.7 

Race Age Gender 

Prevalencsample  EUI (%) Total Women Men Age 65-74 75-84 85+ Race White Black Other Subgroup Race amo White Black Other  65-74 75-84 85+ Age amon 65-74 75-84 85+ Age amon 65-74 75-84 85+ Age amon 65-74 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F66 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

75-84 85+ Age amon 65-74 75-84 85+ Medically and nursiCommuniPast 18 mTotal Gender pAge in ye65-74 675-84 785+ 8race also PrevalencCommunipast 18 many type SI Urge Other Mixed 

Andersson, 200410Population based study II-3 

Swedish population, both men and women ages 18-79 years (Orebro county) in March 2000 Questionnaire mailed to home comprising 12 questions on UI as a supplement to a large public health survey on health and general living. Mailed to 15,360 randomly selected residents out of 274,000 populations in this county. Response rate 64.5% 

7,680 females 7,680 males 

Age Gender 

Prevalencgender foWomen (mWomen (m18-35 50-64 – 1Total for wWomen – 

SI total fo18-34 – 564 – 83(1Urge Inco
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F67 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

men 45% 18-34 – 464 – 48(4

Swedish population 3/2000, Life and Health questionnaire sent to 70,000 residents randomly selected. In Orebro, pop of 274,000, one of the five counties that participated in above study, a special section on UI was given to a sample of 15,360 residents Postal questionnaire with 12 questions on UI Sample of 15,360 residents ages 18-79 years of Orebro, Sweden; Response rate was 64.5% Used definitions from ICS Stats on weights and calibration and found results were the same 

7,680 females 7,680 males 

Age categories 18-36 53.9% 35-51 60.3 50-66 69.6 65-81 72.2 

Gender Age 

Women mProportion increased  At leWomen 18-34 35-49 50-64 65-79 Men 18-34 35-49 50-64 65-79  Women Men Duration o<1 1-6 6-11 >10 

Bogner, 200411Population based longitudinal survey II-2B 

ECA (Epi Catchment Area) program was used to sample from Baltimore to include 3,481 persons selected from East Baltimore for this study. Community dwelling adults who were initially living in East Baltimore in 1981. Out of 3,481 persons, 1,920 were contacted (73% of original cohort). Study sample included 822 persons aged ≥50 who completed info on UI. After exclusions for missing data, 747 were the final sample. 

Mean age of study sample was 67.2 64% were women 72.3% White; mean age 68.2 ±11 27.7% AA – mean age 64.5 ±10  White Black Diabetes 14.3 16.9 Heart trouble 27.4 26.6 Arthritis 51.1 56.5 Stroke 8.2 7.3 Cancer 14.4 6.3 

Age Gender Functional status Cognitive status Chronic medical conditions-diabetes, heart trouble, stroke, arthritis or cancer Race 

22% Whit13% of Bl19.8% reppreceding  WUI No informAssociatioPsychologCrude  
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F68 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

African Americans and Whites aged ≥50 at followup interview performed 1993-1996 Age ≥65 were over sampled GHQ used and self report on UI UI = “Have you ever had any difficulty in controlling your water, losing your urine or having trouble getting to the bathroom on time?” If any uncontrolled urine loss was reported within the 12 months before the interview, persons were classified as having UI. 

MME 27.6±2.6 25.6±3.6 ADL impaired 1.9% 3.9% 

White 1.28 (.76-Black 4.22 (1.72

Corcos, 200412Prospective cohort No control mentioned 

Canadian population ≥35 Stratified by census of metro area and by gender. 7,487 persons were sample base. 53.7% response rate. 3,249 interviews from Montreal, Toronto, Vancouver, and Edmonton were final sample Investigators developed standardized questionnaire to ascertain OAB and SUI and impact on quality of life. Computer assisted telephone interviews conducted in 2 steps: an initial questionnaire evaluate presence of OAB followed by detailed questionnaire completing the assessment. 

48.2% men; mean age 52 51.8% women; mean age 50.9 

82.4% younger than 65 and 17.6% older 

Gender Age 

Wet OAB men and No correlaage and pin women relationsh

Dallosso, 200413Prospective longitudinal study II=2B 

Part of the Leicestershire MRC Incontinence Study. This study focused on women living in the community in UK ages ≥40. A random sample of 20,244 women drawn, 12,565 returned the questionnaire (65% response rate). FFQ sent to 10,852 of above sample. 7,460 completed it (response rate 65%) 1st postal questionnaire mailed Oct 

Baseline data compared to those who provided FFQ data. Median age 57 vs. 61. Rating of health poorer in baseline after adjusting for age (OR: 1.66; 95% CI 1.51-1.82). More longterm health problems in baseline (OR 1.14; 95% CI, 1.05-1.25). No difference in reporting SUI (OR: 1.02; CI 95%, .92-1.13) 

BMI Fat intake Vitamin usage Cholesterol and other dietary factors Age 

 In T40-49 50-59 60-69 70-79 80y + only signiothers in aTotal fat OR (95% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F69 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

1998 and completed by 7,046 women. 2nd postal questionnaire mailed Oct 

1999 and completed by 6,424 women (91% response rate). 

Excluded women living in residential or nursing homes Excluded those of South Asian origin who make up 5.3% of Leicestershire pop over 40 years. Used ICS definitions 

1.38 (.89-(.83-1.94)Sat fat 1.08 (.69-(.7-1.67); Carbs .95 (.65-1(.39-.9); .7Cholester1.09 (.70-(.88-2.04)after adjuunchangelonger sig 

3 vitamins Vit B12 Zinc Retinol waAfter adjuwith B12 no longer 

de Tayrac, 200431Case control, retrospective study II-3 

French women – study population 717 who had Dargent and Rudigoz technique 449 did not respond 365 (50.9%) returned questionnaires 51 excluded leaving 314 women 117 patients who had a vaginal hysterectomy for menorrhagia from Jan 1991 to Dec 2001 control group of 116 patients who had conservative treatment 197 had hysterectomy for pelvic pain and 117 for menorrhagia self report questionnaire 

Vaginal hyst. Control group Age 51.4 50.9 Parity 2.1 2.2 Menopause 43.5% 47.4% Smoking 17.9% 17.2% Drink >2 L/day 7.7% 9.5% History of uro sxs 0 0 

Age Parity Menopausal status Smoking Volume of drink 

Did not report incidence by each of these 

Prevalenc Freq day>Noc: day Urgency Qmo Qwk Qday UI Use of paUrge Inc Qmonth Qweek Qday SI Qmonth Qweek 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F70 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Qday Age <60 UI Urge IncoSI Age >60 UI Urge IncoSI 

Deliveliotis, 200415Prospective cohort II-2A 

283 Greek men from 441 patients enrolled. 105/142 patients treated with RRP for prostate cancer 98/151patients treated with TURP for BPH 80/148 healthy men as control completed surveys used AUA Sx Index, UCLA Prostate Cancer Index; Rand 36-Item Health Survey and BMSFI translated into Greek Patient outcomes 2 years post treatment compared to pretreatment status at 2 weeks prior to treatment investigators felt poor returns due to length of questionnaires and the number of them 

Mean ages 67.4 range 55-75 group 1 70.3 range 58-74 group 2 72.4 range 62-82 control 

HRQOL post treatment RRP TURP Control Physical functioning 81.5 78.1 82.3 

Types of surgery RRP; TUR

treatment Urinary fu85.1; 80.2Urinary bo85.1; 70.6AUA SI 11.1; 8.6; UI every d2%; 9%; .RRP had urinary fusurgery bsignificandeterioratUI in cont

Fritel, 200452Retrospective cohort II-2C 

French women from hospital database of 1st birth women who had not 

previously delivered fetus >22 weeks 

307/669 primiparous women who delivered in 1996 in vertex position between 37-41 weeks (274 had moved and 88 did not respond) 45.9% response rate. Excluding the women who did not receive the questionnaire (274), response rate was 77.7% Mailed questionnaire sent 4 weeks after 

Table I. Analysis of the differences among responders, women not reached and nonresponders concerning potential risk factors for stress urinary incontinence (SUI) Risk factor Responders Not reached Nonresponders p Age at delivery 29.3 [4.4]; 28.2 [4.4]; 28.9 [4.7] 0.01 

Age at 1st delivery 

BMI Birth weight Duration of labor Duration of second stage Mode of delivery 3rd degree tear at first 

delivery Second delivery since 1996 Urinary leakage before 

Table III. after the fSUI Risk factoAge at de36.7 (80); BMI >27 kBirth weig0.58 Labor ≥8 0.0002 Active 2nd 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F71 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

delivery and asked about SUI before, during, and after pregnancy – “Do you have loss of urine during physical exertion, cough or sneeze?” UI categorized slight, mode or severe using Sandvik Index 

BMI (kg/m2): 21.3 [2.9]; 21.1 [2.9]; 21.3 [3.2] 0.62 Birth weight (g): 3240 [384]; 3253 [400]; 3241 [430] 0.92 Labor (hours) 6.2 [2.3]; 6.5 [2.5]; 6.6 [2.3] 0.21 Active 2nd stage (minutes): 11.1 [7.5];10.6 [7.9]; 10.9 [7.9] 0.69 C- section: 10.1 (31);17.5 (48);17.0 (15) 0.03 Forceps: 36.2 (111);31.3 (86); 44.3 (39) 0.08 Third-degree tear: 1.3 (4); 1.1 (3);1.1 (1) 0.97 

1st pregnancy 

Urinary leakage during 1st pregnancy 

(15); 19.3 C sectionForceps: 3rd degree 

Leak befo<0.0001 Leak duri<0.0001 2nd delive

0.81 Table IV. urinary incfirst deliveRisk factoLeakage 18.7 3.6–Leakage 1.3–4.8 0Age at the  >30 yearLabor ≥8 Cesarean 0.9 0.04 Adjusted logistic reAccording regressiorisk factorurine leakpregnancconfidenc(CI) 3.6–9the first p1.3–4.8), of first labCI 1.7–5.7at the first (OR 2.4; 9cesarean 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F72 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

(OR 0.3; 9Table III. after the fSUI Risk factoAge at de36.7 (80) BMI >27 kBirth weig0.58 Labor ≥8 0.0002 Active 2nd 

(15); 19.3 C sectionForceps: 3rd degree 

Leak befo<0.0001 Leak duri<0.0001 2nd delive

0.81 Table IV. urinary incfirst deliveRisk factoLeakage 3.6–96.4 Leakage 1.3–4.8 0Age at 1s1.4–4.2 0Labor ≥8  3.1 1.7–5Cesarean  0.3 0.1–0Adjusted logistic re
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F73 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Grodstein, 200416Prospective cohort II-2A Confounded for stroke and physical limitations and results were the same in both analysis 

Nurse Health Study from 1996-2000 females Questionnaire mailed in 1996 to 39,436 women post menopausal women who had no leaking of urine and were followed for 4 years Incident cases of occasion UI were defined as leaking 1-3 times per month; frequent were at least once per week Excluded premenopausal women or users of estrogen creams, or reported leaking in 1996 

Cohort of 39,436 women ages 50-75 Mean age 61 for current HRT use; 64 for never used BMI for never used HRT was 27 Current use BMI was 47 and past use for BMI was 47 Hormone Use Post Menopause Never Current Past Caucasian 98 97 98 African American 1 1 1 Hispanic 0 1 0 Asian 1 1 1 Smokers @ 45% all Hysterectomy 6 47 40 

Age BMI Smokers Recurrent UTI Diabetes COPD Neurological disorders Parity HRT 

5,060 inciUI 2,495 inci

Average iyear and 50-55 yea3% in tho56-60 – 361-65 – 366-70 – 471-75 yea

Groutz, 200453Prospective cohort elective C-section without trial of labor vs. vaginal delivery vs. Csection due to obstructed labor II-2A (if controls are considered types of deliveries) 

363 consecutive primiparae followed for 1 year SUI before pregnancy excluded Non-singleton deliveries, instrumentalassisted vaginal deliveries excluded 145 spontaneous vaginal delivery 100 C-section following obstructed labor with mean cervical dilation of 8.7 

± 1.6cm

118 elective C section 

Interviewed one year PP SUI – involuntary leakage with cough, sneeze, etc Regular UI as defined by involuntary excretion or leakage of urine in inappropriate places or times twice or more a month, regardless of quantity loss 

Vaginal; Obstructed; Elective Csec Delivery; labo; c-sec Age: 28

±4; 32.5

±5.3; 31.7

±5.2 

Weight: 60

±9; 62.5

±11.6; 63

±13 

Height: 164+/-6/6; 162

±5.6; 164

±6.7 

Gestation age: 39.7; 40.2 ; 38.8 Birth weight: 3,251; 3,450; 3,260 Israeli women delivered at Tel Aviv Sourasky Medical Center 

Age Maternal age Weight Height Mode of delivery 

SUI signif67

±10kg v

increase ipregnanc

Duration o

second stlonger (p<PP SUI coP SUI (37min; 61 vs

Older matyears), he(71kg vs. SUI durinamong inwomen
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F74 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Hagglund, 2004174 year followup cohort study II-2A 

Swedish women all 145 incontinent and 193 continent women ages 22-50 in year 2000. Same group of women had participated in earlier study 1995 on prevalence. Response rate 73% 248/338 Among the 248 responders as followup, 118 reported UI and 130 reported being continent. Changes in type of UI measured using DIS “Do you have problem with involuntary loss of urine?” 

 Age Women c

incidence 22-31 131-41 141-50 1Women in22-31 33 31-41 141-51 1

Haltbakk, 200418Prospective cohort no control mentioned ? historical control 

480 Norwegian men at St. Olavs Hospital, Trondheim Norway. Tentative diagnosis of BPH made on 612 patients and from this pool, sample analyzed was 480 (78%). ICS LUTS questionnaire (ICS-BPH) between 1997-2000. IPSS, SPI and SISI used also. UI defined as any involuntary leakage of urine. 

Mean age of patients was 67 years, SD 10.6 years; median 69 years range 39-91 years 

15% mild symptoms 54% moderate symptoms 31% severe symptoms Mean age in incontinent group was 68 years 

Age 3/4 of me

problems and 31% problems Issues relwere recoand 47% mostly disurinary syof life. Incontinen64% had 22% for 56% for >/=remaining 

Holroyd-Leduc, 200419Population based Prospective cohort Confounders – sex, age, socioeconomic status, race, smoking, alcohol, BMI, sensory 

Community dwelling in U.S. 6,506 of 7,447 subjects ages ≥70 in the 

Asset and Health Dynamics Among the Oldest Old study who had complete info on continence status were baseline –outcomes 3 groups- 5,872 nursing home, 5,521 ADL decline and 5,509 IADL decline as outcomes 

Subjects interviewed in 1993 and 1995 Blacks, Hispanics, and Florida residents 

Mean age ≤SD = 77 (range 69-103) 63% female 86% White 

Median number of baseline comorbid medical conditions was 2 10% received help with 1 or more ADLs and 23% were receiving help in 1 or more 

Age Sex SES Race Smoking/alcohol BMI Sensory impairment Comorbidity Cognitive scores Depression ADL 

UI and ou(95%CI) Death: 10Nursing hADL decliIADL decMore funcbaseline 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F75 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

impairment, comorbid disease, depression, cognitive function and baseline dependency. II-2A 

were over sampled Overall response rate was 80% UI measured “next question might not be easy to talk about, but it is very important for research on health & aging, during the last 12 months, have you lost any amountof urine beyond your control?” 

IADLS at baseline 

Patients with UI had more comorbidities (p=.001), higher rate of visual impairment (35% vs. 22.4% p <.001) and hearing impairment (39.7% vs. 30.5% p<.001) 

IADL 

Hunskaar, 200420Cross national study, Prospective No control group 

Postal survey mailed to 29,500 households in 4 countries – France, Germany, UK and Spain age ≥18 years 58.1% response rate women with UI included in analysis was 5976 (35% of study population) Definitions used by ICS; symptoms in last 30 days and in last 7 days 

Mean age France – 44.8 Germany – 59 UK – 45 Spain – 64 All – 58 

Age Ethnic background 

No new cOnly prev

Jackson, 200422Population based Prospective cohort; also randomly selected from HMO diabetes registry II-2A 

1,017 post menopausal U.S. women ages 55-75 enrolled in HMO and followed for 2 years (1998-2002) inclusion criteria were no natural menstrual cycle in past 12 months. Exclusion: oral estrogen or vaginal estrogen, residential nursing care, restriction to wheel chair, dementia or severe psych disorder, indwelling catheter or intermittent urinary catheter, 

end stage renal disease requiring dialysis, active malignancy other than skin cancer, chronic antibiotic use, acute cystitis in past 90 days. 

Post void residual bladder volume measured using portable ultrasound device 12 month followup done by 87% and 24 month followup by 81% Primary study outcome was sx cystitis 

Frequency of Exposures at Enrollment and Univariate Risk of Symptomatic Urinary Tract Infection Characteristic (%) Hazard ratio Washington State, USA 

Smoking Alcohol Depression Diabetes BMI Parity Hysterectomy Oral estrogen use COPD Stroke Arthritis Age Race Urinary tract infection Vaginal estrogen use 

Race and arthritis were associated with SI and Urge. Current oral estrogen use and arthritis were associated with 1.5 to 2 fold higher odds of SI and Urge 

Incidence per year. Independincluded i(hazard ra[HR]=3.4;[CI]: 1.7 to of urinary or more in3.5 to 13.included a estrogen month (H3.4), a his(HR=1.9; asymptombaseline (3.5). 27% white 14% blac(95% ConComplete Age (year
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F76 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

See table 4 55-59 

60-69 70-75 Ethnicity White Other General h76-100 51-75 0-50 Smoking Never Former Current (Diabetes No (Yes (Diabetes Not diabe (Diet or pil (Insulin (AccidentaNo (Yes (Type of umonth None (Stress on174 (Urge¶ on106 (Stress an324 (Postvoid <50ml res (50-100ml  (
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F77 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

>100ml re (History of No (Yes (History of No (Yes (History of No (Yes (Parity (nupregnanc0 (1-3 (≥4 (

Johnson, 200423Long-term cohort, Prospective study of RRP vs. radiotherapy II-2B 

Men from the Prostate Cancer Outcomes Study diagnosis with primary prostate cancer between Oct 1994-Oct 1995 Residents of LA, King County Washington, states of Connecticut, NM, UT. Between ages of 60-89 years in King County and younger than 90 in others. Self questionnaire at 6, 12, 24 and 60 months after diagnosis and medical record review at 12 and 60 months. 11,137 men identified in registries; 5,672 randomly selected, letters sent to 4,736 (83.5%) of selected cases. Total of 3,533 men (62.3%) completed 6 and 12 months were included in f/u cohort. 1,433 men had RRP completed 6 months 1,178 did 24 months (82.2%) 1,109 did 60 months (77.4%) For radiotherapy – urinary problems not 

1,433 men RRP 642 men received radiotherapy 

RRP group – wt % by race  NHW AA Hispanic Arthritis 33.3 38.6 35.8 Diabetes 11.1 29.5 17.2 COPD 7.5 6.6 5.4 HF 4.9 2.1 4.4 CVA 2.6 2.5 3.3 HTN 37.3 54 37.5 MI 7.9 4 4.2 Age at dx <60 27.5 38.6 23.4 60-64 26.8 26.1 30 65-75 41.9 32.9 45.5 >/=75 3.8 2.4 1 

Prostate cancer RRD Radiation therapy 

Wt % for  Level of ubaseline Total contOcc leakaFreq leakP = 6 months total controcc leakafreq p = 12 monthtotal controcc leakafreq p= 24 monthtotal controcc leakafreq p = 60 month
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F78 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

reported Questionnaire also translated into Spanish and interview conducted in Spanish when necessary. 

total controcc leakafreq p = 

Lagergren, 200424National, longitudinal, multipurpose study in Sweden (SNAC). Study consisted of two parts – population part and the care/service part. II-2A 

Swedish men and women from Skane, Karlskrona, Kungshomen and Nordanstig ages ≥65 starting in 2001-March 2004, 12% in SNAC is 65-79 years old, 6% >80 years Total pop of SNAC 17,044; baseline 8,627 targeted persons/ 7,518 sampled 16-25% of SNAC received public care Followup every 6 years starting at 66 years Combo of interviews and questionnaires 

Functionally disabled – 37% Average PADL – 6.9 Severe cognitive impairment (Berger 2-6)- 27% Severe mobility restrictions – 51% 

Men 3,052 Women 4,465 Total 7,518 Average age 85 compared to average age in Sweden 83 

Men 3052 Women 4465 Total 7518 

Avg age 85 compared to avg age in Sweden 83 Residency 

PrevalencSevere UOrdinary Special aTotal 31% 

McGrother, 200426Cross sectional and longitudinal II – 2B 

United Kingdom women AND men 162,533 prevalence study and 39,602 incidence study people age ≥40 years Response rate 60 and 63% respectively and 79% at followup Excluded people living in institutional settings 

15% age ≥65 years 85.5% White 44.9% employed 91.8% good health Mean age: 57 54% women 

Gender Female to 

disorder wwith incon1.6; frequ1.0. 

Neumann, 200427Prospective study II-2A 

Study group – 549 Denmark women who had hysterectomy from 1/1/98-12/31/2000 born after 1939 Background group – 144 women who had non-GYN surgery born between 1940-1965 who had lap chole in Denmark. Nulliparae were excluded. Questionnaire sent 9- 45 months postop SI was involuntary leakage during effort, urge as leakage with a sense of urgency, significant UI was defined as involuntary leakage at least once a week, bothersome UI as significant incontinence and use of devices, 

All women were Caucasian In study group 12% hysterectomy – 33% of these had abdominal, 55% vaginal 

BMI BMI asso

significannovo urgep<.01) – Bthe varian

BMI assoafter hystep<.01) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F79 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

decreased social ability or having hygienic problem with incontinence. Questionnaires returned by 82% in study group, 76% in background group 

Ozerdogan, 2004 29Cross sectional study, Prospective II-2A 

625 women living in Turkey ages 20 and over 4 different cities of Turkey. Questionnaire and I-QOL; Rare – UI less than once a month Reg – UI more than twice per month Serious – continuous use of sanitary protection. SI and urge defined as usual definitions 

Age distribution 20-29 – 26.4% 30-39 – 22.6 40-49 – 18.7 50-59 – 13.4 60-69 – 11/7 ≥70 – 7.2 illiteracy rate 9.4% 1 out of 4 resided in rural area 1 in 5 gave birth at least 4 or more times and most were vaginal deliveries (25%) 

Age BMI Smokers Diabetes 

UI was asage (p <09.69% in 

HysterectMI and UrBMI (OR Diabetes Neuro (ORUTIs (O50% BMI recurrent COPD 7.5

Schytt, 200430Prospective, longitudinal cohort II-2A 

Swedish women after childbirth at 593 clinics in Sweden. 5,550 women booked appointments during recruitment time, 4,500 eligible, 3,191 consented, and 3,061 completed 1st questionnaire, 2,762 completed 2nd, and 2,563 

completed 3rd. Total 2,450 completed all 

three. Study sample was 2,390 women after exclusion factors also. Selected data from a National Swedish survey investigating physical and psychological assessment of childbirth May and Sept 1999 and January 2000 antepartal visits Three questionnaires 1st at baseline, 2nd mailed 6-8 weeks 

after the birth and 3rd 1 year after birth. 

Women were asked to recall any symptoms of UI during the pregnancy and post. Excluded miscarriages, non-Swedish speaking, and women from nonparticipating clinics, delivery of twins 

Average gestation answering 1st quest – 16 weeks, 2nd – 10 weeks post, 3rd – 1 year and 2 

weeks. 

Average age at recruitment – 29.5 years Primiparas – 44% Multiparas – 56% 79.2% had vaginal delivery 13.4% had C-section 

Age Parity Education Mode of delivery Smoking 

Strongest in primipaUI during predictors constipatiafter birthWithin the the most UI during CI 95% 2-(RR 2.9, I (RR 1.3, C(RR 1.5 9constipatitrimester 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F80 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Stenzelius, 200454Cross-sectional Adjusted by: Age, Gender, Quality of life, Occupation, Economy, Living condition, Need of help, Satisfaction with children contact, and problems with Communication, Mobility, Elimination, Digestion, Breathing and circulation Psychosocial problems Other type of pain Level of evidence: III

Subjects were selected and mailed a questionnaire from a randomized, agestratified sample of persons ≥75 years living in a southern part of Sweden. Response rate: 52.8% (n=4,277) Data source: Self-reported postal questionnaire Incontinence as a yes to the question, “Have you had problems controlling urine in the last 3 months?” 

Age: 75 and above Mean: 83.7 (SD: 5.69) 

Gender: Male and Female Male: 38.4% Female: 61.6% Race: Not reported Ethnicity: Not reported Residency: Community dwelling and special accommodations residents in Southern Sweden. 

Risk Factor Sex (0=women, 1=man) Difficult talking Memory problems Difficulty walking Mobility limitation Oedema in legs Other urinary symptoms Diarrhea Dizziness Protracted coughing Fatigue 

OR 

0.68 1.25 

1.7 

1.63 1.23 1.32 1.37 0.66 1.26 1.33 1.21 

Vandoninck, 200455Age stratified Prospective cohort for men in the original study. Mentions sampling weights upon the ratio of # of women in each age group in the sample to # of women in the age group in population. Prospective cohort, no controls 

Dutch women from Urepik (Uro Epi in Europe and Korea)study in the community In 1999, a national postal questionnaire survey 1,460 spouses of 1,771 men. 1,071 returned- 73% response rate UI assessed by total score on short UI specific questionnaire – 3 groups – no symptoms score 0-2; minimal 3-6 and severe 7-14. In addition self reported UI calculated conforming to ICS standard definitions. “Do you ever have involuntary urine loss?” QOL also used 

Mean age 57 (29-79) 34% minimal UI 12% severe 

Mean parity 2.6 13.5% women were childless During the past month: % How often have you leaked urine? 0 Never 54.5 1 Not more than once/wk 19.6 2 More than one but less than three times a week 10.0 3 More than 3 times/week 6.0 4 Nearly always 8.6 If you experienced urine loss, how much did you leak? 0 I never leak 50.2 

Age Parity 

No relatioparity or aonly in oldin article).
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F81 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

1 Some drops 32.2 2 A small stream 11.4 3 Protection material or clothes soaking wet 4.9 4 Leaking through pads or clothes 0.3 How often do you use protection material 0 Never 68.1 1 Occasionally 21.4 2 Nearly always 3.9 3 Always 5.8 Did you lose urine on coughing or sneezing? 0 Never 31.1 1 Occasionally 45.0 2 Nearly always 13.5 3 Always 9.3 

Arya, 200156

Prospective Observational II-2 

Subject selection: 315 consecutive primiparous women delivering by forceps (n = 90), vacuum (n = 75), or spontaneously (n = 150). Follow-up for UI was done at 2 weeks, 3 months, and 1 year after delivery. The labor room logs were screened every morning by a research nurse to identify patients who met the eligibility criteria for the study. Inclusion criteria: primiparity, vaginal route for delivery, age, gestational age ≥37 weeks, and accessibility by telephone. Exclusion criteria: history of urinary incontinence before or during pregnancy, delivery by cesarean section, known diabetes or neurologic disease, and non- English speaking. Definition: Urinary incontinence was defined as the presence of urine loss of any amount that had occurred on at least 2 occasions.

Women ≥18 years USA 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F82 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Sherburn, 200157

Cross-sectional and Longitudinal phases III 

Subject selection: 2 parts: (1) a crosssectional phase involving a populationbased sample of 1,897 Australian-born women who participated in the baseline interview; (2) a 7-year follow-up phase, assessing a 373 women (premenopausal at 1 year follow-up) from the cross-sectional study. Eligibility for longitudinal study: menstruation in previous 3 months, an intact uterus, at least one ovary, and not currently taking oral contraceptives or HRT. Response rate: of original cohort, 779 met these criteria and 438 (56%) agreed to be interviewed in the first year of the longitudinal study. 

Women 45–55 years. Australia 

Multivariate analysis found that urinary incontinence patients were significantly more likely than those without incontinence to have higher body mass index (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.15, 1.95), have had gynecologic surgery (OR 2.17, 95% CI 1.42, 3.32), report urinary tract infections (OR 4.75, 95% CI 2.28, 9.90), diarrhea or constipation (OR 1.95, 95% CI 1.27, 3.00), and have had three or more children (OR 1.47, 95% CI 1.06, 2.05). 

During the overall incwho expeduring the higher inc

Van Kessel, 200158

Retrospective Observational II-2 Adjustment for factors including mode of delivery, age in years, and duration of enrollment 

Subject selection: The study was conducted at a managed care organization with over 500,000 enrollees. All women who had given birth between 1982 and 1986 and who were continuously enrolled until 1998 were identified with the patient computerized data file. From this cohort, a random sample of women with SUI was selected. 43,288 mother-baby pairs were identified within the computerized database. A random, case-controlled sample of 85 cases and 88 controls was identified 

Women 22.6-52.9 years USA 

After adjustment factors, the risk for SUI associated with duration of second stage of labor was 1.10 (95% Cl 0.90-1.28; p = .5) There was no significant difference in mode of delivery between cases and controls with one exception; 10.7% of the cases underwent forceps delivery compared with only 1.1% of controls (odds ratio, 10.4; 95% CI, 1.17-93.4; p = .04)
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F83 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Larrieu, 200459

Cross-sectional III 

Data from the Three-City (3C) study; a collaborative research program from a cohort of 9,294 community-dwellers ≥65 years. Subjects living at home were randomly sampled from electoral rolls. Included 8,966 subjects after excluding 328 subjects with missing BMI. 

Men and Women ≥65 years 

3566 men (39.8%); Mean age: 74.2 y (SD=5.6, not different according to sex) France 

BMI The univa

quite freqwith prevain the sev20% in otP<0.0001

Viktrup, 199260

Observational II-2 

305 primiparas interviewed repeatedly about stress incontinence before and during pregnancy and after delivery over 6 month period. Definition: ICS 

Women 17-41years Denmark 

Pregnancy SUI 

Before prDuring preAfter preg

Van Kuijk, 200161

Observational (cohort) II-2 

Subject selection: All patients with firsttime, unilateral hemispheric stroke admitted from August 1994 to August 1997 for a post-acute inpatient rehabilitation program. Exclusion criteria: non-ischemic stroke, history of previous stroke, evidence of brainstem lesions or bilateral signs on examination, diabetes mellitus, use of anticholinergic medication, history of urinary incontinence, previous urologic surgery, indwelling or intermittent catheterization not regarded as incontinent because of stroke. Definition: Urinary incontinence as any form of involuntary urinary loss. Only urinary incontinence ≤6 months post stroke, considered to be from stroke. 

Men and Women Age: Men: Mean, 62+-11.5; Range, 32-83 years Women: Mean, 62+-12.7 years; Range, 30-83 years Netherlands 

 Incidence 

Overall: 2Women: 1Men: 39/1The incideincontinenper month [CI], 18-4

Schmidbauer, 200162

Cross-sectional III 

Subject selection: Analysis of ~2,500 participants in a health screening project in the area of Vienna, using Bristol LUTS incontinence questionnaire and (a) medical history; (b) a physical investigation; (c) socio-demographic parameters (smoking, eating and drinking habits), and (d) urine and blood study including 14 parameters. The 

Age: Men (49.7+-13.6yrs), Women(48.6+-13yrs) Austria 

Parity showed a strong correlation to UI. c 26.3% reported episodes of urinary incontinence in the past 4 weeks. Other factors, age (r = 0.22), BMI (r = 0.20), urgency 

In women reported oincreased 29.6% (twchildren), children). 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F84 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

parameters collected during this health investigation were correlated to the presence of urinary incontinence to identify potential risk factors for urinary incontinence. Definition: UI was defined as any involuntary loss of urine within the past four weeks. 

(r = 0.16), feeling of incomplete bladder emptying (r = 0.21), previous urogynecological surgery and fasting blood glucose correlated significantly to UI., 5% of men were incontinent, age (r = 0.12), urgency (r = 0.16), nocturia (r = 0.16), feeling of incomplete emptying (r = 0.16), reduced uroflow (r = 0.18) and previous prostatectomy (r = 0.11) correlated to the presence of UI. Smoking habits and education level revealed no association in either sex. 

Hu, 200463Observational II-2 

Subject selection: women at Group Health Cooperative of Puget Sound

(GHC), a staff-model health maintenance organization with approximately 450,000 members in 

western Washington State. Study subjects with a recent diagnosis of acute UTI. Women were then randomly selected from GHC enrollment files to 

serve as control subjects, matched to cases by date of birth (within 2 years). 

Women aged 55-75 years USA 

Acute UTI Case sub

controls to 

incontinenadjusted O2.10) and quantities (age-adju1.38-2.11

and incondrops wer

increased 

O’Donnell, 200565

Observational II-2 

Subject selection: In 2001, a 13 item questionnaire was mailed to a representative sample of 29,500 community-dwelling women to 

Women ≥18 years with UI France, Germany, Spain and the UK. 

UI and women's attitudes were found to be associated with help-seeking after 

Initial survSUI France: 3Germany
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F85 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

determine the prevalence, type and treatment behavior of women with UI. Within 2 months of the initial survey a more detailed self-completion questionnaire was mailed to a randomly selected sub-sample of 2,953 women identified as having UI from the initial survey. Follow-up included questions on general health status, quality of life and help-seeking behavior, characteristics of UI, and women's attitudes to health care in general and UI specifically. Response rate: 58% in the initial and 535 in the second. Definition: UI was defined as any leakage or involuntary loss of urine, conforming to the standards recommended by the ICS. For the purpose of this study this definition was restricted to an incidence during the last 30 days. 

adjusting for age, UI duration and frequency, and ‘bother’ of UI; factors traditionally associated with help-seeking. After adjustment for these factors, willingness to take long-term medication and having spoken to others about UI were found to be strong predictors of helpseeking in all four countries. 

Spain: 39UK: 41% Total: 37% UUI France: 2GermanySpain: 20UK: 16% Total: 20% MUI France: 3GermanySpain: 26UK: 34% Total: 33% Followup SUI France: 3GermanySpain: 44UK: 44% Total: 43% UUI France: 9GermanySpain: 14UK: 10% Total: 10% MUI France: 5GermanySpain: 34UK: 42% Total: 42% 

Samuelsson, 66Cross-sectional Adjusted by:, Age Parity, Weight 

Subjects were selected from women aged 20-59 who were invited in for their gynecological health examination. The exam is conducted every third year for 

Age: 20-59 

Gender: Female Race: Not reported 

Age years 20-29 years 30-39 years 40-49 years 

Crude Od

1 

4.18 7.21 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F86 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

Smoking Type of delivery Co-morbidity Hormonal use Surgical history Pelvic floor muscle strength Genital prolapse Level of evidence: III 

women in Sweden. Response rate: 76% (n=487) Data source: Self-reported postal questionnaire Incontinence was defined as a positive response to, “Do you suffer from involuntary loss of urine?” 

Ethnicity: Not reported 

Residency: Urban area in MidSweden 

50-59 years Parity 0 deliveries 1 delivery 2 deliveries >3 deliveries Smoking habits Never smoked Former smoker Current smoker Weight 45-58 kg 59-70 kg 71-105 kg ERT use No Yes Type of delivery Vaginal Section Episiotomy No episiotomy Episiotomy Maximum birth weight (g) <3199 3200 – 3924 >3925 Type of genital prolapse Loss of urethrovesical crease Rectocele Cystocele Uterine prolapse Degree of prolapse None Not to introitus 

9.52 

1 

3.92 5.24 8.59 

1 

1.28 1.78 

1 

0.87 1.13 

1 

4.89 

Prevalenc

42.2 30.8 45.2 35.7 35.5 44.7 43.8 53.2 55.3 58.1 

72 

18.7 47.9 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

 F1-b. Risk factors for unrinary incontinence in adults (continued) 

F87 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement Methods 

(survey, screening, case finding, 

definition) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Levels of Risk 

Factors 

In

Incontin

Sever

To introitus Number of prolapse components None One Two Three Four Age (years) 20-29 30-39 40-49 50-59 Parity 0 deliveries 1 delivery 2 deliveries 3 deliveries or more Smoking habits Never smoked Former smoker Current smoker PFMS 4 3 2 1 Presence of cystocele and/or absence of urethrovesical crease No Yes ERT use No Yes 

62.5 18.7 

31 

59.6 66.7 

100 

Adjusted 

1 

2.31 

2.2 

3.47 

1 

1.38 1.84 2.71 

1 

1.42 1.86 

1 

1.51 2.56 3.44 

1 

2.49 

1 

2.91 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F88 

Multiple logistic regression of ’long term’ UI and delivery mode history67

Incontinence 

Variable Total N % Odds ratio (95% CI) P 

Delivery mode history 

All other histories 2,707 1263 (46.7) 1.0 Reference Only caesarean section(s) 435 141 (32.4) 0.50 0.40-0.63 0.001 Any forceps 1,029 480 (46.6) 0.96 0.83-1.11 0.567 Maternal age at first birth <25 1,432 568 (39.7) 1.0 Reference 0.001 25-29 1,697 766 (45.1) 1.34 1.15-1.55 0.001 30-34 835 427 (51.1) 1.88 1.57-2.25 0.001 >35 207 123 (59.4) 2.98 2.18-4.07 0.001 Number of births One 528 202 (38.3) 1.0 Reference 0.001 Two 2,202 993 (45.1) 1.30 1.07-1.59 0.001 Three 1,025 490 (47.8) 1.61 1.29-2.02 0.001 Four or more 416 199 (47.8) 1.73 1.31-2.27 0.001 Number of women 5 4171 Number symptomatic 5 1884 Symptoms are yes at 6 years 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F89 

Supplemental Evidence Table: Association between risk factors and incidence of UI in adults in the community and long-term Odds of UI according to potential risk factors , 200668

Occasional Incontinence* Frequent Incontinence* Severe Incontinence* Variable 

OR (95% CI) OR (95% CI) OR (95% CI) 

Age (years) 

<40 2,270 Reference 3,174 Reference 1,293 Reference 40-44 4,664 1.20 (1.13,1.28) 6,475 1.16 (1.10,1.22) 3,125 1.34 (1.24,1.44) 45-49 4,949 1.29 (1.21,1.37) 7,685 1.32 (1.26,1.40) 4,146 1.69 (1.57,1.81) 50-54 2,623 1.38 (1.28,1.48) 4,105 1.35 (1.27,1.44) 2,354 1.81 (1.66,1.97) P for trend <.0001 !.0001 !.0001 Race/ethnicity White 13,512 Reference 20,011 Reference 10,186 Reference Black 159 0.58 (0.48,0.69) 254 0.56 (0.48,0.65) 128 0.49 (0.40,0.60) Hispanic 207 1.09 (0.92,1.28) 286 1.01 (0.87,1.17) 159 1.10 (0.91,1.33) Asian 184 0.78 (0.67,0.92) 224 0.71 (0.61,0.83) 87 0.57 (0.46,0.72) BMI (kg/m2) <22 2,881 0.80 (0.76,0.85) 3,623 0.78 (0.74,0.82) 1,476 0.70 (0.66,0.76) 22-24 3,574 Reference 4,703 Reference 2,150 Reference 25-29 3,905 1.26 (1.20,1.33) 5,651 1.37 (1.31,1.44) 2,931 1.52 (1.43,1.62) >30 3,547 1.80 (1.70,1.91) 6,544 2.43 (2.31,2.55) 3,888 3.10 (2.91,3.30) P for trend <.0001 <.0001 <.0001 Type 2 diabetes mellitus 987 1.08 (1.00,1.17) 1,678 1.18 (1.10,1.26) 990 1.30 (1.20,1.41) Hysterectomy 2,295 1.23 (1.13,1.33) 4,147 1.43 (1.33,1.54) 2,373 1.59 (1.45,1.73) Parity None 2,142 Reference 3,538 Reference 1,587 Reference 1 birth 2,038 1.43 (1.33,1.53) 3,005 1.26 (1.19,1.34) 1,560 1.48 (1.36,1.60) 2 births 6,038 1.58 (1.49,1.67) 8,783 1.41 (1.35,1.48) 4,566 1.67 (1.57,1.79) >3 births 4,288 1.59 (1.50,1.69) 6,113 1.41 (1.34,1.49) 3,205 1.69 (1.58,1.82) Oral contraceptive use Never 1,735 Reference 2,465 Reference 1,252 Reference Former 10,954 1.18 (1.12,1.26) 16,302 1.21 (1.15,1.28) 8,556 1.20 (1.12,1.29) Current 1,780 1.04 (0.96,1.12) 2,591 1.13 (1.05,1.21) 1,071 0.97 (0.89,1.07) Cigarette smoking Never 9,629 Reference 13,399 Reference 6,707 Reference Former 3,743 1.00 (0.96,1.05) 5,915 1.12 (1.08,1.16) 3,012 1.11 (1.05,1.17) Current 1,115 0.91 (0.85,0.98) 2,097 1.20 (1.13,1.28) 1,188 1.34 (1.25,1.45) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F90 

F1-c. Prevalence of UI in adults in the community 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

Huang, 200669

Population-based, cross-sectional survey 

Adjusted by age, race, ethnicity, income, occupation, education, health status, fecal incontinence, number of medications, UI severity, UI type, timing of incontinence, age of onset of UI, sexual activity II-2b 

603 of 2,109 women aged 40-69 years previously sampled as part of the RRISK study who enrollees in Kaiser Permanete Medical Care Program with weekly UI UI measured using self-report questionnaires: During the past 12 months, on average, how often have you leaked urine, even a small amount? Additional questions asked: number of incontinent episodes that occurred in past 7 days “with an activity like coughing, lifting, sneezing, or exercise” (stress UI) or with “a physical sense of urgency” (urge UI) UI severity was determined using Sandvick Severity Scale (frequency and amount of urine lost per episode) 

Mean age: 57 (SD 9) years 50% nonwhite 

50% had cliaccording to Scale Predictors o

percentile oQuestionna

High school1.9 , 1.1-3.Good health Fair health sPoor health Fecal incon4.2 Daytime and only: 2.5, 1Some leaka3.3 Not sexually 

Huang, 200670

Population-based, cross-sectional mailed survey II-2a 

1,349 women ages 40-69 years from 2,109 women previously sampled as part of the RRISK study who were enrollees in Kaiser Permanente Medical Care Program 

UI measured using self-report questionnaires: During the past 12 months, on average, how often have you leaked urine, even a small amount? Additional questions asked: number of incontinent episodes that occurred in past 7 days “with an activity like coughing, lifting, sneezing, or exercise” (stress UI) or with “a physical sense of urgency” (urge UI) 

345 Asian-American women ( mean age 53) 1003 White women (mean age 58) Residence: Northern California, USA 

Asian: 10.6% White: 17.8Type: Asian: 7.8% White: 15.5UI 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F91 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

Fitzgerald 200671

Population-based, cross-sectional survey 

Adjusted by age, race, parity, BMI, and other potential confounding variables II-2A 

Random selection from age and race strata of 2,109 women aged 40-69 years who were part of the RRISK study as enrollees in Kaiser Permanente Medical Care; 65% response rate UI measured using self-report questionnaires: During the past 12 months, on average, how often have you leaked urine, even a small amount? Additional questions asked: number of incontinent episodes that occurred in past 7 days “with an activity like coughing, lifting, sneezing, or exercise” (stress UI) or with “a physical sense of urgency” (urge UI) 

598 (28%) aged 40-49 796 (38%) aged 50-59 713 (34%) aged 60+ 1003 (48%) white 383 (18%) Black 350 (17%) Hispanic 345 (16%) Asian 29 (1%) Other Northern California, USA 

29% weekly 13% weekl206 (10%) w113 (5%) weChildhood dSUI: 0.97 [.UUI: 0.76 [Nocturia: SUI: 1.26 [.UUI: 0.69 [Daytime UI: SUI: 1.60 [.UUI: 2.56 [Nocturnal eSUI: 0.57 [.UUI: 2.68 [UTIs (1 morSUI: 2.00 [UUI: 2.03[0

Hatem, 200572

Population-based, cross-sectional survey 

No adjustments 

Random selection of 2,492 primiparous women who had given birth within a 6 month period in Quebec; 1,305 women responded (55%) with 1,291 usable responses (52% of women sent a questionnaire) Mailed questionnaire at 6-months postpartum UI measured: FPSUND tool which assessed six symptoms and their severity: frequency, use of protection, stress-related complaints, and urgerelated complaints, number of daily micturitions. Considered to have UI if had a score of 2 or more 

Mean age 27.2 (SD 4.8) years Race/ethnicity: not reported Residence: Quebec, Canada 

29.6% UI (cfecal incont19.2% UI al43% stress 38% unspe6% urge UI 8% mixed U5% mixed Upredominan

Lewis, 200573

Population-based, cross-sectional survey 

10,678 women aged 50-90 years who were participants in the Health and Retirement Study 

Women aged 50-90 years 73.8% Non-Hispanic white 14.9% African-American 

21.7% UI 57% mild U43% severe 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F92 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

Adjusted by race, parity, BMI, Diabetes (non-insulin dependent and insulin-dependent), hypertension, heart disease, stroke, lung disease, cancer, arthritis, ADLs 

Telephone or face-to-face interviews UI measured: During the last 12 months, have you lost any amount of urine beyond your control? Incontinence defined as mild if urine loss was reported on 15 days or fewer, and sever if reported greater than 15 days a month 

7.7% Hispanic 3.6% Other Residence: USA 

Rait, 2005 74

Cross-sectional survey 

Adjustments by age, gender, residence, marital status, health, needs, hearing, vision, medications, and falls 

15,051 out of 20,934 eligible subjects (71.9%) obtained from patients aged 75 years and over from 106 general practices recruited to participate in the MRC Trial of the Assessment and Management of Older People in the Community Study Data obtained by interview; definition and measurement of UI not reported 

61.5% female 38.5% male 47% 75-79 years 31.4% 80-84 years 16.0% 85-89 years 5.6% 90+ years Ethnicity: not reported Residence: England, Scotland, and Wales 

Associated (MMSE < 24UI: 1.3 [1.0

Téllez-Zeneno, 200575

Population-based, cross-sectional survey 

Adjusted by comorbidities 

49,026 participants from the National Population Health Survey (NHPS) and 130,0882 from the Community Health Survey (CHS) ages 12 years and over which represented 98% of the Canadian population (85% response rate in both surveys) Data obtained by interview; definition and measurement of UI not reported 

50% female 50% male Race/ethnicity: not reported Residence: All Canadian provinces 

Weighted poNHPS: 4.7 CHS: 3.9 Normal vs. eWomen: 14 vs. 48, p4.5] Men: 29 vs[2.6-3.9] UI: AOR 2

Ertunc, 200476

Case-control design 

154 women who underwent SUI surgery (cases) and 100 women without SUI recruited from clinics 

70/108 mothers and 252/305 sisters (cases) 72/100 mothers and 207/272 sisters (control) Self-administered questionnaire using BLUTS: 

Mean age of mothers of incontinent women: 68 (SD 9.8) and 69 (SD 8.4) of continent women Mean age of sisters: 50 (SD 11) of incontinent women and 47 (SD 8.5) of continent women Turkey 

SUI prevale71.4% case40.3% contrSUI prevale24.6% case11.6% contrAge when s“incontinent vs. 41 (SD 7
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F93 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

SUI measurement: leakage with coughing, sneezing, or exertion after sports activities, walking, standing up from sitting position, or even sitting up in bed, leaking while erect or at least movement while lying down 

Hannestad 200477Population-based, cross-sectional Adjusted for age, BMI, number of children, and women at risk 

Secondary analysis of data from the EPINCONT study: 6,021 mothers/8,771 recruited/13,501 available), 69% response rate 2104 older sisters from 2,426 sisters/2866 arecruited/4,456 available), 73% response rate Self-administered questionnaire UI measurement: not provided 

Median age of mothers: 60 and daughters 33 Median age of older sisters: 33 and younger sisters 34 Norway 

Daughters iUI: 13 [1.2-1SUI: 1.5 [1.14.6% UUI: 1.8-3.MUI: 1.6 [1Younger sisSUI, or MUIUI: 16 [1.3-1SUI: 1.8 [1.18.3% UUI: N too MUI: 1.7 [110.8% 

McGrother, 200426Cross sectional and longitudinal mailed survey No adjustments II-A 

Random sample of 92,491 from 154,377 people registered with 108 general practices in mixed urban and rural settings (cross-sectional survey), and 23,182 from 36,799 people for 1-year follow-up (longitudinal survey); response rate: 60.2% for prevalent sample and 63% for incident sample UI measured as: do you ever leak urine when you don’t mean to (day or night)? Stress UI: Does any urine leak when you laugh, cough, or exercise? Urge UI: Do you have such a strong desire to pass urine that you leak before reaching the toilet? UI frequency on 5-point scale: continuously, several times a day, 

Adults aged 40 and over residing in Leicestershire Health Authority, UK Cross-sectional sample: 50,002 women 42,939 men 15% aged 65 and over 85.5% white Longitudinal sample: 9,598 women 7,923 men 

Female to mUI 1-year peWomen: Ov11.8% seveminimal Men: Overasevere, 5.7% UI incidence Women: 8.ages 50-59, 9.4% 70-79 over; 8.8% oMen: 2.2% 50-59, 4.0% ages 70-79 over; 6.3% oRemission rWomen: 26
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F94 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

week, month, or never; UI volume on 4 point scale: any leakage, damp, wet, soaked. UI severity index calculated by multiplying frequency and volume scores, and categorized as minimal, moderate, severe, and profound 

ages 50-59, 26.1% ages 80 and overMen: 46.0 a50-59, 46.580 and over

Østbye, 200428

Population-based with 5 and 10-year follow-up 

8,949 adults aged 65 and over who were participants in the Canadian Study of Health and Aging 

UI measured: Do you ever lose control of your bladder? (By that I mean, do you ever pass water when you don’t intend to?) 

Age at baseline: Women: 2,159 (40.6%) aged 65-74 2,254 (42.4%) aged 75-84 909 (11%), ages 85+ Men: 1,722 (58.9%) aged 65-74 1,455 (40.2%) aged 75-84 397 (11%) age 85+ Race/ethnicity: not reported Residence: Canada 

UI prevalen19% women 14.2% ages 15.9% ages 19.7% ages 25.0% ages 24.6% ages 29% ages 99% men 6.3% ages 7.2% ages 9% ages 7511.2% ages 16.6% ages 16.9% ages Remission a29% women 38% men 

Rohr 200478

Population-based, cross-sectional 

1168 twin pairs (548 monozygotic pairs and 620 dizygotic pairs) selected from Danish Twin Registry with data collected from 4 surveys associated with the Longitudinal Survey of Aging Danish Twins (70-94 years) and Longitudinal Study of Middle-Aged Studies (46-68 years) 

Home interview UI measured: During past month, have you involuntary been wetting yourself in connection with physical exertion, e.g., cough, life, sneeze, and 

46-68 years and 70-94 years, Denmark 

UI prevalenMonozygoti46-68 years15% MUI 70-94 yearsUI, 34% MUDizygotic tw46-68 years15% MUI 70-94 yearsUI, 34% MUTetrachoric 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F95 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

laughing? (Stress UI) During the past month, have you experienced such a strong urge to pass water that it was impossible to get to the toilet in time? (Urge UI) If reported > 1 leakage during past month, classified according to UI type 

Monozygoti46-68 yearsurge UI: 0.50.09-.59] 70-94 yearsUI: .50 [.27.75] Dizygotic tw46-68 yearsUI: -0.22 [-0.60] 70-94 yearsurge UI: .28 .33[.06-.55 Heritability: For UUI and additive genshared envimodel in boUUI: 46-68 years70-94 yearsSUI: best-fisolely on faspecific env

Nygaard, 2003(79) 

Population-based, cross-sectional survey 

Adjusted by age, depression, race, BMI, parity, education, smoking, psychiatric medication use, comorbidity index, ADL, functional status 

5,701 women aged 50-69 years who participated in the third interview of the Health and Retirement Study Telephone interview UI measured: In the last 12 months, have you lost any amount of urine beyond your control? Mild-moderate UI was incontinence on 15 or fewer days in the last month; severe incontinence was 15 days or more of UI in last month 

Age: Continent women: 59 (SD 4) years Mild UI: 58.5 (SD 4.1) years Severe UI: 59.6 (SD 4.2) years Race: Continent: 70.4% white, 18.5% Black, 9.2% Hispanic, 1.9% other Mild UI: 81.7% White, 11.2% Black, 6.2% Hispanic, 0.9% Other Severe UI: 81.7% White, 11.3% Black, 5.0% Hispanic, 2.1% Other Residence: USA 

15.9% UI 4.4% sever10.5% mild-Risk of seveBy ComposInterview (CDepressionBlack: 0.30Hispanic: 0Other: 0.77BMI: 1.44, Parity: 1.27Education: 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F96 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

Smoking: 1Psychiatric 2.19 Comorbidity Functional sAge and ADBy Center foStudies-DepDepressionBlack: .030Hispanic: 0Other: 0.82BMI: 1.44, Parity: NS Education: Smoking: 1Psychiatric 2.34 Comorbidity Functional sAge and ADRisk of mild By ComposInterview (CDepressionBlack: 0.42Hispanic: 0Other: 0.36BMI: 0.97, Parity: NS Education: Smoking: NPsychiatric 2.07 Comorbidity ADL: 1.44, Functional sBy Center fo
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F97 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

Studies-DepDepressionBlack: 0.42Hispanic: 0Other: 0.37BMI: 0.97, Parity: NS Education: Smoking: NPsychiatric 2.18 Comorbidity ADL: 1.46, Functional s

Aaron, 200280

Case-control study 

200 married premenopausal and postmenopausal women aged 40-49 years in seven villages identified through the Christian Medical College and Hospital, Vellore (CHAD) census records 

Interview UI definition: not reported 

Mean age: postmenopausal women: 46.6 (SD 2.2) and premenopausal: 45.4 (SD 2.3) 

Stress UI: 20% preme22% postm

Fitzgerald, 200281

Cross-sectional survey design II-2b 

Convenience sample of 269 from 500 women (54% response rate) employed by a manufacturing and distribution center 

UI measured: Have you ever lost urine when you were not able to get to the toilet in time? Have you ever lost urine when you are asleep? Have you ever lost urine when you laugh, cough, or sneezed? 

Women with mean age of 40 (SD 9.9) years, range 16-69 years, 85.3% age 50 years or younger 87.3% White 4.1% Black 8.6% Asian/Native American/Other Northeastern, USA 

Monthly UI Of those wit88% White 11% Asian/< 1% Black 26% stress 1% urge UI 73% mixed 

Langa, 200282Population-based, cross-sectional survey 

7,443 adults aged 70 years and over who were participants in the Asset and Health Dynamics among the Oldest Old (AHEAD) cohort of the Health and Retirement Study 

Interviews 

Mean age of continent adults: 77.2 (SD 0.2), and incontinent without pad use: 78.1 (SD 0.5), and incontinent with pad use: 79.3 (SD 0.6) 30.3% men 69.7% women 

13% men 24% wome9.9% UI wit9.5% UI –n
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F98 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

UI measured: During the last 12 months, have you lost any amount of urine beyond your control. Use of absorbent products indicating UI severity 

89% White 9.3% Black 1.7% Other 

Nuotio 200283

Population-based, prospective cohort 

Adjusted for chronic diseases and ADL disability 

1,052 persons (524 men and 528 women) randomly selected from the Tampere Longitudinal Study on Aging In 10-years: 175 men and 260 women were re-interviewed in their home or in institutions UI Measured: Do you ever have trouble getting to the lavatory in time? If, yes do you have urinary leakage, either day or night—never, rarely, frequently? Urge UI: urgency and urinary leakage regardless of the frequency of urine loss 

Adults aged 60-89 years, Finland Men at 10-y

UUI at base89% (n=25) 7% (n=2) no 4% (n=1) UUrgency, no 7% (n=30) 83% deceas8% no urge6% urgency3% urge UI No urgency 57% deceas3% urgency3% UUI 7% not knoWomen at 1UUI at base68% decea6% no urge26% UUI Urgency, no 7% 83% deceas8% no urge6% urgency3% urge UI No urgency 57% deceas3% urgency3% UUI 7% not kno
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F99 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

MacLennan 2000(84) 

Population-based, cross-sectional survey 

Random selection of 4,400 households; 3,010 men and women (73.3% response rate) aged 15-97 years who were part of the South Australian Health Omnibus Survey 

In-home interviews UI measured: stress UI (loss of urine with coughing, laughing, or sneezing) or urge UI (suddenly felt urge to go to the toilet but accidentally wetting themselves before reaching toilet) 

48.7% (n=1,464) men, mean age: 42.9 years 51.3%(n=1,546) women Race and ethnicity not reported; 75.3% born in Australia/Oceania, and 24.7% born overseas Residence: South Australia 

Men: 1.5% stress 1.9% urge 1.0% mixed 4.4% UI Highest in thWomen: 20.8% stres2.9% urge 11.6% mixe35.3% UI Highest in aUI type (OR Stress UI: 1Mixed UI: Urge UI: 1.Overall UI: Associated Age: 35-54 years55+ years: Method of dC-section oVaginal onlyAt least on fBoth vagina9.3] BMI: Normal weigOverweightObese: 2.6 Coughing m2.3] OsteoporosArthritis: 1.
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F100 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

Hägglund 199985

Population-based, cross-sectional survey 

All women (N=3,493) aged 18-70 years in the population register of Surahammar, Sweden; 3,076 responded (88% response rates) 

Mailed questionnaire UI measured: For the present dime do you have a problem with involuntary loss of urine (for example when you laugh, jump, cough, or sneeze)? 

653 aged 18-30 years 626 aged 31-40 years 736 aged 41-50 years 578 aged 51-60 years 478 aged 61-70 years Race/ethnicity: not reported Residence: Sweden 

26% overall 12% ages 20% ages 332% ages 436% ages 528% ages 6

Palmer 199986

Cross-sectional survey 

Random sample of 2,000 of 4,000 women aged 18 years and over employed full-time at large urban academic center; 1,134 returned questionnaires (57% response rate), with 1,113 usable questionnaires 

Mailed questionnaire UI measurement: Have you ever lost urine when you were not able to get to the toilet in time? Have you ever lost urine when you are asleep? Have you ever lost urine when you laugh, cough or sneeze? Have you ever lost urine without meaning to at any time not mentioned above. UI defined as monthly leakage 

Mean age: 40.3 (SD 10.6) years 72% Caucasian 21% African-American 7% Asian, Hispanic, or American Indian Residence: Baltimore, MD, USA 

21% monthIncontinent ≤ 50 years: > 50 years: African-AmeWhite: 83% Asian/Amervs. 8.6%

Roe, 199987

Population-based, cross-sectional survey 

Adjusted by age, sex 

6,037 of 11,523 adults with usable questionnaires (52.4% response rate) aged 18 years and over randomly sampled from family physician patient registers in two health authorities in England Mailed questionnaire UI measured by asking respondents “if they had ever had bladder problems,” e.g., accidentally leaking urine, having wet pants, needing to go 

2,681 men with mean age of 53.5 3,356 women with mean age of 49.5 years Race: 5,581 (90.9%) White 33 (0.6%) Black Caribbean 3 (<.01%) Black African 167 (2.8%) Indian 29 (0.5%) Pakistani 3 (< .01%) Bangladeshi 11 (1.8%) Chinese 22 (3.6%) Other Asian 

9% regular Incontinent Females vs < .0001 Age : 55.7 No associatconsumptioalcohol; assHigher BMI: No significaand UI for m
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F101 

Author, Design, 

Adjustment for Confounding 

Factors, Level of Evidence 

Subject Selection, Response Rate, 

Data Source, Methods to Measure 

Incontinence (survey, screening, 

case finding, definition of 

incontinence) 

Subject Age, Gender, Race, 

Ethnicity, Residency 

Preva

Incontine

Seve

to the toilet frequently, and not making it on time, and using aids or appliances to manage urinary incontinence. UI defined as 1 or more of these symptoms at least twice a month 

38 (6.2%) Other Residence: England 

13%, P < .0No associatcigarette comoderate (5more per daMobility pro.0001 Foot probleLess activity 31% vs. 12Sleep proble.0001) Parity: Not controlled foFetal weigh14%, P < .0

Mushkat 199688

Case-control design III 

780 first degree female relatives of 259 women with stress UI from gynecological outpatient clinic with 474 first degree relatives of 165 matched controls 

Clinic interview of cases and controls about female relatives UI measured: SUI symptoms (sneezing, coughing, laughing, walking, bending, or exercising) at least twice a week 

Mean age: cases 53 (SD 10.1), controls 50 (10.7) years Ethnicity: not reported Residence: Israel 

 UI prevalenrelatives in scontrol grouMothers (P 34.9% case12.7% contSisters: (P < 19.9% case6.8% controDaughters: 6.7% cases 2.9% contro
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F102 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Diokno, 200789Cross-sectional Adjusted by: Age Household size Income Region size Level of evidence: III

Subjects from a randomly selected pool of 250,000 households that volunteered to participate in National Family Opinion surveys, balanced to match census 2000 distributions on multiple factors. 

Response rate: 66.5% (n=29,903) Data source: Self-reported, mailed questionnaire. UI as, “Involuntary leakage or loss of urine during the last 30 days.” 

Age: 18 and above Mean: 50.03 (SD: 15.23) Gender: Male Race: Not reported Ethnicity: Not reported Residency: United States 

Prevalence: 12.7% 

By type (of incontinent Stress: 24.5%, Mixed: 

Age % 18-34 7.25 35-44 7.17 45-54 10.98 55-64 15.58 65-74 23.82 75 + 30.19 Age group Stress 18–35 38.1 35–45 35.74 45–55 30.77 55–65 19.28 65–75 16.67 76+ 13.22 Total 24.48 Characteristic 

UI Symptoms in the past 7 days (n = 1923) Duration of symptoms (n = 1628)   

Consulted physician for UI symptoms (n = 1787) 

Kinchen, 200790

Cross-sectional Adjusted by: Age Race Years with Kaiser Permanente Medication history Surgical history 

Subjects randomly selected from all Kaiser Permanente of Northern California members seeking care within a 12 week period in 2002. Response rate: 49.7% (n=3,344) Data source: Mailed self-reported survey. Non-responders followed up with a phone call with survey over the phone or by mail. 

Age: 21-75 years Gender: Female 

<30: 6.9% 

30-<40: 13.6% 40-<50: 20.5% 50-<60: 24.6% 60-<70: 10.5% 

70-75: 2.5% 

Race: White: 57.3%, Black: 9.5%, Asian: 7.0%, Hispanic: 7.0%, American Indian: 

Overall: 44% 

Age group Pr<50 50-64 65+ 

By type - 

Stress Urge Mixed 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F103 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Level of evidence: III UI as, “Having leaked urine in the last 

7 days”. Stress and urge symptoms were also determined. 

0.8%, Other/unknown: 18.5% Ethnicity: Not reported 

By severityReported as “bothersom

Altman, 20062Prospective, cohort study with 10-year followup Adjusted by maternal age and parity Level II-2A

304/309 (98% response rate) primparous women who had a vaginal delivery over a 10-week period in 1995 Excluded: Elective or acute cesarean delivery; inadequate knowledge of Swedish language; dual pregnancy 

229/309 (74.1% from original sample) available and met eligibility criteria at 10 years Excluded: UI surgery, C-sections after index delivery UI Measurement by survey with selfadministered questionnaire 

• Do you experience sudden desires 

to void urine that are difficult to hold back? 

• Do you experience involuntary loss 

of urine at physical activities? 

• Do you experience bladder emptying 

difficulties? 

UI Severity Definition • Mild SUI defined as less than 

once/week 

• Moderate-severe SUI defined as UI 

more than once per week or daily

Swedish women with mean age at index delivery 29.9±4.1 years 

Prevalence rates: 

• Mild UI at index delive

8, and at 10-year folloCI: 25-37 

• Moderate-severe UI a

5/309, 95% CI 1-4, an18%, 27/229, 95% CI

Mild SUI at the followin

• 5% (n=16/304) at ba• 14% (n=41/287) at 5 • 47% (n=17/278) at 9 • 25% (n=57/230) at 5 • 31% (n=71/229) at 1• P <.001 5 months, 9 

Moderate-severe SUI: • 2% (n=5/304, 95% C• 43% (n=15/287) at 5 • 7% (n=19/278) at 9 m• 11%(n=24/230) at 5 • 12% (n=27/229) at 1• P <.001 at 5 months

years 

Altman, 200691Case-control study Mean duration of followup: 13.8 years (range 3-23) Median followup: 14.3 years Adjusted for confounding factors 

48/52 female patients (92%) with history of abdominal rectal prolapse surgery (65.8% of the 73 patients who had the surgery and were alive at the time of the study) 165/200 (82.5%) randomly selected age matched controls 

UI Measurement: mailed survey with questions on UI (no definition, time 

Swedish women with mean age of cases at followup: 69 (range 32-90), and mean age of rectopexy was 56.2 (range 26-75) Median parity: 2.0 (range 0-4) Mean age of controls: 67.7 (range 30-91) Mean parity: 2.1 (range 0-5) 

31% (n=15/48) cases v

SUI: 17% (8/48) cases UUI: 15% (7/48) cases No difference in SUI prAdjusted OR, 95% CI = • Control: 16% (n=26/No difference in UUI prAdjusted OR, 95% CI = • Control: 10% (n=17/
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F104 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Level of evidence: II-3 frame, or specific question(s) 

provided) 

• Cases: 15% (n=7) 

Anger, 200692Cross-sectional No adjustment for confounding factors Level of evidence: II-2C Same as 17070268? 

Data extrapolated from 9,965 respondents in the National Health and Nutrition Examination Survey (1999-2000) to women ages 60 and over 

Multistage probability cluster design using census information Survey UI Measurement: In the past 12 months, have you had difficulty controlling your bladder, including leaking small amounts of urine when you cough or sneeze (exclusive of pregnancy or recovery from childbirth)? 

Women ages 60 and over; age and ethnicity/race not specified; USA 

UI prevalence was 38% US population estimate

• 41% non-Hispanic wh• 20% non-Hispanic bla• 36% Mexican-AmericBy severity: • 36% reported daily U• 27% (10.3%) reporte• 23% had a few incon• 12% had at least yea• This corresponded to 

least weekly UI: 24% 

Regardless of age, racthe majority of women controlling bladder had exception was the lowewhich 100% of women month Overall prevalence rateto 41% with highest in 7Prevalence of daily UI iranging from: • 12.2% age 60-64 • 20.9% age ≥85 

• Other numbers unab• 32% of women with <

45% of women with h38% of women with s

Women below poverty likely to report UI (29% women above the povewith PIR from 1.0 to 1.8

Anger, 200693Cross-sectional No adjustments 

Female nursing home residents at admission 1,125,163 in 1995 

Female; age and race/gender for overall group not specified; USA 

Prevalence with admittincontinence in medicathe National Nursing Hwas 73.8% to 85.4% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F105 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Level of evidence: II-3 1,156,134 in 1997 

1,170,065 in 1999 

National Nurse Home Survey compared to data from medical records; Data collected in 1995, 1997, and 1999 UI measurement: Admission or current diagnosis of UI in medical records; National Nursing Home Survey questions that asked NH staff about the: presence of indwelling Foley catheter or ostomy, need for assistance from equipment or personnel in using toilet, and difficulty in controlling urination 

All with admitting or cumedical record: (countresidents, 95% CI): 

• 1995: 13,915 (1.2%), • 1997: 20,679 (1.8%), • 1999: 15,979 (1.4%), 

From medical record frprevalence was: UI rate female residents (1.4%Age: with admitting or cmedical record (count, CI): • ≤74 years 

o 1995: 2,443 (17.6%o 1997: 2,408 (11.7%o 1999: 2,827 (17.5%

• 75-84 years 

o 1995: 4,159 (29.9o 1997: 9,029 (43.7o 1999: 5,668 (35.0

• ≥ 85 years 

o 1995: 7,313 (52.6o 1997: 9,242 (44.7o 1999: 7,685 (47.5

Race: with admitting or medical record (count, White: • 1995: 13,397, 1,340 • 1997: 17,962, 1,779 • 1999: 15,075, 15,07Other: 

• 1995: 518, 421 (0.0-• 1997: 2,717, 1,969 (• 1999: 904, 554 (58–

• African Americans: 1

10% of continent 

• Hispanics: 2.8% of in

3.3% of continent re
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F106 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

• Counts (%) and rate

admitting or current by the NNHS with di100,000 residents (9

• 1995: 10,695/13,915 

87,176) 

• 1997: 15,255/20,679 

82,597) 

• 1999: 13,648/15,979 

93,460) 

Counts (%), and rates (admitting or current diaNHHS with indwelling f

• 1995: 1,435/13,914 

17,768) 

• 1997: 2,423/20,679 

18,125) 

• 1999: 1,517/15,979 

16,099) 

Counts (%), and rates fostomy of residents regstatus per 100,000 (95% 

• 1995: 101,827 (9.1%• 1997: 90,855 (7.9%)• 1999: 96,151 (8.2%)

Counts (% for those anthose where question sor left blank) and rates residents with UI identifassistance for using toi

• 1995: 9,847 (70.8%)• 1997: 14,237 (83.6%• 1999: 8,898 (73.3%)

Counts (% for those anthose where question sor left blank) and rates residents regardless of by NHHS as requiring a
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F107 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

• 1995: 659,035 (69.7

81,702) 

• 1997: 652,615 (70.7

78,424) 

• 1999: 670,006 (71.0

67,586) 

Also provides rates for but did not include thosCounts (% of those answhere question skipped blank) and rates per 10with UI requiring assistwhen using toilet: 

• 1995: 3,214 (33.2%)• 1997: 4,464 (33.0)), • 1999: 2,821 (32.4%)

Counts (% of those ansthose who skipped queleft questions blank) anCI) of residents regardlassistance from equipm

• 1995: 182,813 (28.4

33,295) 

• 1997: 180,518 (29.4

29,709) 

• 1999: 178,305 (27.6

48,188) 

UI prevalence with an diagnosis of UI in medidentified in NNHS as urination Regardless of record-b56.3% to 58.6% had d

Counts (% of those ansthose who skipped queleft questions blank) anCI) of residents with UI a person when using to
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F108 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

• 1995: 9,619 (97.7%)• 1997: 14,000 (100%• 1999: 8,675 (97.5%) 

Counts (% of those ansthose who skipped queleft questions blank) anCI) of residents regardlrequiring assistance frotoilet: 

• 1995: 652,088 (99.1

(56,636,59,274) 

• 1997: 640,137 (98.8

56,689) 

• 1999: 661,92799.0%

Anger, 200694Cross-sectional No adjustment for confounding factors Level of evidence: II-2C 

Data extrapolated from 9,965 respondents ≥60 years in the National Health and Nutrition Survey (1999-2000), comparing men to women. Multistage probability cluster design using census information and crosssectional data 

Survey UI measurement: In the past 12 

months, have you had difficulty controlling your bladder, including leaking small amounts of urine when you cough or sneeze? 

Men and women aged 60 years and over; ethnicity/race not specified; USA 

Prevalence rate of 17% extrapolated from US eBy race: 

• 21% Non-Hispanic b• 16% Non-Hispanic w• 14% Mexican-Americ

By education: 

• 20% <high school ed• 15% high school edu• 16% some college 

By income level: 

• 55% <poverty level (P• Higher income group

By UI severity: 

• 42% (7% of all men) • 24% (4% of all men) 

By age and severity: 

• 50% aged 75-79 had 

age groups reporting 

• 37% aged 60-64 had 

among age groups re

• Among all age group

ranged from 62% age
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F109 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

the 60-64 age group 

In comparison to NHANand women older than • Prevalence in men is 

vs. 38%) 

• UI prevalence in men 

peaked in 85 and ovprevalence peaked in 

• Prevalence of UI am

same as black wome

• Black men had highe

Black women who haof UI 

• Differences noted by 

between genders 

o Men with less than h

highest prevalence wthan high school deg

• Stratification by pove

disparity with prevalein men but lowest in 

Brown, 200695Cross-sectional Adjusted for BMI Level of Evidence: II-2C 

1,461/2,531 (57.7%) nonpregnant female participants aged ≥20 years in 

the NHANES study (2001-2002) with diabetes or impaired fasting glucose Excluded: incomplete UI information, did not complete physical examination, without diabetes diagnosis and had not fasted 8 hours before laboratory testing 

• 246 (16.8%) had diabetes (selfreport of FBS ≥ 126 mg/dl) 

• 146 (11.2%) had impaired fasting 

glucose (FBS 100-125 mg/dl) 

Stratified, multistage probability cluster design Survey UI measurement using selfadministered questionnaire: During 

Female, USA Mean age ( P <.001) • 60.2 ± 1.5 diabetic women • 58.0 ± 1.1 prediabetic women • 44.0 ± 0.8 normal glucose women Race: (P= .24) • Non-Hispanic white 

o 104 (42.3%) Diabetic o 90 (54.9%) Prediabetic o 565 (53.8%) Normal glucose 

• Non-Hispanic black 

o 59 (24.0%) Diabetic o 90 (54.9%) Prediabetic o 188 (17.9%) Normal glucose 

• Mexican-American 

o 65 (26.4%) Diabetic o 32 (19.5%) Prediabetic o 225 (21.1%) Normal glucose 

Prevalence of UI: 

• Similar between thos

and impaired fasting 

• Higher than those wit

(16.8%; P <.001) 

• Based on these num

~ 12.7 million women prediabetic women (9million women with d

Type of UI • ≥ weekly UUI more c

and prediabetic (24.6women (7.7%, (P <.0

• ≥ weekly SUI more c

and prediabetic (31.2women (14.4%, P <.0

• Bothersome UI is gre

(31.3%) and prediabe
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F110 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

the past 12 months, have you leaked or lost control of even a small amount of urine with an activity like coughing, lifting, or exercise (stress incontinence) and “with an urge or pressure to urinate and could not get to the toilet fast enough? “ (urge incontinence) Primary outcome: weekly or more frequent UI Bothersome UI and impact of UI: asked to rate degree of worry created by urine leakage and affect of urine leakage on day-to-day activities (categorized by not at all, only a little, versus somewhat, very much, or greatly 

normal women (18.2

• Impact on daily activ

diabetic (12.6%) and normal women (4.9%

Danforth, 200668Cross-sectional Adjusted for BMI, Type II Diabetes, hysterectomy, parity, oral contraceptive use, cigarette smoking Level of evidence: II-A 

83,355 women who provided information on UI and parity out of 101,294 women who were sampled (82.3% response rate) 

Nurses Health Study II Mailed survey UI Measurement: During the last 12 months, how often have you leaked or lost control of your urine? (never, <1 time/month, 1x/month, 2-3 x/month, 1 time/week, almost every day) If you lose urine, how much usually leaks? (a few drops, enough to wet underwear, enough to wet outer clothing, enough to wet floor) Created two cases: 1) occasional urine loss (leaking 1-3 

times/month 

2) frequent urine loss (leaking at 

least weekly) 

Severe UI=enough to wet underwear 

Women, mean age 44.8 years, USA Leaked urine in past 1

available) 

• 57% never or <1 tim• 17% 1-3 times/month • 26% 1 time/week By race (%) • Never or <1 time/mo

o 56% White o 64% Black o 55% Hispanic o 14% Asian o 17% other or miss

• 1-3 times per month 

o 18% White o 15% Black o 19% Hispanic o 14% Asian o 17% other/missing 

• 1time/week 

o 26% White o 22% Black o 26% Hispanic 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F111 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

o 18% Asian o 25% Other/missin

Quantity of urine leaked• 41% a few drops • 53% enough to wet u• 6% enough to wet ouQuantity of urine leaked • A few drops 

o 41% White o 35% Black o 36% Hispanic o 49% Asian o 40% Other/missin

• Enough to wet under

o 53% White o 62% Black o 58% Hispanic o 4% Asian o 6% Other/Missing 

• Enough to wet outer 

o 6% White o 4% Black o 6% Hispanic o 4% Asian o 6% Other/missing 

After adjustment for cotable on supplemental factors): • Significant trend of in

increasing age 

Women ages 50-54 yodds of severe UI comCU 1.66-1.97). After ad95% CI: .40-.60) and (OR: .57, CI: .46-.72) severe incontinence cHispanic and White wprevalence 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F112 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Glazener, 20065Cross-sectional Adjusted Level of evidence: 

3,405/4,537 (75.1% response rate) of women responding they had singleton births delivered over 1-year between 1994-1995 (3489/4555 responded to survey) Excluded: Twin pregnancies 

Mailed survey UI Measurement: A positive response to one or more of the following questions: 

• At present, do you ever lose any 

urine when you don’t mean to? 

• In the last month, how often has this 

happened on average? 

• Do you wear a pad for this? 

Women mean age 26.7 years (SD 5.3), Scotland, New Zealand, and England 

Race/ethnicity not reported 

UI prevalence: 29% 

UI frequency at 3 mon

• 50% (n=485) <1 time• 41% (n=401) <daily a• 9% (n=88) >daily lea

UI pad usage at 3 mon• 68% (n=664) none • 23% (n=221) sometim• 10% (n=98) daily Effect on quality of life • 51% (n=462) hygiene • 47% (n=342) home, w• 17% (N=140) sex life UI Type at 3 months: • 48% (n=459) SUI • 23% (n=221) UUI • 15% (n=285) MUI Co-existing FI at 3 mon• 15% (n=136) After adjustments were was increased with ma

Irwin, 200696Population-based, cross-sectional Not adjusted Level of evidence: II-2A 

19,165/58,139 adults aged ≥ 18 years 

(33% response rate) who were participants in the EPIC Study 

Interview UI Measurement: How often do you experience urinary leakage? 

Women and men residing in Canada, Germany, Italy, Sweden, and UK 

95.6% white Percent of women and men not reported 

UI 

• 13.1% women • 5.4% men UI type by age and gentable 

MacArthur, 200667Prospective cohort study with 6 year followup Followup from Glazener, 2006 report Adjusted for maternal age, delivery mode, and parity Level of evidence: II-2A 

4,214/7,872 women who had a childbirth during 1993-1994 and had responded to a 3 month questionnaire (54% response rate) 

Conducted in 3 countries Mailed survey 3 months and 6 years after index birth UI Measurement: A positive response to one or more of the following 

Women mean age 26.7 years (SD 5.3), Scotland, New Zealand, and England 

Race/ethnicity not reported 

Prevalence of persiste6 years was 24% 

Severity of persistent U

• 12% (120/1010) daily • 21% (208) a few time• 23% (231) sometime• 11% (111) used a pa

UI impact of persistent • 47% (477) hygiene 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F113 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

questions: 

• At present, do you ever lose any 

urine when you don’t mean to? 

• In the last month, how often has this 

happened on average? 

Do you wear a pad for this? 

• 16% (166) home life • 35% (356) social life • 21% (162/783 who w• 13% (120/915 with p

Median VAS assessing = 25.0 with 22% (226) sscores=worse) 

Lewinshtein, 200697Cross-sectional Stratified by age and comorbidity (e.g., circulation problems and diabetes and tested using Chi-square tests Level of evidence: 

366 men aged 33-80 years participating in a prostate cancer screening Excluded: diagnosis of prostate cancer 

Self-administered questionnaire UI Measurement: Over the past 4 weeks, how often have you leaked urine? Overall, how big a problem has your urinary function been for you during the last 4 weeks? 

Men with a median age of 54.8 years; Quebec, Canada 

226 (76.4%) Caucasian 14 (4.7% African-American 56 (18.9%) Other 

Defines UI as SUI excepresence of leaked uri

UI prevalence by age a• <50 years 

o Daily: 0 o 1 time/week: 4 (3.o < 1 time/week: 3 (o Never: 106 (93.8%

• 50.1-60 years 

o Daily: 4 (3.4%) o 1 time/week: 1 (0.o <1 time/week: 8 (6o Never: 104 (88.9%

• >60 years 

o Daily: 5 (7.0%) o 1 time/week: 1 (1.4o < 1 time/week: 4 (o Never: 61 (85.9%) 

• Total 

o Daily: 9 (3.0%) o 1 time/week: 6 (2.o <1 time/week:15 (o Never: 271 (90.0%

Urinary bother by age, • <50 years 

o Big problem: 0 o Moderate problem o Minor problem: 8 (o Very minor probleo No problem: 91 (8

• 50.1-60 years 

o Big problem: 3 (2
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F114 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

o Moderate problem o Minor problem: 5 o Very minor probleo No problem: 89 (7

• > 60 years 

o Big problem: 1 (1.4o Moderate problemo Minor problem: 3 (o Very minor probleo No problem: 51 (6

• Total 

o Big problem: 4 (1.o Moderate problemo Minor problem:16 o Very minor probleo No problem: 231 (

Urinary bother, regardlesignificantly increased UI was not associated w

Mardon, 200698Cross-sectional Adjusted by age, sex, race, Hispanic status Level of evidence: II-2C 

Baseline surveys: 145,765 (67% response rate) community-dwelling Medicare beneficiaries ≥65 years 

Excluded: institutionalized individuals and <65 years Random sample Medicare Health Outcomes Survey (Mailed) 

86,708 women 

58,470 men 

Mailed survey UI Measurement: UI in past 6 months UI described as not a problem, a small or big problem 

Men and women ≥65 years, USA 

Race/ethnicity: • 8,343 Hispanics • 133,860 Non-Hispanics • 5,626 American Indians • 3,047 Asians • 10,775 African-Americans • 125,154 Whites • 3,863 Other 

UI in past 6 months (P 

• 43.6% women • 27.9% men • Overall: 37.3% 

By age: • 31.9% age 65-69 • 34.0% age 70-74 • 37.9% age 75-79 • 41.1% age 80-84 • 49.3% age 90-94 • 54.3% ≥age 95 By race/ethnicity: • 30.6% Hispanics • 37.9% Non-Hispanic• 38.7% American Ind• 31.6% Asians • 30.3% African-Amer• 38.3% Whites • 31.2% other 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F115 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Impact (big, small):: • 19.2%, 58.0% wome• 13.4%, 57.5% men • 17.3%, 58.8% overaBig impact by age • 13.6% age 65-69 • 14.7% age 70-74 • 18.2% age 75-79 • 19.0% age 80-84 • 22.6% age 85-89 • 27.0% age 90-94 • 37.5% ≥age 95 By race and impact (big • 58.9% Hispanic • 55.4% Non-Hispanic • 58.7% American Ind• 53.6% Asian • 55.1% African-Amer• 55,3% White • 61.3% Other 

McGrother, 20066Prospective cohort study with 1-year followup Adjusted for age and ADL; separate models adjusted for general and specific morbidities and parity Level of evidence: II-2A 

12,570/19,241 (65.3% response rate) com40-98munity-dwelling women drawn from 108 general practices (71% of all practices) 

Mailed questionnaire at baseline and 1 year UI Measurement: SUI: leakage upon laughing, coughing, or exercise ≥monthly 

OAB included but could not differentiate those with OAB with urge incontinence from those with OAB without urge incontinence 

Women aged ≥40 years (range 40-98), UK Median age: 58 years 

At baseline: 

• Pure SUI: 837/12,57

Thom, 200699Cohort study (crosssectional) Adjusted by age, 

2,108 out of 10,230 women initially invited who were enrolled in the Kaiser Permanente Medical Care Program of Northern California since age 18 and have at least half of births 

Women ages 40-69 years, Mean age 56 (SD 8.6) years; USA 

Race/ethnicity status: • 47.6% (1003) white 

UI prevalence in past 1and adjusted for age (O

• Any incontinence (P 

o White: 73.3, 71.4-o Hispanic: 74.8, 73
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F116 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

response bias, parity, maternal age at first birth, menopausal status, hysterectomy, current oral estrogen use, BMI, Comorbidity (e.g., 1 or more UTIS in last year, Diabetes), current smoker, alcohol 1 drink/wk or more Level of evidence: II-2A 

with Kaiser system 

2,108/3,240 enrolled (65.1% response rate) Population-based sample with age and race stratified sampling Self-report questionnaires and inperson interviews; medical record data abstraction UI measurement: 

• At least 1 self-reported UI episode in 

past 12 month 

• SUI: Number of UI episodes over 

last 7 days that occurred with an activity like coughing, lifting, sneezing, or exercise 

• UUI: Number of UI episodes 

accompanied by a physical sense of urgency 

• Severity based on Sandvik Severity 

score 

• 16.6% (350) Hispanic • 18.2% (382) Black • 16.4% (345) Asian-American • 1.3% (28) Did not select category 

o Black: 64.8, 62.8-6o Asian: 68.8-66.9-7

• Monthly or more (P <

o White: 45.0, 42.9-4o Hispanic: 51.0, 48o Black: 36.8, 34.7-3o Asian: 33.7, 31.7-3

• Weekly or more (P<

o White: 29.6, 27.7-o Hispanic: 35.9, 33o Black: 25.2, 23.2-2o Asian:19.0, 17.3-2

• Daily (P =.0077) 

o White: 12.1, 10.7-o Hispanic: 17.2, 15o Black: 11.8, 10.4-1o Asian: 8.5, 7.3-9.7 

Incontinence severity aCI) • Moderate severity (d

weekly UI which wetpants) 

o White: 21.2, 19.4-o Hispanic: 24.0, 22o Black: 17.9, 16.2-1o Asian: 13.8, 12.3-

• Severe/very severe 

wets pants or floor) (

o White: 8.3, 7.1-9.5 o Hispanic: 11/7, 10o Black: 7.3, 6.2-8.4 o Asian: 5.2, 4.3-6.2 

UI prevalence in last wage (any UI, SUI, UUI: • White: 27.2%, 15,1%• Hispanic: 33.1%, 17• Black: 23%, 7.5%, 1• Asian: 18.5%, 7.9%, UI prevalence at least w
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F117 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

for age, %, 95% CI • SUI only (P <.0001) 

o White: 7.2%, 6.1-8o Hispanic: 9.0%, 7.o Black: 2.3%, 1.7-3o Asian: 3.4%, 2.6-4

• Mixed, predominantl

o White: 7.9%, 6.7-9o Hispanic: 8.8%, 7.o Black: 5.2%, 4.3-6o Asian: 4.5%, 3.6-5

• UUI only (P=.027) 

o White: 4.8%, 3.9-5o Hispanic: 5.8%, 4.o Black: 7.6%, 6.5-8o Asian: 3.0%, 2.3-3

• Mixed, predominantl

o White: 4.0%, 3.1-4o Hispanic: 4.2%, 3.o Black: 6.0%, 5.0-7o Asian: 4.4%, 3.5-5

• Mixed, equal SUI an

o White: 3.3%, 2.5-4o Hispanic: 5.3%, 4.o Black: 1.9%, 1.3-2o Asian: 3.2%, 2.5-4

Readjusted rates of weresponse bias of no en• White: From 29.6% t• Hispanic: From 36.0 • Black: From 25.3% t• Asian: From 19.1% tReadjusted rates by UI response bias of no enleast 1 time/month, onc• White: 69.2%, 43.3%• Hispanic: 61.2%, 40• Black: 50.5%, 29%, • Asian: 56.1%, 29.2%
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F118 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

• Prevalence was sign

Asian-American womand Hispanic women 

After adjustment for agestrogen use, BMI, mediabetes: • SUI risk lower in blac

0.23-0.57) and Asian.54, 0.34-0.86) comp

• UUI risk similar in bla

0.79-1.81) and Asian.86, .52-1.43) compa

Wehrberger, 20069Prospective cohort study with mean duration of follow-up of 6.5 years Adjusted for confounding factors Level of evidence: II-2A 

441/925 women (47.7% response rate) who completed a free examination in 1998 or 1999 

Mailed questionnaire UI Measurement: BFLUTS: Have you leaked any urine at all during past 4 weeks? 

Women aged 20-84 years; Austrian UI prevalence: 

• 32% at baseline • 43% at 6.5 years 

Jackson, 2006100Prospective cohort Adjusted for diabetes Level of evidence: II-2A 

Randomly selected 1,107 women from Group Health Cooperative enrollees from 1998 to 2002 which included 799 nondiabetic women and 218 diabetic women (26% of total number of eligible nondiabetic and diabetic women) who were participants in a longitudinal study on urinary tract infection risk 

Excluded: Natural menstrual cycle in past 12 months; nursing home care, wheel chair bound, dementia, severe psychiatric disorder, indwelling or intermittent catheterization, end-stage renal disease requiring dialysis, active malignancy other than skin cancer, acute cystitis in past 90 days, chronic antibiotic use; enrollment in GHC <1 year 

Women ages 55-75 years; USA (Washington state) 87.6% White 4.5% African-American 4.9% Asian or Pacific Islander 3.0% Other (from Boyko, 2005 which first described the sample) 

Baseline prevalence oof UI was 66% and 8% in past year (see Jacks
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F119 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Mailed survey, clinic interview, and computerized laboratory, hospital, and pharmacy records collected at baseline, 12 and 24 months UI measurement: Report of any UI or severe UI at 12 or 24-month followup visits using question: Have you had accidental leakage of your urine during the past year. Approximated the Sandvik index for incontinence severity 

Lukacz, 2006102Cross-sectional Adjusted by age, obesity, parity, menopause, caffeine, diabetes, and delivery method Level of evidence: II-2 

Age-stratified random selection in 4 age strata 

4,458/12,200 (37%) respondents participating in the Kaiser Permanente Continence Associated Risks Epidemiology Study 4,103 available for analysis Mailed survey UI Measurement: See previous publications 

Women ages 25-84 years in 4 age strata: 25-39, 40-54, 55-69, and 70-84 years 

USA 60% non-Hispanic White 20% Hispanic 10% African American 8% Asian-Pacific Islander 1% American Indian 1% Other or unknown 

SUI overall prevalence

Prevalence by birth gro

• Nulliparous: SUI: 8% • C-Section: SUI: 11%• Vaginal delivery: SUI• P <.05 for difference 

nulliparous and vaginP <.05 for differences section delivery 

Tannebaum, 2006103Cross-sectional (population-based) No adjustment Level of evidence: II-2A 

Population-based sampling of women ages 55 years and over who responded to a 2002 survey on older women’s priorities for healthy aging 

2,361/5,000 women (47% response rate; 15%-18% response rate from all Canadian households Mailed survey UI Measurement: ICI questions SUI: urine leakage with laughing, coughing, or exercising UUI: urine leakage on way to the bathroom MUI: combination of SUI and MUI Nocturnal UI: urine leakage at night while asleep 

Women ages 55 years and over; 10 Canadian provinces 

Mean age 71±7 years 

Overall prevalence: 39% 

SUI: 32.0% UUI: 22.0% MUI: 35.0% Nocturnal UI: 7.0% UI at least once per daModerate or large amoepisode: 16.7% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F120 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

van Brummen, 20067Prospective cohort study No adjustment for confounding factors Level of evidence: II-2A Note: van Brummen, 20068 had similar 

sample but recruited from fewer midwifery practices over same time period and van Brummen, 20067 had 

similar sample size 

Consecutive recruitment of nulliparous pregnant women with single, low-risk pregnancy between 12 and 18 weeks gestation recruited from 10 midwifery practices from January 2002 to July 2003 

Exclusion criteria: previous urogynaecological surgery, urogynaecological malformations, diabetes mellitus, or neurological disorders; good knowledge of Dutch language; pregnancy within 1 year after index pregnancy 344 (72.6%) returned all questionnaires Self-report questionnaire at 12, 24, and 36 weeks gestation, and 3 and 12 months after delivery UI Measurement (OAB-wet): Using questions from the UDI, 

• Wet OAB: Do you experience a 

strong feeling of urgency to empty your bladder? Do you experience frequent urination? Do you experience urine leakage related to the feeling of urgency? All 3 questions must be answered positively to have OAB-wet 

Measured impact by IIQ 

Baseline continence status unknown 

Women with a mean age of 30.4 (SF 0.19); Netherlands 

Prevalence of OAB-we

• 12 (3.5%) at 12 week• 50 (14.6%) at 36 wee• 12 (3.5%) at 3 month• 12 (3.5%) at 1-year 

Van Brummen, 20068Prospective cohort study No adjustment for confounding factors Level of evidence: II-2A See van Brummen, 20067 (different N and 

Consecutive sample 1,366 nulliparous pregnant women with single, low-risk pregnancy between 12 and 18 weeks gestation recruited from 8 midwifery practices from January 2002 to July 2003 

Exclusion criteria: previous urogenital surgery, diabetes mellitus, or 

Women with a mean age 30.4 years (SD 3.9, range 20-40); Netherlands Race not specified 

At 12 weeks gestation: 

• UUI: 33 (6.4%) • SUI: 96 (18.6%) 

At 36 weeks gestation: 

• UUI: 99 (19.2%) • SUI: 217 (42.1%) 

Symptom bother (deno
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F121 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

number of practices but can be similar study population) 

neurological disorders; non-Dutch speaking 

515/1244 eligible women (41.4%) Self-report questionnaire at 12, 24, and 36 weeks gestation, and 3 and 12 months after delivery UI Measurement: Using questions from the UDI, 

• SUI was defined as: Do you 

experience urine leakage related to physical activity, coughing, or sneezing? 

• UUI: Do you experience urine 

leakage related to the feeling of urgency? 

Defined symptom bother using item levels and total scores from UDI Baseline continence status unknown 

• UUI: 2 (0.2%) at 12 w

weeks 

• SUI: 12 (2.3%) at 12 

weeks 

Symptom bother at 36 symptom: 

• UUI: 15/99 (15.2%) • SUI: 29/217 (13.4%) 

Viktrup, 2006104Prospective cohort study with 12-year followup after first pregnancy Not adjusted Level of evidence: II-2A 

Consecutive sample of 241/305 primiparous women (79%) 

Excluded: UUI symptoms Data obtained from birth registration records, hospital records, telephone interviews a few days after first delivery, 3 months; and mailed questionnaire at 5 and 12 years UI measurement (using ICS definitions): Do you have UI provoked by physical exertion? Do you have daily incontinence? Whether UI was a hygienic or social problem? 

Women with a mean age during first delivery 26 (range 17-41); Norway 

Race not specified 

Prevalence of SUI: 

• Before 1st pregnancy

daily SUI, 0.4% socia

• 30.7% any SUI durin

SUI, and .8% social o

• 18.7% any SUI durin

SUI, 2.5% social/hyg

• 5.8% any SUI 3 mon

daily SUI, 0.4% socia

• 29.5% any SUI 5 yea

daily SUI, 8.3% socia

• 42.3% any SUI 12 ye

daily SUI, and 8.7% syears after first delive

• 42% (102/241) • 5.4% (13/241) had da• 8.7% (21/241) compl

discomfort because o

SUI prevalence by vag

33.0% (38/115) vagina
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F122 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

SUI before or during p60.8% (31/51) with SUOR 3.1, CI: 1.6-6.2) 

SUI prevalence by C-se

• 19.4% (6/31) without 

pregnancy 

• 40.0% (6/15) with SU• OR 2.8, CI: 0.7-10.9

Teleman, 2005105Cross sectional survey No Adjustment for confounding factors Purpose: To investigate the prevalence of storage and emptying LUTS in women reporting UI or continence; the perceived bother induced by UI, and investigate a possible cut off above which most women perceive their leakage frequency as bothersome 

All women born between 12/1/35 and 12/1/45 (n=10,766), invited to screening 12/1/95; data drawn from population register 6,917 screened; 2,213 admitted they were incontinent 1,500 randomly drawn from 2,213 incontinent and 1500 randomly drawn from 4704 not admitting to incontinence Incontinence as self reported urinary leakage which causes a social and/or hygienic problem BFLUTS survey then administered to both groups; response rate 89%-(1,336/1,500) from incontinent group and (1,346/1,500) from continent group 

Study says ages 55-64 but taking definition, ages should be 60-70 100% women No figures on race/ethnicity Lund area of Sweden Excluded subjects with incomplete data 

o Any type UI in contino Any type of UI in incoo Estimated overall preo Any type UI defined 

or leakage without re

o Incontinence by typeIncont Cont Urge 79.2% Stress 85.1% Noc 13.1% No cause 34% o Amount by Freque <1/wk 2-3Drops 74.2% 87.Dribble 1.9% 6.9Soak 0.3% 1.2Run down 0.2% 0.3legs Problem 57.8% 86.(calc) 

Swanson, 2005106Cross sectional survey Adjusted for age Purpose: To examine age specific prevalence and correlates of UI and its subtypes among community dwelling women 

Survey mailed to 100% (362/362) of small family practice and to random sample of 62.4% (720/1,553) in second practice (list of women generated from roster and/or billing databases) UI and type defined by yes to 1 of 2 questions: 1) during past month have you ever experienced urine loss (wet yourself) when coughing, laughing, or doing some other activity? (stress incont) 2) During the past month have 

o Ages 45-81+ o 100% women o No figures on race/ethnicity o Practices in Hamilton Ontario o Excluded subjects with incomplete 

data 

Prevalence Any UI = 51.3% (311/6Stress UI = 17.5% (106Urge UI = 7.4% (45/606Mixed UI = 26.4% (160CI = 95% 

No breakdown by seve
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F123 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

you ever had to pee and then wet yourself before getting to the toilet? (urge incont.); if answered yes to both questions, defined as mixed incontinence Negative answer to 3rd question 

defined continent women: Is wetting yourself a problem that interferes with your day-to-day activities or bothers you in other ways? Response rate: 61.1% by author report (606/992); calculated rate is 56% (606/1082); 90 returned undelivered, 115 not participating, and 271 not returned at all 

Rohr, 2005107Cross sectional study using in person interviews No Adjustment for confounding factors Purpose: To describe the prevalence of urge and stress incontinence and find simple clinical characteristics that are useful in general practice for identifying women with a high probability of UI 

Study population identified from Central Person Registry participating in 3 studies using same survey, invited via letter (n=6,369); randomly sampled 45-68 year olds from the Longitudinal Study of Danish Twins (n=2075); 70-94 year olds from the Longitudinal Study of Aging Danish Twins (N=2400) and The 1905 Cohort Study of Danes (n=1,320) from 1998. Response rate: 91% (5,795/6,369); original studies’ response rate varied between 63-83% Interviews in home by trained 

interviewers; 3 attempts to contact Incontinence self reported as leaking >1 time during the past month with either physical exertion, strong urgency or both 

Age ≥45 

100% women No figures on race/ethnicity Danish subjects only Excluded 574 subjects unable to complete the interview without a proxy; incomplete data for any questions 

Incontinence by type:  All UI StrAll age 32.6% 24(calc) (1,857/5,699) (1

By Age: <60 20.1% 15 (268/1,336) (20760-80 29.8% 21 (677/2274) (496≥80 43.7% 32 (912/2089) (679Asked about frequencyDid not ask about impa

Ruff, 2005108Cross sectional survey Purpose: To examine prevalence and risk factors of UI To determine most 

Population: Convenience sample of 500 college educated women from prestigious AA women’s group of attending a conference Response rate: 47% (233/500) Inclusion criteria: membership in the 

Ages 19-82 100% women 100% African Americans Unknown residency-presumed US No exclusion criteria given 

Incontinence (n=85): All ages/all types 37.6% Stress 76% Urge 84% Mixed 68% 

By severity (n=83): 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F124 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

commonly seen types of incontinence in healthy African American women 

organization, attendance at 1 of the conferences sponsored by the organization and willingness to participate in the study Incontinence based on self report answers to Incontinence Screening Questionnaire (Romanzi & Blaivas, 1997) Incontinence defined as leaking urine or losing control of urination when subject did not want to 

 StreNever 24.1% Few x’s/yr. 41.0% Few x’s/month 13.3% Few x’s/wk 10.8% Daily 10.9% By pad usage (n=48): None 39.7% 1 pad 29.3% 2 pads 10.3% 3 pads 3.4% (24+ pads 17.2% Four women reported sTen women reported soBy bother rating (n=78)No bother 15.4% 1-2 39.7% 3-4 18.3% 5-6 9.2% 7-9 17.9% 10 (intolerable) 5.3% Duration also given in a

Lifford, 2005109Cross sectional study using survey methodology embedded in prospective cohort design Adjustment for age, duration and complications of DM Purpose: To evaluate the association between type II diabetes and development of urinary incontinence in women 

Study population: Nurses Health Study cohort established in 1976 responding to UI items in the biennial questionnaire in 1996 (n=83,569) Sample size after exclusions 81,845 Response rate: unknown 3 attempts to contact, then shortened questionnaire sent Incontinence and diabetes based on self report Incontinence as leaking at least weekly, severe incontinence as weekly leaking of sufficient quantity to wet the underwear 

o Aged 50-75 o 100% women o No figures on race/ethnicity o Nurses in US o Excluded 13,909 women who had 

leakage 1-3 times/month; also women with type I diabetes, gestational diabetes or those who self-reported DM but did not provide diagnostic details excluded from analysis 

Prevalence: 17.4% (14Severity: 

 10.9% (1555/14,286) 

outer clothing or floor 

 21.8% (17,829/81,84 9.4% (7672/81,845) <

or more 

Did not ask about impa

Fritel, 2005110Cross sectional self 

Population: GAZEL cohort 45-50 years between 1990-1996 100% sample sent a questionnaire on 

o Ages 49-61 o 100% women o Unknown race 

(n=2625) Stress UI: 68Severe SUI: 15
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F125 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

reported survey Purpose: To examine prevalence of stress UI To examine potential obstetric risk factors of UI 

UI and obstetric symptoms in 2000 (n=3114) Response rate: 84% (2625/3114) Used answers from questionnaire developed for GAZEL study Stress UI defined as urine leak when physically active, coughing or sneezing in the previous four weeks Severely incontinence women leaked often or all the time 

o French workers of national power 

company 

o No exclusion criteria given 

By severity:  StNever 32Occasionally 28Sometimes 26Often 10All the time 5% Whether a problem in sNot a problem 1% Slight problem 21Quite a problem 24Serious problem 53

Oskay, 2005111Cross sectional in person survey No Adjustment for confounding factors Purpose: To determine the prevalence of urogenital complaints in post-menopausal women aged 50 and over 

From latest national census: Purposive/categorical sampling of 500 women, each representing 1/10,000 women in the 4 age groups on the census (50-54 n=126, 55-59 n=113, 60-64 n=101, 65+ n=160) ,seen at health center for problems other than UI or with a person coming to the clinic Inclusion criteria: Post-menopausal (no period in the last year) SUI as involuntary urinary loss precipitated by coughing, sneezing or physical exertion; Urge incontinence as involuntary urinary loss proceeding the urge to void or uncontrollable voiding with little or no warning; Mixed incontinence as the presence of both stress and urge incontinence Serious incontinence as continuous use of pad Developed their own survey No response rate given-appears 100% 

o Ages 50-65+ o 100% women o No figures on race/ethnicity o Lived in Istanbul, Turkey o Excluded subjects with surgically 

induced menopause or those with presenting complaint of UI 

Any type UI =68.8% (34o Stress UI=37.2% (12o Urge Incontinence=3o Mixed Incontinenc

Frequency (n=500): <1x/mo 18.2 >2x/mo 30.8Serious UI 19.8Weekly incontinence (n<1x/wk 33.2Weekly 17.7Once daily 8.4% >1x/day 22.7Severity (n=344): Drops 41.6Wets underwear 36.9Wets dresses 14.5Urine leaks through leg 7.0% 

Melville, 2005112Cross sectional survey using mailed questionnaire Adjusted: for age 

Population: 6,000 women 30-90 years drawn from claims, and pharmacy data from Group Health Cooperative members (n=550,000), stratified by decade of age with over sampling of women in younger decades 

o Ages 30-90 o 100% women o No figures on race/ethnicity, just a 

non-white category 

o Women living in Washington state o Excluded subjects that were unable to 

Prevalence: All UI/all ages: 42% (14SUI: 33% (480/3438) Urge UI: 13% (187/343Mixed UI: 50% (732/34
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F126 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Purpose: To determine the prevalence and severity of UI and the factors associated with this condition in a population based sample of women aged 30-90 

UI as by leakage of any amount that occurred at least monthly 

 SUI: leaking or loosing urine 

during activities such as coughing, laughing or walking 

 Urge UI: leaking or losing urine 

associated with an urge to urinate so strong and sudden that the participant could not reach the toilet fast enough 

 Mixed: if answered affirmatively 

to both sets of symptoms 

Sandvik Severity Index used to characterize degree of incontinence; QOL measured by Incontinence QOL Instrument (I-QOL) and severity by Patient Incontinence Severity Assessment Response rate: 64% (3536/5531); actual analysis on 3,438-calc: 62% 

be located, had dis-enrolled, had paralysis, mental or physical incapacity to complete a written questionnaire or a current UTI 

Severity (no n given): No UI: 58% Slight UI: 9% Moderate UI: 15% Severe UI: 18% 

Frequency of UI (no n gMonthly: 44% Weekly: 30% Daily: 26% 

Homma, 2005113Cross-sectional Adjusted by: Age, Gender, Parity Functional status General health condition Co morbid diseases Level of evidence: III

Randomly selected using a 2 stage randomization process in proportion to the numbers of households. 

Response rate: 45% (n=4,570) Data source: Self-reported mailed questionnaires Incontinence as, “Urgency with urge incontinence.” 

Age: 40-100 (Mean: 61) Gender: Male and female Race: Not reported Ethnicity: Not reported Residency: Japan 

Prevalence: 

Overall (Urge incontineMale: 6% Female: 7% 

Jorgensen, 2005114Cross-sectional Adjusted by: Age, Gender Health status, Medical history Drug use, Alcohol consumption Smoking Level of evidence: III

Selected from all in the municipality of Tromso including those that had suffered stroke and controls. 

Response rate: 64.5% (213 stroke patients, 242 age-matched controls) Data source: Self-administered questionnaires and clinical evaluation Incontinence as, “Involuntary loss of urine.” 

Age: 24 and older Gender: Male and Female Race: Not reported Ethnicity: Not reported Residency: Norway 

Prevalence:  Controls: Stroke survivors: 

By severity - “More tha Controls: Stroke survivors: 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F127 

Author Sample 

Subject Selection, Response Rate, 

Data Source, Measurement 

Methods (survey, screening, case 

finding, definition) 

Subject Age, Gender, Race, Ethnicity, 

Residency 

Prevalence (%) of 

Severity, and 

Jumadilova, 2005115Design: retrospective, cross sectional secondary data analysis Adjusted: demographics, comorbid conditions, locomotion, incontinence appliances/conditions Purpose: To provide a descriptive overview of the elderly, nursing home patient population with UI 

Population: 200,000+ residents of eligible NH nationwide 

Sample: All residents of any home in the US if admitted to eligible home and rec’d care between 1/2/02 and 12/31/03 (n=87,000) Analyzed: 57,596 records Data Source: MDS, NH progress notes, care plans, medication and tx records, physician orders, accounts payable/receivable and cost accounting Definition of UI: used MDS question H, 1b to classify UI 

Subjects: =29,645 Women: 63.8% Race: 89.2% white Resided in US Excluded n= 27951; if rec’ing hospice care, were comatose or had bowel incontinence during the period as indicated on the MDS 

UI prevalence prior to eincontinence : 58% (33

Of those eligible UI pre(8,995/29,645) No breakdown by type, 

Stothers, 2005116Cross-sectional Adjusted by: Age Ethnicity Education Income Region Special needs requirements Level of evidence: III

Subjects were selected from pooled population based surveys and Medicare data. 

Response rate: Not reported Data source: Population based surveys, such as NHANES, as well as Medicare data. Incontinence was defined as, “Difficulty controlling bladder.” 

Age: 60+ Gender: Male Race/Ethnicity: Non-Hispanic White, Non-Hispanic Black, Mexican-American, Other, Other Hispanic Ethnicity: Same as above Residency: USA 

Prevalence: Overall: 17% 

By age: By ra60-64: 11% Non-65-69: 11% Non-70-74: 19% Mexi75-79: 27% Othe80-84: 27% Othe85+: 31% 

Tegerstedt, 2005117Design: cross sectional mailed survey Adjusted: age and parity Purpose: To estimate prevalence of symptomatic pelvic organ prolapse in urban female population 

Population: 8,000 residents 30-79 years, representative of source population (random sample) Response rate: 69% (5,500/8,000) 

Source: validated 5 item questionnaire with weighted scoring giving a total score Definition: Do you suddenly feel the urge to go to the toilet and then accidentally leak urine? Do you leak urine when you cough, sneeze of lift heavy objects? 

Subjects: n=5,489 100% women No race/ethnicity figures given Resided in Stockholm, Sweden Excluded: inconsistencies in age information From updated Swedish population register 

Overall UI: no figures go SUI: 63.2% (3444/54o Urge UI: 50.5% (275

o Mixed UI: 3.2% (CI 2“Frequent” (often) SUI: “Frequent” (often) Urge 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F128 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Adelmann, 200450Prospective cohort 

Community UI prevalence sample of a 1998-1999 survey enrolled in a Medicaid managed health plan in 7 county Minneapolis/St. Paul metro area 

Age 65 above Random sample of 910 persons enrolled in Medicaid health plan. Of this the n= 378 that were eligible due to UI. Sample was further limited to persons based on at least one claim for a doctor’s visit and medical chart could be located. n=236 Nursing home abstraction sample was randomly drawn from Medicaid persons for a total of 480 persons. Interviews face to face in residence. Response rate 59%, cooperation rate 90% Abstraction of medical record at clinics also. Definition – ever/current UI measured by a yes response to questions about trouble holding urine or leaking urine 

Characteristics of community and nursing home N=910  Community Nursing Home Women 82.1% 79.2% Men 17.9 20.8 Age in years 65-74 50% 14% 75-84 34.9 34.2 85+ 15.1 51.9 mean 75.9 84.5 

Race White 69.4 93.8 Black 14.5 4.6 Other 16.2 1.7 

Prevalence of UI in community sam Ever/current Past week Total 41.6% 23% Women 45% 25.5 Men 25.8 11.7 Age 65-74 34.1 17.6 75-84 45.3 26.2 85+ 58.1 33.8 White 45 25.5 Black 39.8 20.3 Other 30.1 16.1 

Andersson, 200410Population based study, cross sectional Prospective no control mentioned 

3/2000, Life and Health questionnaire sent to 70,000 residents randomly selected from 274,000, who participated in above study; a special section on UI was given to a sample of 15,360 residents 18-79 years. 

7,680 females 7,680 males 

Age categories 18-37 53.9% 35-52 60.3 50-67 69.6 65-82 72.2 

Prevalence for UI was 19% when and 7% when defined as ‘at least o17% with UI reported severe probl

daily life 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F129 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Response rate was 64.5% Postal questionnaire with 12 questions on UI using definitions from ICS Stats on weights and calibration and found results were the same 

Orebro, Sweden 

Bogner, 200411Population based longitudinal survey II-2B 

ECA (Epi Catchment Area) program used to sample 3,481 community dwelling adults (African Americans and Whites initially living in area in 1981) selected for this study. 1,920 were contacted (73% of original cohort) including 822 persons ≥50 years who 

completed info on UI. After exclusions for missing data, 747 were the final sample. Cohort ≥50years at followup interview performed 1993-1996. Those ≥65 years were over-sampled GHQ used and self report on UI UI = “Have you ever had any difficulty in controlling your water, losing your urine or having trouble getting to the bathroom on time?” If any uncontrolled urine loss was reported within the 12 months before the interview, persons were classified as having UI. 

Mean age of study sample was 67.2 64% were women 72.3% White; mean age 68.2±11 27.7% AA – mean age 64.5±10  White Black Diabetes 14.3 6.9 Heart trouble 27.4 26.6 Arthritis 51.1 56.5 Stroke 8.2 7.3 Cancer 14.4 6.3 

MME 27.6+-2.6 25.6+-3.6 ADL impaired 1.9% 3.9% East Baltimore, MD USA 

19.8% reported UI during the year 

 white(540) AA(207) UI 22.4% 13% No information on SI, Urge Incon. 

Corcos, 200412Prospective cohort. 

Population ≥35 years, stratified by census of metro area and by gender. 7,487 persons in 

48.2% men; mean age 52 51.8% women; mean age 50.9 

603 persons had wet OAB, dry or and 21.3% women) Prevalence of wet OAB; 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F130 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

No control mentioned. 

the sample base. 53.7% response rate with 3,249 interviews in final sample. 

Investigators developed standardized questionnaire to ascertain OAB and SUI and impact on quality of life. Computer assisted telephone interviews conducted in 2 steps: an initial questionnaire evaluated presence of OAB followed by detailed questionnaire completing the assessment. Urgency – “In past few months, did you ever feel an urgent need to urinate, to such a point that if you did not immediately go to the bathroom, you risked having an involuntary urine loss or leak?” 

82.4% < 65 years. 17.6% > 65 years. Montreal, Toronto, Vancouver and Edmonton, Canada 

2.3% (2% men and 2.6% women) Mixed OAB 1.2% (3% men and 2.1% women) Urgency total men woEvery day 1.5% 9% 23-4 times/week 1.5% 5% 21-2 times/week 3.6% 2.7% 44 times/4weeks 1.9% 1.3% 2≤3/month 12.7% 11.6% 13Urgency 9.4% (15.3% men and 23.3% womSUI; 5.9% (.8% men and 10.6% w

Dallosso, 200413

Prospective longitudinal study. 

II=2B 

Part of the Leicestershire MRC Incontinence Study, focused on women ≥40 years 

living in the community: From a random sample of 20,244 women drawn, 12,565 returned the questionnaire (65% response). 

7,046 completed FFQ sent to 10,852 of above sample (response rate 65%). 1st

postal questionnaire mailed Oct 1998 and completed by 7,046 women. 2nd postal 

questionnaire mailed Oct 

Baseline data compared to those who provided FFQ data – Median age 57 vs. 61 Rating of health poorer in baseline after adjusting for age (OR: 1.66; 95% CI 1.51-1.82) More long term health problems in baseline (OR 1.14; 95% CI, 1.05-1.25) No difference in reporting SUI (OR: 1.02; CI 95%, .92-1.13) Leicestershire, UK 

Prevalence of SUI at baseline was 

 Prevalence at baseline  Total N SUI cases % 40-49 1,694 16.7 50-59 1,761 19.8 60-69 1,453 16.2 70-79 995 15.2 80y + 321 18.1 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F131 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

1999 and completed by 6,424 women (91% response rate). Excluded: those in residential/nursing homes and those of South Asian origin (5.3% of pop ≥40 years). Used ICS definitions. 

de Tayrac, 200431Case control, retrospective study II-3 *Authors state it was a case control but they had a control group 

717 women who had Dargent and Rudigoz technique. 365 (50.9%) returned questionnaires, 449 did not respond. 51 excluded leaving 314 women. 

117 patients who had a vaginal hysterectomy for menorrhagia from Jan 1991 to Dec 2001 and a control group of 116 patients who had conservative treatment. 197 had hysterectomy for pelvic pain and 117 for menorrhagia. Self report questionnaire. 

 Vaginal hyst. Control Age 51.4 50.9 Parity 2.1 2.2 Menopause 43.5% 47.4% Smoking 17.9% 17.2% Drink>2 L/d 7.7% 9.5% Hx of uro sxs 0 0 France 

Prevalence (as stated in article)  Vag hyster % coFreq day>8 19.7% 1Noc: day >1 5.1 6Urgency 62.4 5Qmo 36.8 3Qwk 19.7 1Qday 6 1UI 39.3 3Use of pads 15.4 1Urge Inc 20.5 1Qmo 12 7Qwk 4.3 5Qday 4.3 0SI 36.7 3Qmo 18.8 1Qwk 12.8 8Qday 4.3 3

Age <60 VH CUI 41.8% 3UI 21.8 1SI 40 3Age >60 UI 28.6 4Urge UI 14.3 2SI 28.6 3

Foldspang, 200451Age stratified random samples II-2A 

Sample of 6,240 and 6,468 women living in the municipalities of Aarhus and Randers 20-59 years. 

C-sec in 12.2% of 1st childbirths. Average age – 32.8yrs (20-41). 52.1% reported having 2 births or more. Mean age at 1st birth = 27.5yrs and 

UI during pregnancy with 1st child 

and 12% of deliveries by c-section 

UI following 1st birth was reported 

UI >4wks, 9.4%); 2nd birth, 30.5% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F132 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Analysis based on 1,232 women in combined samples who reported their 1st and last 

childbirth within 13-120 months prior to responding to the questionnaire; minimum f/u period after childbirth was 12months. 

Self questionnaire mailed Jan-March 1995 and 1998. 67.8% responded 

29.9yrs at 2nd..

Average duration since 1st childbirth was 

5.3yrs. Denmark 

>4wks, 5.9%) 

Table I. 1st and 2nd birth postpartu

(PPUI) occurrence* by UI during pdelivery (cesarean section vs. vagchildbirth number, in 1232 womenDenmark, 1995 and 1998 WDeterminant n (%) (%) OR 1st birth (n=1,232) 

All women 1,232 (100.0) 26.3 Pregnancy UI Yes: 192 (15.6) 66.7 8.6 (6.1–12.1No: 1,040 (84.4) 18.8 (ReferenceMode of delivery Vag: 1082 (87.8) 28.3 2.9 (1.7–4.8C- section: 150 (12.2) 12.0 (Refere

2nd birth: (n=642) All women: 642 (100.0) 30.5 Pregnancy UI Yes: 119 (18.5) 75.6 12.2 (7.6–19No: 523 (81.5) 20.3 (Reference) Mode of delivery Vag: 603 (93.9) 31.3 2.1 (0.9–4.8) C section: 39 (6.1) 17.9 (Referenc*PPUI occurring at all. †p<0.10; ‡pTable II. 1st and 2nd (PP UI) occudelivery; cesarean section (CS) vspreceding pregnancy UI (PRUI) anwomen. Pregnancy UI Mode Total no. PPU1st birth (n=1,232) PRUI VC 169 PRUI CS 23 No PRUI VC 913 No PRUI CS 127 2nd birth (n=642) PRUI VS 113 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F133 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

PRUI CS 6 No PRUI VS 490 No PRUI CS 33 

Fritel, 200452retrospective cohort II-2C 

French women from hospital database of 1st birth women 

who had not previously delivered fetus >22 weeks 307/669 primiparous women who delivered in 1996 in vertex position between 37-41 wks (274 had moved and 88 did not respond) 45.9% response rate. Excluding the women who did not receive the questionnaire (274), response rate was 77.7% Questionnaire sent by mail 4weeks after delivery asking about SUI before, during and after pregnancy – “Do you have loss of urine during physical exertion, cough or sneeze?” UI categorized slight, mode or severe using Sandvik Index. 

Age at delivery (years) 

29.3 (4.4) 

BMI (kg/m2) 21.3 (2.9) Birth weight (g) 3240 3240 (384) Labor (h) 6.2 (2.3) Active 2nd stage (min) 11.1 (7.5) Cesarean section 10.1 (31) Forceps 36.2 (111) Third-degree tear 1.3 (4) 

Circumstances of leakage Stress Urge Other circumstances Frequency of leakage Less than once a month One to 3 times per month One to 3 times per week Everyday Unknown Amount of leakage Drops Small amount More Unknown Bothered by incontinence Not at all A little Moderately A lot Unknown Use of pads for incontinence None One to 6 per week One or more per day Unknown 

Haltbakk, 200418Prospective cohort no control mentioned ?historical control 

480 Norwegian men at St. Olavs Hospital, Trondheim Norway. Tentative dx of BPH made on 612 pts and from this pool, sample analyzed was 480 (78%). 

ICS LUTS questionnaire (ICS-BPH) between 1997-2000. IPSS, SPI and SISI 

Mean age of patients was 67 years, SD 10.6 years; median 69 years range 39-9 1years 

mean age in incontinent group was 68 years 

37% any leakage 12% slight 18% moderate 3% severe 4% not possible to classify 

20% experienced at least some bo21% drops 13% small splashes 1% substantial amounts 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F134 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

used also. UI defined as any involuntary leakage of urine. 

61% of incontinent group had urge 2% had stress incon 9% had mixed 28% were unclassified 

Holroyd-Leduc, 200419Population based Prospective cohort Confounders – sex, age, sex, race, smoking, alcohol, BMI, sensory impairment, comorbid disease, depression, cognitive function and baseline dependency. II-2A 

Community dwelling in US 6506 of 7447 subjects aged 70 and > in the Asset and Health Dynamics Among the Oldest Old study who had complete info on continence status were baseline –outcomes 3 groups- 5,872 nursing home, 5521 ADL decline and 5,509 IADL decline as outcomes 

Subjects interviewed in 1993 and 1995 Blacks, Hispanics and Florida residents were over-sampled Overall response rate was 80% UI measured “next question might not be easy to talk about, but it is very important for research on health and aging, during the last 12 months, have you lost any amount of urine beyond your control?” 

Mean age =/- SD = 77 (range 69-103) 63% female 86% white 

Median number of baseline comorbid medical conditions was 2 10% received help with ≥1ADLs and 23% were receiving help in ≥1 IADLS at 

baseline 

Pts with UI had more comorbidities (p =.001), higher rate of visual impairment (35% vs. 22.4% p <.001) and hearing impairment (39.7% vs. 30.5% p <.001) more functionally impaired at baseline 

Baseline prevalence for UI was 148.5% in men) 

Hunskaar, 200420Cross national study, Prospective No control group 

Postal survey mailed to 29,500 households in 4 countries – France, Germany, UK and Spain (age ≥18yrs) 

58.1% response rate 5976 women with UI included in analysis (35% of study pop) 

Mean age France – 44.8 Germany – 59 UK – 45 Spain – 64 All – 58 

In all, 35% of women reported they 

France – 44% Germany – 41% Spain – 23% UK – 42% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F135 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Definitions used by ICS; sxs in last 30 days and in last 7 days 

Jackson, 200422population based Prospective cohort; also randomly selected from HMO diabetes registry II-2A 

1,017 post menopausal US women a 55-75 years enrolled in HMO and followed for 2 years (1998-2002) inclusion criteria were no natural menstrual cycle in past 12 months (oral estrogen or vaginal estrogen users were excluded), resided in Washington state. Exclusion factors were residential nursing care, restriction to wheel chair, dementia or severe psych disorder, indwelling catheter or intermittent urinary catheter, end stage renal disease requiring dialysis, active malignancy other than skin cancer and chronic antibiotic use. Acute cystitis in past 90 days exclusionary. 

Postvoid residual bladder volume measured using portable ultrasound device. 12 month f/u done by 87% and 24mo f/u by 81%. Primary study outcome was sx cystitis. 

Frequency of Exposures at Enrollment and Univariate Risk of Symptomatic Urinary Tract Infection Characteristic (%) Hazard Ratio  (95% Confidence Interval) Complete sample† 1,017 (100) Age (years) 55-59 32 1.0 60-69 42 1.3 (0.8; 2.2) 70-75 26 1.6 (0.9; 2.9) Ethnicity White 87 1.0 Other 12 0.6 (0.3; 1.2) General health score from SF-36 76-100 (51) 1.0 51-75 (37) 2.0 (1.2–3.3) 0-50 (12) 2.6 (1.3–4.8) Smoking history Never (55) 1.0 Former (39) 0.9 (0.5–1.4) Current (6) 0.1 (0.02–0.8) Diabetes at baseline No (79) 1.0 Yes (21) 1.9 (1.1–3.1) Diabetes treatment type Not diabetic (79) 1.0 Diet or pill (17) 1.2 (0.7–2.0) Insulin (4) 4.7 (2.2–10.3) Accidental leakage of urine in last year No (34) 1.0 Yes (66) 1.6 (0.9–2.7) Type of urinary incontinence in last month None (41) 1.0 Stress only 174 (17) 

Accidental leakage of urine in last No (34) Yes (66) Type of urinary incontinence in lasNone (41) 1.0 Stress only 174 (17) 19 0.9 (0.5–1Urge only 106 (10) 20 1.7 (0.8–3.6Stress and urge 324 (32) 52 1.4 (0Postvoid residual bladder volume <50ml residual (79) 1.0 50-100ml residual (10) 1.1 (0.5>100ml residual (10) 1.6 (0.8
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F136 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

 19 0.9 (0.5–1.8) Urge only 106 (10)  20 1.7 (0.8–3.6) Stress and urge 324  (32) 52 1.4 (0.9–2.4) Postvoid residual bladder volume <50ml residua  (79) 1.0 50-100ml residual  (10) 1.1 (0.5–2.2) >100ml residual  (10) 1.6 (0.8–3.2) History of hysterectomy No (69) 1.0 Yes (31) 1.2 (0.8–2.0) History of kidney stones No (90) 11.0 Yes (5) 2.4 (1.2–4.9) History of bladder or urinary surgery No (90) 1.0 Yes (10 1.6 (0.9–3.0) Parity (no. of full-term pregnancies) 0 (14) 1.0 1-3 (63) 1.3 (0.7–2.5) >4 (23) 2.2 (1.1–4.3)

Jackson, 200421

cross sectional analysis, longitudinal study 

II-2A 

Of 1,584 white and black women 70-79 years at 2 clinical sites in Pittsburg and Memphis recruited, 1,558 answered the questions. 

Enrollment Limited to those who reported no difficulty walking 1/4mile, climbing 10 steps or performing ADLs Questionnaires – in the past 12 months, have you leaked even a small amount of urine? How often have you 

Mean age 73.5 49% were black 20% diabetes 64% arthritis 55% hypertension 

27% white reported weekly UI vs. 14% black 

9.6% reported daily UI 11.6% weekly UI 24% less than weekly UI (note abstract reports a different wreports above number) of those with weekly UI Urge UI was 42% and SI was 40% unrelated to stress or urge was 14
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F137 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

leaked? 

Johnson, 200423Long term cohort, Prospective study of RRP vs. Radiotherapy II-2B 

Men from the Prostate Cancer Outcomes Study dx with primary prostate cancer between Oct 1994-Oct 1995 

Residents of LA, King County, Washington, states of Connecticut, NM, UT, between ages of 60-89yrs in King County and younger than 90 in others. Self questionnaire at 6, 12, 24 and 60 months after diagnosis and medical record review at 12 and 60 mos. 11,137 men identified in registries; 5672 randomly selected, letters sent to 4,736(83.5%) of selected cases. Total of 3,533 men(62.3%) completed 6 and 12mo were included in f/u cohort. 1433 men had RRP completed 6mos 1178 did 24 months (82.2%) 1109 did 60mos (77.4%) For Radiotherapy – urinary problems not reported Questionnaire also translated into Spanish and interview conducted in Spanish when necessary. 

1,433 men RRP 642 men received Radiotherapy 

RRP group – wt % by race  NHW AA Hispanic Arthritis 33.3 38.6 35.8 Diabetes 11.1 29.5 17.2 COPD 7.5 6.6 5.4 HF 4.9 2.1 4.4 CVA 2.6 2.5 3.3 HTN 37.3 54 37.5 MI 7.9 4 4.2 Age at dx <60 27.5 38.6 23.4 60-64 26.8 26.1 30 65-75 41.9 32.9 45.5 >/=75 3.8 2.4 1 

Wt % for men with RRP  NHW AA Level of urinary control baseline Total control 87.9 86.6 Occ leakage 8.8 9.5 Freq leakage 2.1 2 P = .77 6months Total control 22.7 27.6 Occ leakage 52.1 44.2 Freq 22.6 23.4 P = .57 12 months Total control 33.1 38.5 Occ leakage 50.2 51.4 Freq 15.6 9 P= .24 24 months Total control 38.2 41.9 Occ leakage 50.2 45.1 Freq 9.8 11.1 P = .86 60 months Total control 30.8 49.3 Occ leakage 53.7 39.7 Freq 14.3 10.4 P= .01 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F138 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Lagergren, 200424National, longitudinal, multipurpose study in Sweden (SNAC). Study consisted of two parts – population part and the care/service part. II-2A 

Subjects from Skane, Karlskrona, Kungshomen and Nordanstig from ≥65 years 

starting in 2001 to 3/2004. 

Total pop of SNAC 17,044; baseline 8,627 targeted persons 7,518 sampled. 16-25% received public care. F/U every 6 yrs beginning at age 66. Combo of interviews and questionnaires 

Men 3,052 Women 4,465 Total 7,518 

12% 65-79yrs old, 6% >80yrs Avg age 85 compared to avg age in Sweden 83 

Severe UI – Ordinary homes – 15% Special accom - 44% Total 31% 

Moorthy, 2004118Cross-sectional Adjusted by: Age, Occupation, Income Family history Place of residence Level of evidence: III

Subjects randomly selected from men visiting urology clinics in 11 Asian countries. (n=2,369) 

Response rate: Not reported Data source: Selfadministered questionnaires Incontinence as, “Urgency with urge incontinence.” 

Age: ≥18 years 

Gender: Male Race: Not reported Ethnicity: Asian Residency: China, Hong Kong, India, Indonesia, Philippines, Singapore, Korea, Thailand, and Taiwan. 

Prevalence (Urge incontinence): 

Overall: 13% 

Ozerdogan, 200429

Cross sectional Prospective study. 

II-2A 

625 women ≥20 years, living in 4 different cities in Turkey. 1/4 resided in rural area. 1/5 gave birth at least ≥4 times and most were vaginal deliveries (25%). Illiteracy rate 9.4% 

Questionnaire and I-QOL Rare – UI <1 time/month. Reg – UI >2 times/month Serious – continuous use of sanitary protection. SI and Urge defined as usual definitions. 

Age distribution 20-29 – 26.4% 30-39 years – 22.6% 40-49 years – 18.7% 50-59 years – 13.4% 60-69 years – 11.7% ≥70 years - 7.2% 50% BMI >25.0% Smokers 25.0% Recurrent UTIs 19.0% Diabetes 6.6% COPD 7.5% Neurological disorders 11.2% 

Prevalence of UI was 25.8% Rate of rare UI was 9.3%, serious SI in women with UI was Urge was MI was Prevalence of SI was greatest befourge incontinence. MI dominated in women ≥50 yrs. 

Prevalence increased in diabetes, UTI. Smoking, HRT menopause did noprevalence. 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F139 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Schytt, 200430Prospective, longitudinal cohort II-2A 

After childbirth at 593 clinics 5,550 women booked appts during recruitment time, 4,500 eligible, 3,191 consented. Three questionnaires: 1st at 

baseline (n=3,061) , 2nd

mailed 6-8 weeks after the birth(n=2,762) and 3rd 1 yr 

after birth(n=2563). Total 2,450 completed all three. Study sample was 2,390 women after exclusions. Women were asked to recall any sxs of UI during and after pregnancy. 

Selected data from a National Swedish survey investigating physical and psychological assessment of childbirth May and Sept 1999 and January 2000 antepartal visits Excluded miscarriages, nonSwedish speaking, and women from nonparticipating clinics, delivery of twins 

Average gestation: 1st quest – 16 weeks, 

2nd – 10 weeks post, 

3rd – 1 year and 2 weeks. 

Avg age at recruit – 29.5 years Primiparas – 44% Multiparas – 56% 79.2% had vaginal delivery 13.4% had c-section Sweden 

21.7% sxs of SI at one year Prevalence Primi Multi Vaginal 18.4% 24.3% 23.4% 

Stenzelius, 200454Cross-sectional Adjusted by: Age, Gender, Quality of life, Occupation, Economy, Living condition, Need of help, Satisfaction with children contact, and problems with Communication, Mobility, Elimination, 

Subjects were selected and mailed a questionnaire from a randomized, age-stratified sample of persons ≥75 years 

living in a southern part of Sweden. Response rate: 52.8% (n=4,277) 

Data source: Self-reported postal questionnaire Incontinence as a yes to the question, “Have you had problems controlling urine in 

Age: 75 and above Mean: 83.7 (SD: 5.69) 

Gender: Male and Female Male: 38.4% Female: 61.6% Race: Not reported Ethnicity: Not reported Residency: Community dwelling and special accommodations residents in Southern Sweden. 

Prevalence by age group and seve

Male 75-79 80-8A little 26 23.6 Very much 5.2 8.9 Total 31.2 32.5 Female 75-79 80-84 A little 23.2 26.8 Very much 10.1 13.5 Total 33.3 40.3 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F140 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Digestion, Breathing and circulation Psychosocial problems Other type of pain Level of evidence: III

the last 3 months?” 

Vandoninck, 200455Age stratified Prospective cohort for men in the original study. Mentions sampling wts upon the ratio of # of women in each age group in the sample to # of women in the age group in population. 

Dutch women from Urepik (Uro Epi in Europe and Korea)study in the community 

In 1999, a national postal questionnaire survey of 1,460 spouses of 1,771 men. 1,071 returned - 73 response rate UI assessed by total score on short UI specific questionnaire – 3 groups – no sxs score (0-2); minimal (3-6) and severe (7-14). In addition, self reported UI was calculated conforming to ICS standard definitions. “Do you ever have involuntary urine loss?” QOL also used 

During the past month: % How often have you leaked urine? 0) Never 54.5% 1) ≤1/week 19.6% 

2) >1 but <3 times/week 10.0% 3) >3 times/week 6.0% 4) Nearly always 8.6% If you experienced urine loss, how much did you leak? 0) I never leak 50.2% 1) Some drops 32.2% 2) A small stream 11.4% 3) Protection material or clothes soaking wet 4.9% 4) Leaking through pads or clothes  0.3% How often do you use protection material 0) Never 68.1% 1) Occasionally 21.4% 2) Nearly always 3.9% 3) Always 5.8% Did you lose urine on coughing or sneezing? 0) Never 31.1% 1) Occasionally ) 45.0% 2) Nearly always 13.5% 3) Always 9.3% 

Mean age 57 (29-79) 34% minimal UI. 12% severe Self report UI was 40% 38% consulted physician Mean parity 2.6 13.5% women were childless 

68% SUI

Teunissen, 2004119Cross-sectional Adjusted by: Age 

Subjects selected from patients ≥60 in 9 general practices in the Nijmegen Monitering Project, Netherlands. 

Age: 60 years and older Gender: Male and Female Male: 46% Female: 64% 

Prevalence: Overall=19%, Male:=9%, Female=By Age and Gender: Male: 

Age Prevalence % 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F141 

Author Sample

Subject Selection, 

Response Rate, Data 

Source, Measurement 

Methods (survey, 

screening, case finding, 

definition)

Subject Age, Gender, Race, Ethnicity, 

Residency

Prevalence (%) of UI, Overall: 

Impact on 

Sex Level of evidence: III 

Response rate: 88% (n=4,650) 

Data source: Self reported, mailed questionnaires. Incontinence was defined as, “Involuntary loss of urine twice or more per month.” 

Race: Not reported 

Ethnicity: Not reported Residency: Netherlands 

60-64 5 65-69 6 70-74 8 75-79 14 80+ 21 Total 9 

Female: 

Age Prevalence % 60-64 22 65-69 26 70-74 29 75-79 36 80+ 38 Total 29 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F142 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Araki, 2003120Cross-sectional Level of evidence: III 

Subject selection: Using the I-PSS questionnaire with an additional question on urinary incontinence, LUTS in all outpatients 40 years or older were examined from June 2001 to December 2002. 

Exclusion criteria: Concurrent urinary tract infection, psychological disease, medication with anticholinergic agents, alpha-receptor blockers, antiandrogens, diuretic agents or other drugs that may possibly affect urinary function. Response rate: 550/1201= 46% Data source: Clinic based Definition: The severity of symptoms was defined by the total I-PSS as mild—0 to 7, moderate—8 to 19 and severe—20 to 35. By an additional question urinary incontinence was scored from 0 to 3 as 0—not at all, 1—wet underwear, 2—wet clothes and 3—a large amount. 

Men and women aged 40-92 years 

Japan 

Women: UI Prevalence: = 40% Severity: Moderate to Sev40-49 years (24%) 50-59 years (24%) 60-69 years (39%) 70-79 years (45%) 80 yrs or older (50%) Men: UI Prevalence = 24% Severity: Moderate to Sev40-49 years (30%) 50-59 years (38%) 60-69 years (44%) 70-79 years (52%) 80 years or older (58%) 

Boyle, 2003121Level of evidence: II-2 

Subject selection: A standard questionnaire asking about frequency and amount of urine loss, use of pads and stress incontinence, was used to measure the prevalence of UI among men in four countries. 

4979 men responded to the questionnaire. Definition: UI was assessed using the total score from four questions which asked about frequency and quantity of urinary leakage, the use of pads and stress incontinence. The score was 0–14, with high scores indicating the presence of a problem. Groups were defined as 0–2 (none), 3–6 (mild), and 7–14 (severe). 

Men Age: 40-79 yrs Boxmeer, The Netherlands; Auxerre, France; Birmingham, UK; and Seoul, Korea). 

Prevalence: Mild-Severe UUK= 14.4% Netherlands=16.2% France=7.3% Korea=4.3% 

Age related prevalence: 40-49yrs UK=14.4% Netherlands=12.7% France= 5.2% Korea= 1.9% 60-69 years UK=13.7% Netherlands=22.6% France= 9.2% Korea= 8.0% 

Burgio, 2003122Level of evidence: II-2 

Subject selection: Participants:  women, ages 14 to 42 years, who had obstetrical deliveries. The women were interviewed on postpartum day 2 or 3 and by telephone 6 weeks, 3 months, 6 months, and 12 months postpartum. 

Definition: When obtaining the continence history, the interviewer asked, “Have you ever experienced any 

Women Age:14 to 42 years (mean, 28.6 years; median, 29.0). 

Caucasian:82.4%, Black: 16.1% Hispanic/Asian:1.2% 

Prevalence : UI Intra-partum =59.6% 6 weeks =11.36% 3 months =9.32% 6 months =10.51% 12 months =13.25% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F143 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

difficulty controlling urination? Have you ever had any accidental loss of urine, even a small amount?” A negative response was followed by rephrasing the question, “Have you ever wet yourself?” Those who acknowledged any incontinence were asked several questions about onset, course, when it occurred, under what circumstances, and the frequency and volume of urine loss. 

USA 

Chen Gin-Den, 2003123Level of evidence: II-2 

Subject selection: 1,581 women sampled (2.92% of registered female residents aged 20 years and older), 

Response rate: 1,253 (79.1%) women were successfully interviewed by using the Bristol Female Urinary Tract Symptoms Questionnaire and the Questionnaire of Impact index regarding the impact on quality of life. Definition: Urinary incontinence as involuntary urine leakage occurring during physical activities that cause stress or an increase in the intra-abdominal pressure and was considered by the participant to be a hygienic or social problem. Severity of UI was classified as: Grade 1 is defined as mild leakage with moderate stress, no protection is needed. Grade 2 is moderate leakage with moderate stress, and protection is needed with excessive activity. Grade 3 is severe leakage with mild stress, and constant protection is required except at rest. Grade 4 is incontinence at rest, and in need of constant protection. Urge incontinence was defined as involuntary urinary loss preceded by the urge to void or uncontrollable 

voiding with little or no warning. 

Overactive bladder was defined as having symptoms of frequency and urgency, or nocturia, with or without urge incontinence. Women who had both stress and urge incontinence were defined as having mixed incontinence. 

Age: Mean= 43.2yrs 

Taiwan 

Prevalence Stress UI:18% Urge UI:18.6% Mixed UI:17.1% Women who were elderly, vaginal deliveries, higher Bsymptoms of uterovaginal diabetes or hypertension wpredisposed to an overactIn multivariate models, presurgery (OR, 2.0; 95% CI, 2.0; 95% CI, 1.1, 3.8), a h3.3; 95% CI, 1.5, 7.6), and uterovaginal prolapse (OR87.1) are the potential risk Overactive bladder is only symptoms of uterovaginal CI, 7.8, 58.2). Overall, the women suffertypes of urinary incontinenworried about smelling of their clothes (68.2%), pad (45.8%), and exposure of At least one third of the wourinary incontinence limiteincluding family life (31.8%(32.7%), outings for pleaschanged their interests or Approximately 19% of the incontinence reported an ion their sexual life. The reof social activities were du
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F144 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

wetting or leakage (60.8%available (60.8%). The stu27.1% of the women sougtheir symptoms. 

Chen Yi-Ching, 2003124Level of evidence: II-2 

Subject selection: Women from a stable community located in central Taiwan. 

1,584 (2.92%) were randomly sampled, 1,253 (79.1%) were successfully interviewed at home. A total of 1,247 (99.5%) women with complete data were included. 

Age Mean(SD): 43.2(+-15.1) 

Taiwan 

Prevalence of Urge UI Overall: 9.1% Pre-menopausal: 6.8 Menopausal: 15.7% 

Engstrom, 2003125Level of evidence: II-2 

A self-administered questionnaire. 

The questionnaire included items on three specific urinary symptoms: urgency, stress incontinence and post-micturition dribbling, and one question about health care-seeking behavior. A response rate of 86% was obtained in the questionnaire study. Definition: The Stress UI question asked the respondents whether they had experienced involuntary urinary loss in association with for example sneezing, lifting, or coughing. 

Men Age: 40-80yrs 

Sweden 

Prevalence of Stress UI: All ages: 2% 40-49yrs: 1% 50-59yrs: 2% 60-69yrs: 4% 70-80yrs: 5% 

Espino, 2003126Cross-sectional Level of evidence: II-2 

Subject selection: A total of 1589 Mexican-American women aged 65 and older who were part of the Hispanic Established Population for the Epidemiologic Study of the Elderly. 

Definition: Stress incontinence symptoms were identified with the question: ‘‘During an episode of severe coughing, sneezing, vomiting, lifting, laughing, or straining, do you lose any urine?’’ Urge incontinence symptoms were determined by positive responses to the question, ‘‘Do you have a feeling of needing to urinate before you lose your urine?’’ 

Women 65 and older 

Mexican-American USA 

Prevalence UI: 15% Stress: 10% Urge: 33% Mixed: 42% 

Eva, 2003127Level of evidence: II-2 

Subject selection: 1000 women born in 1937 and 1000 women born in 1957 were randomly selected. 

The 2000 women received a postal questionnaire concerning their medical and obstetric history, height and weight, exercise and professional activity, and urinary and fecal incontinence defined as flatus, 

Women, aged 40 and 60yrs old. 

Sweden 

Prevalence 

Monthly 

40-yearolds 8% 60-yearolds 10% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F145 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

liquid or solid stool. The incontinent women were asked how often leakages occurred. The urinary incontinent women were asked to complete a set of ten questions concerning voiding and leakage. These questions were adapted from the detrusor instability score (DIS) developed by Kauppila. for detecting detrusor instability in incontinent women Response rate: 67 (%1336/2000) 

UI weekly or more often: 

Age Prevalence19-44 9 45-64 19 

Goldberg, 2003128Level of evidence: II-2 

Subject selection: The study population included 769 mothers of multiples. 

Response rate: 95.3% (733/769) attendees completed the survey. 

Age Median: 37 years Range, 22-75 years 

Ethnicity 94% white, 2.3% black, 1% Hispanic, 0.6% Asian. Parity Mean: 3 Range: 2-12 USA 

Prevalence SUI: 45.5% UUI: 27.3% Mixed: 22.9% 

Grodstein, 2003129Prospective/Observational Level of evidence: II-2 

Subject selection: The Nurses’ Health Study cohort was identified when 121,701 female, married registered nurses, 30 to 55 years of age who resided in 1 of 11 US states returned a mailed questionnaire in 1976.In 1996, information was requested regarding urinary function from study participants. Included were two questions to evaluate the frequency and extent of urine leakage and difficulty holding urine. 

Frequency and quantity of urine loss. Women were asked the question: ‘‘During the past 12 months. How often have you leaked urine or lost control of your urine?’’ with response categories of ‘‘never,’’ ‘‘less than once a month,’’ ‘‘once a month,’’ ‘‘2 to 3 times a month,’’ ‘‘about once a week,’’ and ‘‘almost every day.’’ Women who responded that they lost urine were then asked, ‘‘When you lose your urine, how much usually leaks?’’ with response categories of ‘‘a few drops,’’ ‘‘enough to wet your underwear,’’ ‘‘enough to wet your outer clothing,’’ and ‘‘enough to 

Age Mean: 60.4yrs 

USA 

Prevalence (Reported leaking at least Overall: 17.7% White: 17.9% Black: 9.6% Hispanic: 15.6% Asian: 12.5% 34.1% of the women repoonce per month during the The prevalence of leaking the black, Hispanic, and Awith white women, althougfor the black women (21.2women said that they leakweek; again, 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F146 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

wet the floor.’’ 

Hunskaar, 200420Prospective/observational II-2 

Subject selection: Data collected using postal survey sent to 29,500 community dwelling women ≥18 years 

in 4 countries. 

Definition: UI as any leakage or involuntary loss of urine. Stress UI as a leak or loss of urine caused by sneezing, coughing, exercising, lifting or physical activity. Urge UI as either as an urge to urinate but being unable to reach the toilet before leaking or having a strong sudden urge to go to the toilet to urinate with no advance warning. Mixed UI symptoms as at least 1 stress and 1 urge symptom. Response rate: 17,143/29,500 = 58.1% 

Women aged ≥18 years in France, Germany, Spain and the UK. 

Prevalence: Overall Spain: 23%, France: 44%, Germany: 41% 

UUI Spain: 21% France: 27% Germany: % UK:% 

Hvidman, 2003130Cross-sectional II-2 

Subject selection: Cross-sectional survey in a random (age stratified) population sample of 3900 20- to 59-year-old women. The present study includes 376 women who had their last delivery during 1993–96. 

Definition: Included in the questionnaire was information on UI occurrence, irrespective of type, before and during separate parts of pregnancy, as well as occurrence and duration of PP UI [questions: ‘Did you have involuntary loss of urine in the time following the delivery?’ – ‘If so, how long a time (weeks) did it last after delivery?’]. The questionnaire applied was validated concerning the 6-month period prevalence of pregnancy and delivery independent of UI. Response rate: 3900/6468 (60.3%) 

20- to 59-year-old women 

Denmark 

Prevalence UI Post partum: 23% 6 months after delivery: 2.

Landi, 2003131Observational II-2 

Subject selection: Data was analyzed from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs (n=5418). A total of 22 Home Health Agencies participated in this project evaluating the implementation of the Minimum Data Set for Home Care instrument. 

Patients were Caucasian. Women: 59% Mean age: 78.6 (+-9.5 years) Women had a mean age of 79.5 (+-9.5) years and were approximately 2 years older than men 

Prevalence UI was recorded in 51% onumber of women than me(52%vs 49%, respectivelyThree potentially reversiblthe strongest association iThese are: UTI (adjusted O4.51), Use of physical restraints CI,2.19–4.68), 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F147 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

(77.4"9.4 years; P0.001). Marital status was substantially different between the two groups, with a higher prevalence of widowed among women compared to men. (58% vs. 24% respectively; P0.001).Prevalence 

Environmental barriers (adCI, 1.15–2.02). 

Maffezini, 2003132Observational II-2 

Subject selection: A total of 300 consecutive patients with histologically proven carcinoma of the prostate, staged as clinically organ-confined cT2 or less, underwent radical retropubic prostatectomy with the anatomic approach. 

Definition: Patients were considered continent if they needed no protection to keep outer garments dry. Patients were also considered continent if they occasionally leaked a few drops with abdominal straining.7 Patients who usually wore protection were considered as having stress incontinence. Patients who needed to use four or more pads during the day were considered incontinent. 

Men 

Age Median:65.5 years Range:47 to 73 Italy 

Prevalence Twenty-six patients (8.8%stress incontinence requirthree pads per day. 7 patients (2.3%) were incmore pads per day. Of the 262 continent patieachieved complete urinary continence within the first the median time to recovepatients was 4 weeks (ran

Mawajdeh, 2003133Observational II-2 

Subject selection: The study was designed as a twophase survey. The first phase consisted of a structured personal interview and the second phase was a follow-up physical examination. 

317 women were randomly selected and answered a questionnaire in the first phase of the study. 301 (95%) of the 317 eligible women consented to the general examination. Two hundred sixty agreed to both the general physical and pelvic examination. The main outcome measures were selected reproductive and related nonreproductive morbidities. Single women (n=7) and those suspected or 

Women 

n=317 Age: 18-49 yrs Jordan 

Prevalence UI: 24% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F148 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

confirmed pregnant (n=40) were not eligible for the pelvic exam due to cultural beliefs. 270 women were eligible for the pelvic exam of which 260 consented to the exam. Definition: UI Passing urine when laughing or coughing. 

Miller, 2003134Observational (cohort) II-2 

Subject selection: Five hundred participants were randomly selected from women in the young (aged 18-22 in 1996), mid-age (45-50), and older (70-75) cohorts of the Australian Longitudinal Study of 

Women's Health (ALSWH) who had reported leaking urine in the 1996 baseline survey. 

Definition: Eligible respondents were defined as presently incontinent’’ if they had leaked even small amounts of urine in the previous month (or as ‘‘incontinent in the past’’ otherwise). Those with past incontinence were excluded from measurement of type and severity. Response rates: 50, 83, and 80% in the young, midage, and older women, respectively. The survey was completed by 50% of women sampled in the young cohort, 83% of the mid-age sample, and 80% of the sample of older women. Of those sampled in the young, mid-age, and older cohorts, 3.4, 0.4, and 1.2%, respectively, were ineligible for inclusion, either because they were deceased (n=2) or they reported ‘‘never having leaked even small amounts of urine.’’ Combining all age groups, 89% said they had leaked urine in the month before the survey. 

1500 women 

Comprise women from three age cohorts: young (then aged 18-22 years, but aged 21-26 at the time of the present study), mid-age (45-50, now 48-53 years), and older (70-75, now 73-79 years). Australia 

Prevalence MUI Young:86.6% Mid-age:92.3% Older:91.1% SUI: Young:10.7% Mid-age:6.4% Older:2.0% UUI: Young:2.7% Mid-age:1.3% Older:6.1% 

Miller, 2003135Observational II-2 

Subject selection: The sample for this study comprised 1,000 women who are current participants in the ALSWH, recruited in 1996 through random selection from the Medicare database. Five hundred participants were randomly selected from those in each of the mid-age and older cohorts who reported leaking urine “often” in the 1996 baseline survey of the ALSWH. 

Definition: A screening question asking whether the participant had ever leaked even small amounts of 

The ALSWH sample included women in three age cohorts: young (then aged 18–22 years), mid-age (then aged 45–50, but aged 48–53 years at the time of this study), and older (70–75, now 73–79 years). 

Leaked urine Mid-age:94% Older women:91% Sought help or advice aboMid-age:72.2% Older women:73.1% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F149 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

urine was included at the beginning of the survey to identify participants who may have responded inaccurately at baseline and were thus ineligible for inclusion in the study. For the purposes of this study, respondents who had leaked even small amounts of urine in the month prior to completing the survey were considered presently “incontinent.” Those who indicated that they had not leaked in the last month were excluded from measurement of type and severity (because the scale for measuring type and severity asks about experience of symptoms “in the last month”), but they were asked to complete the remaining items about their previous experience of the problem and assistance sought. The survey was completed by 83% of the mid-age women and 80% of the older women sampled. Of those sampled in the mid-age and older cohorts, 0.4% and 1.2%, respectively, were ineligible for inclusion—either because they were deceased or they reported “never having leaked even small amounts of urine.” 

Australia 

Nuotio, 2003136Cross-sectional II-2 

Subject selection: The data come from the third wave of the Tampere longitudinal Study on Ageing (TamELSA) conducted in 1999 and included 429 survivors. 

The response rate was 92.8%. Stress incontinence was defined as having urinary leakage during exertion, for example coughing or lifting. Urge incontinence as having urinary leakage associated with a strong urge to urinate. Mixed incontinence was defined as reporting both stress and urge incontinence. 

171 men 

227 women Median age Men SUI: 80.5 UUI: 77 Mixed: 78 Women SUI: 76 UUI: 79 Mixed: 78 The median age for men without incontinence was 75 and for women 76 years. Finland 

Prevalence SUI Men:2% Women:23% UUI Men:17% Women:6% MUI Men:6% Women:30% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F150 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Nuotio, 2003137Prospective, Observational II-2 

Subject selection: The baseline data come from the second wave of the Tampere Longitudinal Study on Ageing (TamELSA), a population-based prospective study of living conditions, health, functioning, life styles, and use of services among older people in the city of Tampere, Finland. 

A total of 1036 persons aged 60–99 years were eligible to be interviewed face to face, using a structured questionnaire. Response rate was 80%. After exclusion of 53 subjects already living in institutions and 3 subjects without data on urinary symptoms, the baseline material consisted of 775 community-dwelling persons, of whom 366 were men and 409 were women. Definition To define urge incontinence, the following question was asked: ‘‘Do you ever have trouble getting to the lavatory in time—yes or no?’’ In the case of a positive response, the following question was asked: ‘‘Do you have urinary leakage, either in the daytime or during the nights—never, rarely, frequently?’’ Urge incontinence was defined as having trouble getting to the lavatory in time with urinary leakage. 

Men and women 

Aged 60–99 years Finland 

Prevalence UUI Men:5.2% Women: 14.7% 

Parazzini, 2003138Observational(Casecontrol) II-2 

Subject selection: Cases,1,062 women with urinary incontinence or overactive bladder consecutively observed in first level gynecological centers. Controls, 1,143 women observed in the same centre after the identification of the cases, without any symptoms related to UI or overactive bladder. 

Definition: UI as answering “yes” to the following question: “Have you had any involuntary urinary loss during the last month?” OAB without UI as answering “yes” to 1 or 2 of the following questions: “On average, do you urinate more than 8 times a day and/or >1 time/night?“ or Have you any urgency symptoms?”, but answering no to the question: “Have you had any involuntary urinary loss during the last month?” 

Women 

Age Cases: 40 years or more (mean age 62.3 years, range 40–88) Controls: Mean age 58 years, range 40–86) 

Prevalence Overall SUI: 2,58/1,062= 24.3% UUI: 1,95/1,062= 18.4% MUI: 4,86/1,062= 45.8% OAB: 123/1,062= 11.6% Age related SUI ≤52yrs:40.7% 53-61:36.4% ≥62: 22.9% MUI ≤52yrs:30.9% 53-61:29.4% ≥62: 39.7% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F151 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Peters, 2003139Cross sectional II-2 

An age–sex–practice stratified random sample of 1420 patients registered with four general practices in South Bristol was selected. Forty-four patients 

were excluded because of illness, death or removals out of the area not yet amended on practice records.. 

Response rates for the four practices varied at 56%, 62%, 68% and 71%, respectively. The majority of respondents were married (54%) and one-third was widowed (33%). A minority were single, cohabiting or were divorced. Just over a third of people were living alone (38%) and nearly half had access to a car (48%). The majority of respondents were living in their own home (63%), with the next largest group (24%) living in local authority rented housing. 

White: 99% 

A total of 915 responses were received (402 males and 513 females), of whom 496 (54%) were in the 65–74 years age range, and 419 (46%) were 75 years or older. UK 

Prevalence UI: 39% 

Rortveit, 2003140Observational(Cohort) II-2 

Subject selection: The EPINCONT study, is part of the Nord-Trøndelag health Study 2 (HUNT 2), which was conducted in a county of Norway between 1995 and 1997. All women older than 20 years of age (a total of 47,313 women) received a mailed invitation to visit a screening station. The source population for the EPINCONT study consisted of the 34,755 

community-dwelling women who attended the screening. Women were asked to complete a questionnaire at home, and 27,936 women (80 percent) answered questions related to incontinence. 

Definition If a woman answered yes to an entry question about any involuntary loss of urine, she was asked about the frequency of leakage (less than once a month, once or more per month, once or more per week, or every day, every night, or both), the amount of leakage each time (drops, small amounts, or large amounts), the circumstance of leakage (which could include coughing, sneezing, laughing, and lifting heavy items), whether leakage was accompanied by a sudden and strong urge to urinate, and to what extent she considered leakage a problem (no problem, a small nuisance, some bother, much bother, or a major problem). 

Women 

Age Range: 20-64yrs Norway 

Prevalence Any incontinence: 20.7% Moderate /Severe incontinSUI:12.2% UUI:1.8% MUI:5.9% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F152 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Dallosso, 200314longitudinal, Prospective cohort II – 2B 

United Kingdom women age ≥40 living at home Part of the Leicestershire MRC Incontinence Study on prevalence and incidence including men and women. This study was women only. 

19,239 eligible women; 65.3% returned N= 12,565. 6,424 responded to f/u questionnaire 7,046 women baseline with follow up collected from 6,426 1 yr later = began 10/98 with f/u in 10/99 Postal survey with usual definitions of SI. OAB defined by ICS and for this study as one or both of the sxs urge leakage and urgency. Subgroups of OAB and SI Excluded nursing home or residential pts and SI at baseline was excluded from analysis of onset of SI 

Age: 40-49 - 26% 50-59 27.4% 60-69 23.3% 70-79 17.1% >80 6.2% 

BMI Acceptable 48.4% Underwt 7% Overwt 31.4% Obese 13.3% Smoking Never 54.3 Exsmoker 30.3 Current 15.2 

Prevalence of UI at baseliStress:17.3% OAB: 16.3% Prevalence of OAB increamarked change in SI..3% 

Stewart, 2003141

Observational (Case-control) II-2 

Subject selection: National telephone survey using a clinically validated interview and a follow-up nested study comparing overactive bladder cases to sexand age-matched controls. A total of 17,231 households were contacted (includes 2,427 households where eligible members met criteria for region-sex-age-specific strata in which the sampling quota was filled) between November 2000 and January 2001. Response rate: 68% (11,740/17,231) Eligible: 5,539 (47%) Definition: OAB without urge incontinence was defined by a feeling of urgency ≥4 times in the past 4 

weeks and either >8 micturitions/day or the use ≥1 

of the following coping strategies: restricting fluid intake, locating bathrooms in a new place, limiting travel, or defensive voiding. OAB with urge incontinence included the criteria for OAB without urge incontinence plus ≥3 episodes of urinary leakage in the past 4 weeks that was typical (i.e., frequency of episodes) and was not exclusively due to stress incontinence. 

Men and women >18years USA 

Prevalence Overall OAB: 16.5% OAB with UUI: 6.1% OAB without UUI: 10.4% Women OAB: 16.9% OAB with UUI: 9.3% OAB without UUI: 7.6% Men OAB: 16.0% OAB with UUI: 2.6% OAB without UUI: 13.4% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F153 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Talcott, 2003142

Prospective Observational (Cohort) II-2 

Subject selection: Recruited patients who consulted physicians at participating sites for advice on primary therapy of pathologically-confirmed, untreated early (nonmetastatic) PC at the Massachusetts General Hospital, the Dana-Farber Cancer Institute, and affiliated clinics of the Joint Center for Radiation Therapy. Baseline questionnaires from 613 eligible patients were returned within 7 days of initiating treatment, a requirement to ensure that the reported baseline symptoms were free from the effects of therapy. 91 enrolled patients (14.9%) dropped out or died of 

unrelated causes (4 patients) before first follow-up questionnaire at 3 months after treatment, leaving 522 participating patients. Of the remaining patients, 27 patients (11%) had not yet been followed for 24 months, 66 patients (12.5%) dropped out before completing the 24-month questionnaires, and 429 patients (76.6%) continued through 24 months. Definition: The urinary incontinence index assessed the degree of urinary control and the frequency and magnitude of leakage in men who had less than “complete control.” Five items assessed urinary obstruction and irritation: hesitancy, frequency of urination during the day, nocturia (urination at night), dysuria, and urgency. 

Men 46-82 years Boston, MA USA 

Prevalence UI after radical prostatectoBaseline: 4.9% 3 months: 34.9% 12 months: 23.9% 24 months: 23.4% 

Bogner, 2002143Cross-sectional Adjusted for age, gender, ethnicity, chronic health conditions, education, ADL status Level of evidence: II-3A 

Epidemiologic Catchment Area (ECA) Program, a 

survey of psychiatric disorders in the general population between 1980 and 1984 at 1 of the 5 university-based sites in US (East Baltimore); data obtained from follow-up interviews which occurred in 1993 to 1996, with most in 1994 

Randomly selected blocks based on expected 

number of households, with a random sample of households, and a randomly selected member within a household 

Over sampled older people by interviewing all 

persons in a household aged 65 and older 

Structured interview in respondent’s home by trained 

lay interviewers 

Age range 50-96 years with mean age 67.2 (SD 10.8); Baltimore, MD, USA 502 women (64%) 279 men ((36%) 540 whites (69%) 207 AfricanAmericans (27%) 26 American Indians, Hispanics, or Asians (4%) 

20% (n=158) reported UI i

• 127 women (25.3%) • 30 men (10.8%) 

18% (n=29) reported condloss related to UI; 14 peopreported 2 limitations, 5 re3 reported 4 limitations; nAdjusting for age, gender, persons with UI were more psychological distress as Health Questionnaire than 1.56, 95% CI: 1.00-2.43) However, there was no sigbetween those with UI and 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F154 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

781/820 persons aged 50 and over who had 

complete information on UI (95% analyzed) 

Excluded: unable to determine continence status in 

past year; missing GHQ scores 

UI Measurement: Have you ever had any difficulty in 

controlling your water, that is, losing your urine or 

having trouble getting to the bathroom in time during the past 12 months? 

Condition-Specific Functional Loss (4 questions): 

Because of UI, did they: avoid social gatherings, visiting friends, or going to church; avoid travel; not going shopping; and avoiding physical activities. Condition-specific functional loss due to UI was a positive response to any of the 4 questions 

psychological distress afteimpairment and chronic mwere similar for men and wseparately 

Among persons with UI, pelevated General Health Qwere more likely to report functional impairment from 95% CI: 1.94-22.12) 

Buchsbaum., 2002144Retrospective cohort Adjusted for confounding factors Level of evidence: II-2C 

149/190 nuns (78.4%) residing in two motherhouses 

Self-administered survey UI Measurement: Respondents asked if they had a 

current problem with urine loss 

SUI and UUI determined from items on the IIQ 

Women ages 39-91 years, with a mean age of 68, SD: 11.7; Rochester, NY, USA 

93.3% white (148/149) 

74/149 (49.7%) 63% slightly bothered 25% moderately bothered 4% greatly bothered 52% used sanitary pads 10.3% leaked once a day 19.1% leaked several time29.7% SUI (n=22) 24.3% UUI (n=18) 35.1% MUI (n=26) 10.8% UI unknown origin 

Finkelstein, 2002145Cross-sectional Adjusted by sampling weights, age, gender, income, and other confounding factors but not BMI which was not found to be associated with UI Level of evidence: II-2C 

Secondary analysis of responses to the second wave 

of the National Population Health Survey which surveyed Canadian households in 1996-97 

27,263 households participated in 1994-95 (88.7% 

response rate); In 1996-97, 93.6% response rate 

Mailed survey UI Measurement: Do you have UI diagnosed by a 

health professional? 

Men and women aged 30 years and older; Canada (10 provinces) 

Race not specified 

Prevalence n reporting UI/ estimated rate per 100 usiMen 30-39 years: 35/76540-49 years: 40/60750-59 years: 56/44360-69 years: 121/,3670-79 years: 150/2680+ years: 81/963Women: 30-39 years: 73/82140-49 years: 116/6250-59 years: 150/4960-69 years: 190/4370-79 years: 272/3880+ years: 222/19
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F155 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Landi, 2002146Cross-sectional Adjusted by age, gender, ADL, cognitive performance, delirium, constipation, alcohol use, medications associated with increased UI risk) Level of evidence: II-2C 

Population-based, longitudinal, multilinked database 

that comprises the Minimum Data Set for Home Care (MDS-HC) and their medications coded with the Anatomical Therapeutic Chemic classification system 

4,583/4,717 patients admitted to home care 

programs in 22 home care agencies from 1997 to 2001 who participated in the National Silver Network Project (97.2% analyzed) 

Excluded: < 65 years, comatose, paraplegic, 

permanent indwelling catheter 

UI Measurement: Any involuntary loss of urine, 

regardless of amount, that occurred 2 or more times per week 

Men and women ages 65 and over with mean age 77.1 (SD 11.9); Italy 58% female (n=2658) 42% male (n=1925) 100% white 

UI prevalence: 33% of all patients 21% age 60-74 38% age 75 and over 63% women (n=935) 

Langa, 200282Cross-sectional Adjusted by: Age, Race Gender, Net worth Living situation Chronic conditions Care giving received Level of evidence: III

Community-dwelling people ≥70 years, from the 

AHEAD cohort of the Health and Retirement Study by the University of Michigan. Response rate: 80.4% (n=7443) 

Data source: In person or over the phone interviews. Incontinence as, “Any loss of urine beyond your control in the last 12 months.” 

Age: 70+ 

Gender: Male and female Race: White, AfricanAmerican, and Other Ethnicity: Not reported Residency: Michigan 

Prevalence: Overall: 19.4% By Gender: Male: 13% Female: 24% By impact on life: Use of pads: 9.9% No use of pads: 9.5% 

Liu, 20021472 Prospective cohort Level of evidence: II-2C 

Randomly selected, Age-stratified population-based 

sample using the State Electoral Data Base of adults aged 70 and over in 1992; also included people living with the original selected persons 

Health surveys at baseline, 12 and 24 months 

2272/4187 responded to initial mailed letter (53.2%) 2087/2272 (91.9%) completed all 3 surveys Unclear survey method at baseline and 24 months; 

12 month survey conducted using a computerassisted telephone interview 

 UI Measurement:: UUI: Do you have any difficulty 

holding your urine until you get to the toilet? (often, occasionally, never) SUI: Do you accidentally pass urine? (often, occasionally, never) 

Men and women ages 70 years and over living in South Australia 

Age stratified by 70-74, 75-79, 80-84, and 85 and over Number of men and women not specified Race not specified 

Unable to determine SUI abecause of problems with UUI in men across 3 wave

• Often: 6.6%, 8.5%, • Occasionally: 25.2%• Never: 68.3%, 69.4

UUI in women across 3 wa

• Often: 10.2%, 10.6• Occasionally: 31.2%• Never: 58.5%, 57.3

UUI in all and age-adjustewaves 

• Often: 8.4%, 7.7% • Occasionally: 28.2%
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F156 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

MUI: Answer yes to both questions SUI definition according to currently accepted definitions is not SUI—interpreted as UI 

• Never: 63.5%, 64.8

Nuotio, 2002148Cross-sectional Adjusted by age and gender Level of Evidence: II-2C 

Randomly selected, age and gender stratified 

population-based sample of home-dwelling and institutionalized adults aged 70 years and over from the third wave of the from the Tampere Longitudinal Study on Aging (TamELSA) in 1999 

 398/429 survivors from original study initiated in 

1979 (92.8% response rate) 

Interview UI Measurement: UUI: Urine leakage associated with 

a sudden urge to urinate, regardless of the frequency of urine loss (Does the urge to urinate ever become so strong that there is urinary leakage before you reach the lavatory? [no, yes, sometimes, frequently] 

171 men and 227 women aged 70-98 years; Tampere, Finland Race not specified 

Weighted UUI prevalence Men 

• Age 70-79 years: 2• Age 80-98: 34.3% • All ages: 28.9% 

Women 

• Age 70-79: 31.2% • Age 80-98: 45.6% • All ages: 41.8% 

Peyrat, 2002149Cohort Adjusted?? Level of evidence: II-2C 

1,700/2,800 (60.7% response rate) women 

employees in academic hospital assessed during annual exam with staff physician in 1998 

Self-administered questionnaire UI Measurement: Do you currently have some 

involuntary leakage of urine? 

Women ages 20-62 (mean age 39.7 SD 8.0); France 

Race not specified 

UI: 27.5% (n=467; CI: 25SUI: 12.4%, n=210, CI: 10UUI: 1.6% (n=28, CI: 1.1-2MUI: 13.5% (n=229, CI: 1Prevalence by Age and U

• Any UI 

o < 25: 2/32 (6%) o 25-39: 150/823 o 40-55: 266/699 o > 55: 16/34 (47%

• SUI 

o < 25: 1/32 (3%) o 25-39: 68/823 (8o 40-55: 121/699 o > 55 8/34 (24%) 

• UUI 

o < 25: 0 o 25-39: 12/823 (1o 40-55: 12/699: o > 55: 0 

• MUI 

o <25: 1 (3%) o 25-39: 70 (8.5%
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F157 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

o 40-55: 133 (19.0o > 55: 8 (24%) 

Prevalence Below and Ab

• ≤40: Any UI: 152/85

(8.1%); UUI: 12 (1.4

• > 40: Any UI: 282/7

(12.4%): UUI: 28(1

By Frequency: 

• Occasional: Any UI

(99.5%); UUI: 24 (8

• Permanent (e.g., fre

episodes of urethra38 (8.1%); SUI: 1 (0MUI: 33 (14.4%) 

Pregazzi, 2002150Case control Adjusted for maternal age, parity, induced labor with prostaglandins, type of vaginal delivery, dysuria, urgency, frequency, pre-pregnancy maternal weight, pregnancy weight gain Level of evidence: II-3 

Consecutive sample of 537 women who had a 

vaginal delivery between April 1999 and February 2000 

In-person interview and underwent a urogynecologic examination 3 months after vaginal delivery UI Measurement: SUI: loss of urine on physical effort 

UUI: loss of urine associated with a strong desire to void 

537 women aged 19-44 years; Italy Race not specified 

SUI: 

• Total: 63 (11.7%) • Primparae: 31 (8.2%• Multiparae: 32 (20.3• P =.0001 

UUI: 

• Total: 41 (7.6%) • Primparae: 21 (5.5%• Multiparae: 20 (12.7• P =.004 

Sampselle, 2002151Prospective cohort Adjusted for confounding factors, site, age, and ethnicity Level of evidence: II-2A 

3302 participants ages 42-52 from the Study of 

Women’s Health Across the Nation (SWAN) which studied the natural history of the menopausal transition 

Included: Intact uterus with one ovary, pre-or early 

menopause, not currently using exogeous hormone preparations affecting ovarian function, selfidentification with one of each site’s designated race/ethnic groups, use of English, Spanish, Japanese, Cantonese, and ability to give verbal consent 

Random sampling from 7 cities using census lists, 

commercial electric utility household lists, Kaiser Permanente membership lists, or random digit 

Women with a mean age of 46.4 (SD 2.7) from 7 USA cities (Boston, Chicago, Detroit, Los Angeles, Newark, Pittsburgh, Oakland, CA) 

47.0% white (n=1530) 28.1% Black (n-915) 7.6% Chinese (n=249) 8.7% Hispanic (n=284) 8.6% Japanese 

Any UI: 

• 56.9% of total group • 66.0% white • 49.5% black • 50.2% Chinese • 41.4% Hispanic • 52.9% Japanese 

Mild UI 

• 32.1% total group • 36.9% white • 26.0% black • 34.1% Chinese • 22.3% Hispanic 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F158 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

dialing depending on site 

Self-administered questionnaire UI Measurement: In the past year, have you ever 

leaked even a very small amount of urine involuntarily? 

UI severity derived by multiplying frequency of urine 

loss score by volume score; slight UI= score of 1 or 

2; moderate UI: 3-4; severe UI: >4 

(n=280) • 34.4% Japanese 

Moderate UI 

• 14.6% total • 16.8% white • 14.1% black • 11.6% Chinese • 9.6% Hispanic • 11.8% Japanese 

Severe UI 

• 9.9% total • 12.1% white • 8.8% black • 4.4% Chinese • 9.2% Hispanic • 6.4% Japanese 

25% wear protection or chseveral days per week UI severity strongly assocreference): 

• Moderate UI: OR 3• Severe UI: OR 16.9

Ethnicity and bother (white 

• Black: OR 1.26, 0.9• Chinese: OR .69, .• Hispanic: OR 5.70, • Japanese: OR 1.55

Sebesta, 2002152Retrospective Cohort No adjustment Level of evidence: II-2C 

TRICARE/CHAMPUS claims database searched to 

identify 1,000 patients who underwent radical prostatectomy for localized prostate cancer between 1995 and 1996; Prostatectomy had to be within 18 months of study initiation; patients were < 65 years at time of surgery and had at least 18 months of follow-up 

Out of 1,000 patients, 136 surveys were 

undeliverable because of the patient’s death or 

inaccurate address 

674/864 (78% response rate) Mailed questionnaire 

Men < 65 years of age at time of surgery; USA in multiple states 

Race not specified 

UI in past week: 

• None: 295 (43.7%) • Several per week: 7• < 1/day: 131 (19.4%• 1/day: 113 (16.8%) • > 1/day: 62 (9.2%) • 56.3% reported at le

past week—this difrelates to how the q

With physical exertion: 34UUI only: 35 (5.2%) Sudden urge/no time: 117 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F159 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

UI Measurement: Questioned only about 

postoperative continence by eliciting information regarding the frequency, time, and type of leakage, and use of protective devices and incontinence treatment 

While in bed/running to ba

31.7% use pads or other p

• 8% of these used 2 

12% reported UI was a pro

Sze, 2002153Cross-sectional Adjusted by age and parity Level of evidence: II-2C 

Women seeking gynecologic care between May 

2000 and June 2001 at the Brody Medical School Clinic and Office of East Caroline University Women’s Physicians 

Excluded: urogynecologic and obstetric clinic 

patients 

2370 women (response rate not reported) Self-administered questionnaire UI Measurement: Do you lose urine when you cough, 

sneeze, lift, jump, or get up from a bed or chair? 

Do you wear a pad or protective undergarment 

because you lose urine when you cough, sneeze, lift, 

jump, or get up from a bed or chair? 

Do you lose urine less than 5 minutes after you feel 

the urge to urinate more than once per week? 

Women ranging in age from 15-91; North Carolina, USA 

34% Black (n=799) 39% white (n=932) 639 Hispanic (n=639) 

UI prevalence by race (P < 

• 41% White • 31% Black • 30% Hispanic 

SUI: (P <.001) 

• 39% white • 27% Black • 24% Hispanic 

UUI: (P = NS) 

• 19% white • 16% Black • 16% Hispanic 

Thompson, 2002154Prospective cohort with 24 week postpartum follow-up Adjusted for delivery method and parity Level of evidence: II-2A 

All women living in the Australian Capital Territory 

who gave birth to a live baby between March to Oct 

1997 in one of the two public hospitals and completed 4 questionnaires; study was part of a project to determine risk factors for postnatal depression 

Measurement on 4th postpartum day, at 8, 16, and 

24 weeks postpartum 

1295 women (70%) agree to participate, and of these 1193 (92%) retained in the cohort through 24 weeks postpartum Mailed questionnaire UI Measurement: Thinking about your health and how you have been feeling over the past 8 weeks, have any of the following been a problem for you? UI (e.g., hard to hold urine when coughing, sneezing, or exercising) 

Women aged 16 years and over 

Point prevalence of UI by and 24 weeks postpartum 

• Unassisted vaginal 

o 0-8 weeks: 178 o 9-16 weeks: 10o 17-24 weeks: 1

Van der Vaart, 20021552 Cross-sectional cohort 

Random population-based sample of women ages 

35-70 years obtained from the population registration office of a suburban area in Netherlands 

Women ages 35-70 years; Central Netherlands 

Overall UI: (P <.01) 

• Non-hysterectomy: 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F160 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

study Adjusted by age, educational level, parity, and hysterectomy status Level of evidence: II-2C 

1626/2322 women (70% response rate) Mailed questionnaire UI Measurement: Urogenital distress Inventory SUI: Do you experience urine leakage related to 

physical activity, coughing, or sneezing? 

UUI: Do you experience urine leakage related to a 

feeling of urgency? 

Overall UI: having SUI or UUI 

Race not specified • Hysterectomy: 133

SUI: (P=NS) 

• Non-hysterectomy: • Hysterectomy: 118• Bothersome SUI: 1

UUI: (P <.0001) 

• Non-hysterectomy: • Hysterectomy: 80/2• Bothersome UUI: 2

Van der Vaart, 2002156? Cross-sectional cohort Not adjusted Level of evidence: II-2 

Random, population-based sample of women aged 

20-45 years obtained from the population registration office of a suburban area in 1999 

1029/1393 (73.9% response rate) Mailed questionnaire UI Measurement: Urogenital Distress Inventory: 

SUI: do you experience urine leakage related to physical activity, coughing, or sneezing? UUI: do you experience urine leakage related to the feeling of urgency? 

Women aged 20-45; Mean age 34.2, SD 3.2 years; Central Netherlands 

Race not specified 

365 (39.1%) SUI 143 (15.3%) UUI Prevalence without (n=14hysterectomy (n=209), res

• Overall UI: 902 (49.

.01 

• SUI: 716 (50.5%) vs• Bothersome SUI: 1

(11.1%), NS 

• UUI: 320 (212.6%) • Bothersome UUI: 4

<.0001 

Van Oyen, 2002157Retrospective cohort Prevalence estimates weighted by age and gender distribution of Belgian population age 15 and over 

Multistage sampling using the National population 

Register 

7,706 participants who were part of the 1997 Belgian 

Health Interview Survey ≥15 years 

Excluded: Proxy reports 

Participation was 60% at household level; once a 

household participated, the refusal rate was 2.5% 

7,266 eligible subjects all participated Interview at home using WHO-instrument UI measurement: Do you sometimes lose control of 

your bladder? 

If yes, how often do you lose control of your bladder? 

(at least once a week, less than once a week but at least once a month, less than once a month 

3,462 men and 3,804 women ages 15 and over; Belgium 

Race not specified 

Weighted prevalence to B15 years and over: 

• 1.4% men (n=92) • 4.6% women (n=23

UI in men by age and freq

• 15-24: .1% (n=443)• 25-34: 0 (n=680) • 35-44: .6% (n=705)• 45-54: 0.9% (n=599

66.7% at least 1x/w

• 55-64: 2.7% (n=428

at least 1x/mo, 63.5

• 65-74: 5.2% (n=384

at least 1x/mo; 73.7

• 75+: 13.3% (n=223

at least 1x/mo, 73.7

• TOTAL: 1.4% (n=34
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F161 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

28.6% at least 1x/m

UI in women by age and f

• 15-24: 0.2 (n=481), • 25-34: 1.8% (n=753

at least 1x/mo, 61.1

• 35-44: 2.3% (n=709

at least 1x/mo, 65.2

• 45-54: 3.8% (N=557

21.1% at least 1x/m

• 55-64: 8.6% (n=461

at least 1x/mo, 55.8

• 65-74: 11.7% (n=50

26.5% at least 1x/m

• 75+: 21.0% (n=334

at least 1x/mo, 37.6

• TOTAL: 4.6% (n=39

30.4% at least 1x/m

Maggi, 2001158Cross-sectional Adjusted by: Age Gender Marital status Education Mental health Physical health BMI Self-rated health Sleep medications Alcohol use Cigarette smoking Diarrhea Co-morbidity ADL disability Mobility disability COPD Parkinsonism Hip fracture Night awakening Level of evidence: III

Subjects were randomly selected from noninstitutionalized individuals aged 65 and older. The names and addresses were obtained by resident lists maintained by the municipalities of Northeastern Italy. 

Response rate: 89% (n=2,402) Data source: At home interviews Incontinence was defined by the interviewer asking, “If they had UI problems, and how often they occurred.” 

Age: 65 and older Mean age (Men): 75.2 Mean age (Women): 76.9 

Gender: Male and female Male: 36% Female: 64% Race: Not reported Ethnicity: Not reported Residency: Veneto Region, Italy 

Prevalence: Overall Male=11.2% -Fem

By Age Group: Male: 

Age Group Prevale

65-69 4.70-74 1275-79 1280-84 22

85+ 23

Total 11

Female: 

Age Group Prevale

65-69 1670-74 1775-79 2480-84 23

85+ 34

Total 21
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F162 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Maral, 2001159Cross-sectional Adjusted by: Age Gender Parity Systemic disease Previous surgery Level of evidence: III

Subjects were selected from people at an education and research health district in Turkey >15.years 

Response rate: 90.8% (n=2261) Data source: Self-reported interviews. Incontinence was defined as, “Urinary leakage while coughing, straining, sneezing, or lifting heavy objects.” (Stress) 

Age: ≥15 years 

Gender: Male and Female Race: Not reported Ethnicity: Not reported Residency: Turkey 

Prevalence (Stress): 

Overall: 11.1% Male: 1.0% Female: 20.8% By Age: 15-24: Male: 0% Female: 8.3% 25-34: Male: 0% Female: 20.4% 35-44: Male: 0.9% Female: 24.9% 45-54: Male: 1.2% Female: 29.6% 55-64: Male: 3.8% Female: 28.3% 65 and older: Male: 4.9% Female: 33.7% 

MacLennan, 200084Cross-sectional Adjusted by: Age, Sex, Income, Country of birth, Method of delivery, BMI, Coughing, Osteoporosis, Arthritis Pelvic floor surgery Level of evidence: III 

Subjects were randomly selected from households as part of the 1998 South Australian Health Omnibus Survey. The person with most recent birthday in selected household was interviewed. 

Response rate: 73.3% (n=3,010) Data source: At home interviews by trained female interviewers. Incontinence as, “lost urine when coughing, laughing, or sneezing or accidentally wetting before reaching the toilet.” 

Age: 15-97 years old 

Gender: Male and female Male: 48.7% Female: 51.3% Race: Not reported Ethnicity: Not reported Residency: Australia 

Male: 

UI Type PreStress Urge Mixed Total 

Female: 

UI Type PreStress Urge Mixed Total 

Muscatello, 2001160Cross-sectional Adjusted by: 

Subjects were selected from randomly selected households as part of the 1997 NSW Health Survey of Australia. One person was randomly selected from 

Age: 41 and over 41-49: 35% 50-59: 26% 

Male: 

Type/Age PrevUrge 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F163 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Age Sex Country of birth Language Marital status Education Insurance access Self-reported health Mental health status Smoking Alcohol consumption Physical activity Bodyweight Diabetes Hysterectomy status Level of evidence: III

each household. Selection was from central Sydney. 

Response rate: 68% Data source: Computer assisted telephone interviews relying on self-reported data. Incontinence was defined as, “Sudden and unexpected need to urinate (Urge),” and “Leaking urine during physical activity, coughing, or sneezing (Stress).” The symptoms needed to occur within the past month. 

60-69: 17% 70+: 22% 

Gender: Male and female Male: 47% Female: 53% Race: Not reported Ethnicity: Not reported Residency: Sydney, Australia 

41-49 50-59 60-69 70+ Total Stress 41-49 50-59 60-69 70+ Total 

Female: 

Type/Age PreUrge 41-49 50-59 60-69 70+ Total Stress 41-49 50-59 60-69 70+ Total 

Patel, 2001161

Prospective Observational II-2 

324 incident cases of stroke with incontinence 1 week post-stroke identified from South London stroke register from January 1, 1995, to December 31, 1998. Definition: indwelling catheter within 48hrs of assessment or loss of bladder control. 

Men and Women UK 

Prevalence of UI 39% 

Schmidbauer, 200162Cross-sectional Adjusted by: Age, Gender, BMI, Education, Weight, , Alcohol, Smoking, Urgency, Frequency, Nocturia, Intermittency, Reduced Stream, Childbirth, Incontinence Surgery, 

Subjects were selected from free of charge health examinations sponsored by the city of Vienna. 

Response rate: Not reported (n=2,498) Data source: Self-reported questionnaire Incontinence was defined as, “Any involuntary loss of urine within the past four weeks.” 

Age: 20 years and older Male mean: 48.6 (SD: 13.0) Female mean: 49.7 (SD: 13.6) 

Gender: Male and Female Male: 49.5% Female: 50.5% 

Prevalence: Overall: Male: 5% Female: 26.3% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F164 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Hysterectomy, Vaginal surgery, Prostatectomy, Blood pressure, Serum triglyceride, Fasting glucose Level of evidence: III

Race: Not reported Ethnicity: Not reported Residency: Vienna, Austria 

Stoddart, 2001162Cross-sectional Adjusted by: Age Sex Level of evidence: III 

Subjects were randomly selected from a stratified sample of 2000 community living elderly from 11 general practices in a British city. 

Response rate: 79% (n=1,521) Data source: Self-reported mailed questionnaire Incontinence was defined as subjects, “Reporting that in the last month they leaked urine or indicated how much leakage occurred, that they protected themselves against leakage, or that leakage happened at a defined time.” 

Age: 65 years and older 

Gender: Male and female Male: 51.3% Female: 48.7% Race: Not reported Ethnicity: Not reported Residency: Great Britain 

Male Age group 65-69 70-74 75-79 80+ Total Severity Underwear damp Underwear wet Wet outer clothes/floor Whether UI a problem Y By Type Stress Urge Female Age group 65-69 70-74 75-79 80+ Total Severity Underwear damp Underwear wet Wet outer clothes/floor Whether UI a problem Y By Type Stress Urge 

Aggazzotti, 2000163

Cross-sectional 

Adjusted by: 

Subjects were selected from institutionalized people living in the district of Modena, Italy. Figures provided by the Social and Health Care Authority 

Age: Mean: 82 (SD: 10; Range: 33-102) 

Gender: Male and 

Prevalence: Overall: 54,500 / 100,000 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F165 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Age Gender Mental orientation Mobility Urinary tract infection Constipation Fecal incontinence Neurologic disease Psychiatric disease Hypertension Diabetes Cardiovascular disease Bone fracture Level of evidence: III 

were used to identify and survey 14 institutions. 

Response rate: 89.8% (n=839) Data source: Questionnaire prepared specifically for the study. Data was collected from both clinical records and from physicians and nurses of the residents. Urinary incontinence was defined as, “the involuntary loss of urine occurring at least twice a week.” 

female 

Race: Not reported Ethnicity: Not reported Residency: Institutions in Modena, Italy 

By Gender: Male: 39,200 / 100,000 (3Female: 59,800 / 100,000 

Alling-Moller, 2000164Case-control Adjusted by: Age Physical activity BMI Abortion Parity Fetal weight Episiotomy Lesion of anal sphincter Repair of uterine prolapse Cystocele repair Hysterectomy Constipation Straining at stool Hormonal inactivity Use of diuretics Cystitis treated w/antibiotics Medication for noninfectious urinary symptoms County Level of evidence: II-3

Subjects were selected randomly from women in the Danish Civil Registration System, which contains everyone living in Denmark. The subjects were selected from the urban county Copenhagen and the rural county Storstroms. All subjects were between 40 and 60 years of age. 

Response rate: Cases: 97% (n=487) Controls: 76% (n=564) Data source: Validated, self-reported questionnaire Definition of incontinence: “The definitions of stress and urge incontinence were those defined by the International Continence Society.” 

Age: 40-60 years of age 40-44: 22% (n=228) 45-49: 20% (n=207) 50-54: 21% (n=216) 55-59: 20% (n=211) 60: 18% (n=189) 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Counties of Copenhagen and Storstroms, Denmark 

Prevalence: 

Overall: 46,300 / 100,000 By Type (of those who are Stress Incontinence: 64,3Urge incontinence: 35,500 Continuous incontinence: (14.1%) Nightly incontinence: 4,00
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F166 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

Bortolotti, 2000165Cross-sectional Adjusted by: Age, Sex, BMI, Education, Smoking, Alcohol and Coffee consumption, Abdominal or Pelvic surgery, BPCO, Diabetes, Urinary infections, Perineal trauma, Enuresis, Neurological disease, Parity Level of evidence: III

Subjects were selected from randomly identified individuals from a network of general practitioners in Italy from 3/97-10/97. Computer generated random number lists were used. 

Response rate: “Practically 100%” (n=5,488) Data source: At home interviews Incontinence was defined as, “Loss of urine in the last year.” 

Age: ≥40 (Female) ≥50 (Male) 

Gender: Male: 49.6% Female: 50.4% Race: Not reported Ethnicity: Not reported Residency: Italy 

Males: 

Age category P51-60 61-70 70+ Total 

Females: 

Age category P40-50 51-60 61-70 70+ Total 

Hannestad, 2000166Cross-sectional Adjusted by: Age Level of evidence: III 

Subjects were selected from all females in a particular county. The study was a part of the HUNT 2 survey. 

Response rate: 80% (n=27,936) Data source: Self-reported questionnaire Incontinence defined as, “Involuntary loss of urine.” 

Age: ≥20 years 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Norway 

Age 

group 

Prevalence 

% St

20-24 10 25-29 14 30-34 18 35-39 21 40-44 24 45-49 28 50-54 30 55-59 28 60-64 26 65-69 27 70-74 30 75-79 34 80-84 35 85-89 35 

90+ 40 

Total 25 

By Severity 

Age 

group 

Unknown S

20-24 0.3 25-29 0.6 30-34 1 135-39 1.1 140-44 1.6 145-49 2.4 1
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F167 

Author Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods (survey, screening, case 

finding, definition)

Subject age, gender, 

race, ethnicity, 

residency

Prevalence (%) of urina

and by type, severity

50-54 3 155-59 3.1 60-64 3.6 65-69 4.8 70-74 4 75-79 4.2 80-84 5.2 

85+ 5.7 

Impact on life No problem Small nuisance Some bother Much bothered Great problem 

Gavira-Iglesias, 2000167Cross-sectional Adjusted by: Age Marital status Educational level Living status Urethral catheter use Level of functioning Level of evidence: III

Subjects were randomly selected from a representative sample of people ≥65years in the Basic Health Zone of Cabra in Spain. 

Response rate: 95% (n=827) Data source: Home health interview conducted by the investigators and relying on self-reported symptoms. Incontinence was defined as a positive response to the question, “Do you ever have involuntary or unexpected leakages of urine without being able to control them?” Or a positive response to the question, “Do you ever wet or dampen your underwear, clothes, or bedclothes against your will?” In addition, anyone using a urinary catheter or absorbent pads was also considered incontinent. 

Age: Mean: 77.7 (SD: 8.1) 

Gender: Male and Female Male: 41% (n=341) Female: 59% (n=486) Race: Not reported Ethnicity: Not reported Residency: Municipal districts or Cabra, Dona Mencia, and Nueva Carteya in Spain. 

Gender Male Female 

Male: 

Frequency <Monthly Monthly Weekly Daily Unknown Severity Drops or small amount Large amount 

Female: 

Frequency <Monthly Monthly Weekly Daily Unknown Severity Drops or small amount Large amount 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F168 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Roe, 2000168Cross-sectional Adjusted by: Age Gender Social class Ethnicity Physical function Social function Mental health Energy Pain Health perceptions Level of evidence: III 

Subjects were selected from random samples of the adult populations generated from patient registers of 

the Family Health Services Authorities in the UK. 

Response rate: 53% (n=6,139) Data source: Self-reported mailed questionnaire Incontinence was defined as leaking urine twice or more a month. 

Age: 18-98 

Gender: Male and female Race: Not reported Ethnicity: White: 98% Black Caribbean: 0.3% Black other: 0.1% Indian: 0.5% Pakistani: 0.1% Chinese: 0.2% Other Asian: 0.1% Other: 0.7% Residency: United Kingdom 

Age group 

18-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 

80+ 

Total current 

incontinent 

Total ever incontinent 

Smoger, 2000169

Cross-sectional Adjusted by: Age Ethnicity Prostate cancer Prostate surgery Bladder surgery Diuretics Antispasmodic agents Prostate active agents Level of evidence: III 

Male patients at primary care clinics (VA Medical Center), during a 14-week period. Investigators randomly selected morning or afternoon clinics and approached all patients seen within the selected clinic session. Response rate: 81.6% (n=809) Data source: anonymous, self-reported written survey without interviewer assistance. Incontinence defined as, “Urine loss in the last 12 months.” 

Age: Mean: 59.8 (Range: 25-93) Gender: Male Race: Not reported Ethnicity: White: 82.1% African-American: 16.5% Other: 1.4% Residency: Louisville, Kentucky 

Prevalence (Overall): 32,300/100,000 (32.3%) By frequency: <1/month: 19,500/100,000 About 1/month: 4,700/100<1/week: 3,300/100,000 (3About 1/week: 6,800/100,0Almost every day: 7,000/1By severity: Few drops: 19,500/100,00Wet my underwear: 7,800Wet outer clothing: 2,200/Wet the floor: 700/100,000 

Smoger, 2000169Cross-sectional Adjusted by: Age Ethnicity Prostate Cancer Prostate surgery Bladder surgery Diuretics 

investigators randomly selected morning or afternoon clinics and approached all patients in waiting room at primary care clinics in VA Medical Center over a 14-week period. Response rate: 81.6% (n=809) 

Data source: self-reported written anonymous survey without assistance. UI as, “Urine loss in the last 12 months.” 

Age: Mean: 59.8 (Range: 25-93) 

Gender: Male Race: Not reported Ethnicity: White: 82.1% African-American: 16.5% Other: 1.4% 

Ethnicity White African-American Other Overall 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F169 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Antispasmodic agents Prostate active agents Level of evidence: III

Residency: Louisville, Kentucky 

Temml. 2000170Cross-sectional Adjusted by:, Age, Gender Medical history, Concurrent medical therapies Weight, Height, BMI Heart rate Blood pressure Echocardiogram Marital status Cigarette smoking Alcohol consumption Education Sportive activities Stress factors Level of evidence: III

Subjects were selected from voluntary health examinations sponsored by the city of Vienna. The exams are regularly organized and are offered free of charge. 

Response rate: 100% (n=2,498) Data source: Self-reported questionnaires (based on Bristol LUTS questionnaire) Urinary incontinence was defined as, “Any involuntary loss of urine within the past 4 weeks.” 

Age: ≥20 years (Mean age female: 49.7 SD: 13.6) (Mean age male: 48.6 SD: 13.0) 

Gender: Male and Female (Male: 49.5%) (Female: 50.5%) Race: Not reported Ethnicity: Not reported Residency: Vienna, Austria 

Prevalence (Overall): FemBy type (Of incontinent indFemale: Stress-92.0%, UrMale: Stress-29.5%, Urge

  Stress incontinence Urge incontinence Post-void dribbling Nocturnal incontinence Pure stress incontinence Pure urge incontinence Pure nocturia Pure post-void dribbling 

“Negative impact on qualitFemales-65.7% (incontine

 Women (n . 332Not at all 34.3 A little 47.4 Moderate 11.6 Severe 6.7 

By severity: 

Frequency Women (n . 332<1/week 45.8 2-3/week 24.6 1/day day 10.5 >1/day 21.1 Permanent 1.8 

Tseng, 2000171Cross-sectional Adjusted by: Age Gender Education Fitness 

Subjects were randomly selected from elderly residents of Taiwan, residing in Tungkang. 

Response rate: 80% (n=504) Data source: Face to face interviews by registered nurses. Incontinence was defined as, “Inappropriate leakage of urine.” 

Age: 65 years and older 

Gender: Male and female Male: 49.2% Female: 50.8% Race: Not reported 

By gender P

Male 

Female 

Total 

By Type 

% of in

Stress 

Urge 

Mixed 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F170 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Parity UI experience UI perception Treatment intention Level of evidence: III 

Ethnicity: Not reported Residency: Tungkang, Taiwan 

Undetermined 

Male 

Age group P

<70 70+ 

Female 

Age group P

<70 70+ 

Ueda, 2000172Cross-sectional Adjusted by: Age Gender Stroke Angina Diabetes Cystitis Ability to change clothes Ability to walk outside Hysterectomy Constipation Level of evidence: III

Subjects were selected from a random sample of 40-80 year olds living in 7 towns of Shiga Prefecture, Japan. 

Response rate: 52.5% (n=1,836) Data source: self-reported, mailed questionnaires Urinary incontinence was defined as a positive answer to the question, “Do you suffer from involuntary loss of urine?” 

Age: 40-80 

Gender: Male and female Male: 46% Female: 54% Race: Not reported Ethnicity: Not reported Residency: Japan 

Prevalence: Overall Male: 10.5% Female: 53.7% 

Chiarelli, 1999173Cross-sectional study (Nested within a large randomized cohort known as the WHA project.) Confounding factors: Parity, Constipation, Other bowel problems, BMI, Urine that burns or stings, Surgery (In midage and older cohort) Level of Evidence: III

Randomly selected from national health insurance database, including all women in Australia. To increase the number of rural residents, oversampling of remote areas was done. Response rate: Youngest (18-23): 48%, Mid-age 45-50): 54%, Oldest (70-75): 41% 

Self-report survey questionnaires from WHA project. UI as, “Experiencing the leaking of urine in the last year”. Responses: never, rarely, sometimes, or often. 

Age: 35.4 % in youngest cohort (18-23) (n=14,761) 33.7% in mid-age cohort (45-50) (n=14,070) 30.9% in oldest cohort (70-75) (n=12,893) Gender: Women Race/ Ethnicity: Not reported Residency: Broadly representative of all States and Territories of Australia 

Age group Preva18-23: 45-50: 70-75: 

Prevalence: OverallYoungest: 12,800/100,000 

Mid-age: 36,100/100,000 Oldest: 35,000/100,000 (3The question asked “Did nbetween the different typeexperienced by women, nmixed incontinence.” 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F171 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Dolan, 1999174Cross-sectional Adjusted by: Age Parity Employment status Pelvic floor exercises Gynecological operations Level of evidence: III

Subjects were randomly selected from a computerized register of family practice general practitioners living in four geographical areas of Northern Ireland. Response rate: 65.6% (n=689) Data source: Self-administered postal questionnaire Incontinence was defined as, “Leaking of urine within the past 2 years.”

Age: 35-74 Gender: Female Race: Not reported Ethnicity: Not reported Residency: Northern Ireland

Age 35-44 45-54 55-64 65-74 Total # of pregnancies 

0 1 2 3 4 

Total 

By Frequency Sometimes Often 

Foldspang, 1999175Cross-sectional Adjusted by: Pregnancy Vaginal childbirth Age at childbirth Obstetric procedures (Episiotomy, perineal suturing, forceps delivery, vacuum delivery) Level of evidence: III 

Subjects were selected from the Danish Central Population Registry. Subjects were randomly selected and age-stratified. All subjects lived in the municipalities of Aarthus and Randers. 

Response rate: 75.5% (n=4,710 respondents) Data source: Mailed, self-administered questionnaire. Women were asked, “Whether they had experienced urinary incontinence during the previous year.” If so, they were then asked whether the “episodes were generally provoked by physical stress or accompanied by a feeling of urge.” 

Age: 20-59 years of age 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Municipalities of Aarthus and Randers, Denmark. 

Prevalence: Overall: 17,700 / 100,000 Stress UI: 15,100 / 100,00Urge UI: 8,700 / 100,000 (Mixed UI: 6,800 / 100,000 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F172 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Damian, 1998176Cross-sectional Adjusted by: Age Gender Marital status Education Occupation BMI Number of children + miscarriages Self-rated health U.I. related chronic conditions General mobility Level of evidence: III

Subjects were randomly selected from community dwelling individuals ≥65 years, registered on the 

Madrid City Roll. 

Response rate: 71.2% Response by age group: 65-74: 71.4% 75-84: 73.1% 85 and over: 67.1% Response by gender: Males: 78.0% Females: 64.5% Data source: At home interviews by trained, gendermatched professionals. Incontinence was determined by a positive answer to the question, “Do you currently experience any difficulty in controlling your urine? In other words, does your urine escape involuntarily?” 

Age: ≥65 years. (n of each age group not reported) 

Gender: Male and female (n of each gender not reported) Race: Not reported Ethnicity: Not reported Residency: All respondents are community dwelling residents of Madrid, Spain 

Prevalence: Overall: (15.5%) By Gender: Male: (14.5%) Female: (16.1%) Of those that are incontineUrge: (26.6%) Stress: (12.5%) Mixed: (16.1%) Other: (15.5%) Of those that are incontineMale Urge: (52.2%) Male Stress: (10.6%) Male Mixed: (16.1%) Male Other: (21.1%) Female Urge: (12.3%) Female Stress: (13.5% Female Mixed: (61.8%) Female Other: (12.3%) 

Koyama, 1998177Cross-sectional Adjusted by: Age Gender Parity Living area Level of evidence: III

Subjects from residents >60 years in 3 different communities. Questionnaires were distributed through the town or village office. 

Response rate: Rural: 98.4% (n=937) Suburban: 65% (n=934) Nursing home: Not reported (n=433) Data source: Self reported questionnaires. In the nursing home, some subject data was obtained from the nurse or caregiver of the patient. Incontinence as, “even a small amount of leakage at a time when there was no intention of urinating.” 

Age: 60 and older 

Gender: male and female Race: not reported Ethnicity: Not reported Residency: Japan (Suburban, rural, and nursing home residents). 

Prevalence: Overall: Male: 4.7% Female: 11.3% By age: 60-69: Male: 0.7% Female: 7.9% 70-79: Male: 6.3% Female: 10.2% 80+: Male: 9.1% Female: 20.2% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F173 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Koskimaki, 1998178Cross-sectional Adjusted by: Age Level of evidence: III

Subjects were selected from all men born in 1924, 1934, and 1944 living in Tampere, Finland or one of the rural or semi-rural municipalities within the same 

county. Subjects were identified from the National Population Register. 

Response rate: 68% (n=2,128) Data source: Self-reported mailed questionnaire Incontinence was measured on a 4 item scale, from 0 points for no symptom to 3 points for severe symptoms. Urge incontinence, stress incontinence, and other incontinence were classified as mild when they were reported to occur rarely, and moderate to severe when occurring more often. 

Age: 50: (38%, n=806) 60: (34%, n=732) 70: (28%, n=590)) 

Gender: Male Race: Not reported Ethnicity: Not reported Residency: Tampere, Finland 

Age-adjusted prevalence: By type: Urge incontinence: 17,000 Stress incontinence: 9,000 Other incontinence: 10,00By severity: Urge incontinence: Mild: 16,000 / 100,000 (16Moderate/severe: 1,000 / Stress incontinence: Mild: 8,000 / 100,000 (8%Moderate/severe: 1,000 / Other incontinence: Mild: 9,000 / 100,000 (9%Moderate/severe: 1,000 / 

Kuh, 1999179Design: Nationally representative prospective cohort. Confounders: Childhood enuresis, Information on the data of the birth of children, Caesarian deliveries, BMI, Kidney or bladder infections, Menopausal status, Health status (Self-reported), Socioeconomic status Level of evidence: II-2B

Selected from participants in the Medical Research Council Survey of Health and Development. Response rate: 93% (n=1,378)). 

Measured using a mailed self-administered questionnaire. Definition of UI: Severe as occurring ≥2/month in the previous year and reporting loss of more than a few drops of urine. Moderate as 1 but not both of the aforementioned symptoms. Mild or none at all: reporting milder symptoms or none at all. Stress as yes to: “Do you ever lose urine when you cough, sneeze, laugh, run, or exercise?” Urge as yes to: “Do you ever have an urgent and strong desire to pass urine which is difficult to control?” and follow up question, “Do you ever lose any urine before you reach the toilet?” 

Age: 48 years old 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: General population sample of women living in England, Scotland, and Wales. 

 Severe Urge Stress Overall By Impact on life Bothered a little Bothered a lot 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F174 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Stenberg, 1999180Cross-sectional Adjusted by: “Socio-demographic factors,” obstetrical and gynecological history, somatic diseases, previous surgery, previous fractures, current medications, and estrogen treatment Level of evidence: III 

Subjects were selected from all women born in a county in Sweden between December 1921 and January 1923 (71 year old group) as well as born between December 1911 and January 1913 (81 year old group). Names and addresses were obtained from the population register. 

Response rate: 87% (Of those aged 71) (n=1,084) 62% (Of those aged 81) (n=611) Data source: Mailed, self-reported questionnaire. Definition of incontinence used in study not reported, but the article claims that the “questionnaire covered all urinary incontinence problems.” Symptoms were classified as, “none, trivial, moderate, severe, or unbearable.” 

Subject age: 71 years of age and 81 years of age 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Uppsala County, Sweden 

Prevalence: Overall: 71-year-old group: 46,000 81-year-old group: 45,000 Mixed incontinence: 71-year-old group: 20,000 81-year-old group: 20,000 Urge and stress UI prevaleUI of considerate severity: deemed considerate when “moderate, severe, or unbresponse sheet) 71-year-old group: 48,000 women experiencing urinatheir UI considerately seveprevalence not reported. 81-year-old group: 59,000 women experiencing urinatheir UI considerately seveprevalence not reported. 

Swithinbank, 1999181Cross-sectional Adjustment factors not reported. Level of evidence: III 

Women ≥19 years registered at a general practice were selected and mailed a questionnaire. The practice was chosen because it had near average social and demographic patterns for the city. 

Response rate: 80% Data source: Validated, self-completed questionnaire. Incontinence defined using the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS), asking about symptom occurrence during the previous month with a five point likert scale; the 2nd part asks about the degree to which the symptom causes a problem, on a 4-point scale. This definition of UI, was not reported in the article. 

Age: 52 (Mean), 19-97 (Range) 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: a major British city(Not identified in article). 

Prevalence: Overall: 69,000/100,000 (6By Type: Stress incontinence: 60,00Urge incontinence: 46,000Impact on life: Incontinence having a socper ICS definition of incon100,000 (30%) Of those women reporting reported that it was “probleOverall, 40% of women suexperienced incontinence (40,000/100,000) 

Jitapunkul, 1998182Cross-sectional Adjusted by: Age, Gender 

Selected from all elderly persons living in the Klong Tuey slum in Thailand. Response rate: 72.6% (n=114) 

Data source: At home interviews 

Age 60+ (Mean: 69.3) 

Gender: Male and female (Male: 33%, Female 

Prevalence: Overall: 16.2% Male: 10.8% By type, Stress: Overall: 2Male: 0.43 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F175 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Marital status, Literacy Work and Perceived health status Life satisfaction Level of evidence: III

Incontinence as: “During the last 12 months, does urine ever drip unexpectedly without your being able to stop it and you get wet?” 

67%) 

Race: Not reported Ethnicity: Asian Residency: Thailand 

By type, Urge: Overall: 9.5Male: 7.33 By type, Mixed: Overall: 2Male: 1.72 

Roberts, 1998183Cross-sectional Adjusted by: Age Gender Self-rated health status Level of evidence: III

Random individuals ≥ 50 years in Olmsted County, MN. Selected using records from the Rochester Epidemiology Project. There was a separate cohort for men and for women. A third cohort included men ≥40 years. Response rate: 66% (n=1,540) Data source: Self-reported, validated questionnaires (incontinence as), “In the last year “ - “Were there any days when you leaked more than a few drops of urine?” – “If yes, how many days did you leak more than a few drops of urine?” - “ Have you had slow leakage or dribbling throughout the day?” - “Have you had leakage when you coughed or sneezed?” “When leakage has occurred, were you aware of the need to urinate before the leakage occurred?” Response options: never, l<25%, >25%, and >75% 

Gender: Male and Female Age: ≥50 years 3rd cohort of men ≥40 years. 

Race: Not reported Ethnicity: Not reported Residency: Olmsted County, MN 

Prevalence: Male 50+ Cohort: (24.3%) Female 50+ Cohort: (48.7Male 40+ Cohort: (17.3%) By type: Women: Stress incontinence: (13.2Urge incontinence: (5.4%) Mixed incontinence: (77.9Neither stress nor urge (3Men: Stress incontinence: (3.5%Urge incontinence: (40.8%Mixed incontinence: (24.9Neither stress nor urge: (3By severity: Men: Mild: (77.8%) Moderate/severe: (22.2%) Women: Mild: (69.7%) Moderate/severe: (30.3%) 

Talcott, 1998184Prospective cohort study Adjusted by: Age Marital status Employment status Income Education Radiotherapy Radical prostatectomy Sexual dysfunction Level of evidence: II-2A

Subjects were selected from August 1990-May 1994 from men seeking physician advice on early prostate cancer. Patients needed a tissue diagnosis of adenocarcinoma of the prostate, a radionuclide bone scan free of metastatic cancer, and no prior surgery or radiotherapy for prostate cancer to be eligible. All study enrollments occurred at Harvard Medical School, although treatments often occurred elsewhere. 

Response rate: 72% (n=279) Data source: Initial self-reported questionnaire. Medical records. Follow-up questionnaires at 3 and 12 months. 

Age: Mean: 64.6 Median: 65 Range: 41-86 Gender: Male Race: Not reported Ethnicity: Not reported Residency: USA 

Prevalence of incontinencBaseline and by treatmentProstatectomy: 64 or less: 2,000 / 100,000 65 or more: 3,000 / 100,00Radiotherapy: 64 or less: 0 / 100,000 (0%65 or more: 1,000 / 100,00At 3 months: Prostatectomy: 64 or less: 24,000 / 100,0065 or more: 24,000 / 100,0Radiotherapy: 64 or less: 0 / 100,000 (0%
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F176 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Incontinence was defined as “dribbling or leaking” and also by the use of “absorptive pad worn in the past week.” 

65 or more: 2,000 / 100,00At 12 months: Prostatectomy: 64 or less: 9,000 / 100,000 65 or more: 15,000 / 100,0Radiotherapy: 64 or less: 0 / 100,000 (0%65 or more: 2,000 / 100,00

By severity (Absorptive paBaseline and by treatmentProstatectomy: 64 or less: 2,000 / 100,000 65 or more: 3,000 / 100,00Radiotherapy: 64 or less: 0 / 100,000 (0%65 or more: 2,000 / 100,00At 3 months: Prostatectomy: 64 or less: 57,000 / 100,0065 or more: 61,000 / 100,0Radiotherapy: 64 or less: 0 / 100,000 (0%65 or more: 6,000 / 100,00At 12 months: Prostatectomy: 64 or less: 35,000 / 100,0065 or more: 36,000 / 100,0Radiotherapy: 64 or less: 0 / 100,000 (0%65 or more: 7,000 / 100,00

Bogren, 1997185Prospective cohort Level of evidence: 

Swedish population from a Primary Health Care District, SW Sweden, 54000 people in this area 

458 persons, 65yrs and older questionnaire mailed to home – history of UI defined as involuntary voiding of urine, type of UI 76% response rate after 1st mailing, 1st reminder 

answered by 14% and 2nd by 6%. 

225 women 233 men Prevalence of UI, gender differences Women% men % p neuro disease 3% 10% NS diabetes 5 heart dis. 7 14 

Prevalence = 28% women

33% women reported sig. <.05 as well as more Urge men 40% p<.05 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F177 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

back pain 52% 57% current UTI 34 10 <.05 surgery bladder 5 14 surgery genital 43 14 <.05 diuretics 15 14 sedatives 8 5 hypnotics 20 <.05 sex hormones 36 

Brandeis, 1997186Cross-sectional Adjusted by: Age Gender Race Anti-depressant use Impaired mobility ADL’s Specific diseases (fecal impaction, CHF, UTI, diabetes, pedal edema, delirium, dementia) Level of evidence: III

Subjects were selected from a representative sample of Medicaid-certified American nursing homes, drawn from ten states. A random sample of residents was selected from each of the 270 nursing homes studied. 

Response rate: 92.6% (n=2,014) Data source: Standardized forms called the Minimum Data Set (MDS). Registered nurses were trained on data collection using that form. Data was collected from chart review, interview with nursing home staff, and observation of residents. Incontinence was defined as, “at least two episodes per week of involuntary urine loss within the past two weeks.” 

Age: Residents 60 years of age or older Mean: 84.3 (SD: 8.7) 

Gender: Male (24.5%) and female (75.5%) Race: White: 81.9% Black: 12.7% Other not reported Ethnicity: Not reported Residency: Nursing home residents in ten states in the USA 

Prevalence of urinary incoOverall: 49,000 / 100,000 Men: 45,100 / 100,000 (45Women: 78,400 / 100,000 Type, severity, and impacreported. 

Brieger, 1997187Cross-sectional Adjusted by: Age Height Weight BMI Place of birth Parity 

Subjects were randomly selected from telephone directories in the regions of Hong Kong Island, Kowloon, and the New Territories. 

Response rate: 43% Data source: Telephone survey with a previously validated and tested questionnaire. Incontinence was defined as “involuntary loss of urine which is socially or hygienically unacceptable.” 

Age: Mean: 45 (SD: 15) 

Gender: Female Race: Not reported Ethnicity: Chinese Residency: Hong Kong, China 

Prevalence: Overall: 13,000 / 100,000 By Type: Stress Incontinence: 10,00Urge Incontinence: 700 / 1
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F178 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Employed Constipation Smoking Level of Evidence: IIIMalmsten, 1997188Cross-sectional Adjusted by: Age Marital status Foreign extraction Place of residence Urinary tract infections Level of evidence: III

Subjects were randomly selected from the total population of men 45 and older living in Goteborg, Sweden in 1992. The subjects were selected from the population register, and were selected by year of birth. Several cohorts were obtained at 5-year intervals. A sample was taken from those born in: 1947, 1942, 1937, 1932, 1927, 1922, 1917, and 1912. All men born in 1907 or earlier were included to obtain a more comprehensive sample of older men. Response rate: 74% (n=7,763) Data source: Self-reported, mailed questionnaire Urinary incontinence was defined according to the International Continence Society and was confirmed by a 48-hour pad test and voiding lists.

Age: ≥45 years Mean: 63.1 (SD: 19.0) Gender: Male Race: Not reported Ethnicity: Not reported Residency: Goteborg, Sweden

Age (years) Prev

45 50 55 60 65 70 75 80 

85-89 

90+ 

Total 

Overall: 9,200 / 100,000 (9

By severity (Of incontinenDaily leakage: 64,100 / 102-3 times/week: 12,600 / 1Once weekly: 8,200 / 100,Once monthly: 15,100 / 10By impact on life: Men who considered their life:” 31,000 / 100,000 (31

Mozes, 1997189Adjusted by: Age Origin Education Economic status Urinary symptoms Co-morbidities (Heart disease, diabetes, respiratory disease, hypertension, joint disease, peptic disease, renal disease, cancer) Level of evidence: III

Subjects were randomly selected from all Israeli cities and settlements over 5,000. Areas were stratified by region and population size. Within selected cities, the sampling unit was according to dwelling. Within dwellings, individuals were recruited using quotas for socioeconomic status and age. 

Response rate: 93.3% (n=896) Data source: Personal interviews in homes of respondents with a validated questionnaire. This study looked at “urinary symptoms.” The only question dealing specifically with incontinence was, “Do you experience involuntary urination while coughing or laughing?” Stress incontinence was the only type of incontinence measured. 

Age: 45-75 years old 

Gender: Male Race: (Listed as “origin” in report) Asia-Africa: 43.2% Europe-America: 47.7% Israel: 9.1% Ethnicity: Not reported Residency: Israeli cities and settlements 

Prevalence: Stress Incontinence: 2,100 By Severity: (Of any urinainclude: weak stream, freqdribbling, dysuria, incompstress incontinence, urinarBothersome: Mild: 86,500 / 100,000 (86Moderate: 8,900 / 100,000 Severe: 4,600 / 100,000 (4
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F179 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Nakanishi, 1997190Cross-sectional Adjusted by: Gender Age General health status Stroke Diabetes Dementia Social activity Anxiety “No life worth living” Level of evidence: III

Subjects were randomly selected from all residents of Settsu, Japan aged 65 or older. Subjects were identified from a computerized age/sex register. Response rate: 95.4% (n=1405) Data source: At home interviews Incontinence was determined by a positive response to the question, “Do you wet or soil yourself?” 

Age: 65 and older 

Gender: Male and Female Race: Not reported Ethnicity: Not reported Residency: Settsu, Japan 

Male Daily or m65-74 0.3 75-84 1.2 85+ 0 Male Less than 65-74 0.5 75-84 7.9 85+ 9.7 Female Daily or m65-74 0 75-84 1.8 85+ 3.4 Female Less than 65-74 2.2 75-84 6.4 85+ 8.5 

Samuelsson, 1997191Cross-sectional Adjusted by: Age Marital status Education Work status Smoking Coffee consumption History of disease and medication, including HRT Parity Obstetric history Menopausal age Gynecological symptoms Gynecological operations Level of evidence: III 

Subjects were selected from all women scheduled for a gynecological health examination by midwives in a primary health care district during one year. Subjects were mailed a questionnaire if they were between 20-59. Exclusions were women who were pregnant or lactating, had a cervical smear in the last year, or who had mental retardation. 

Response rate: 77% (n=491) Data source: Self-reported postal questionnaire. Urinary continence was defined as a positive answer to the question, “Do you suffer from involuntary loss of urine?” Stress incontinence was defined as, “leakage during effort,” and urge incontinence was defined as, “leakage with sense of urge.” Mixed incontinence was the presence of both. Unspecific incontinence was defined as, “leakage, but not during effort or with sense of urge.” 

Age: Subjects were 20-59 years of age. By age group: 20-29: 153 30-39: 118 40-49: 87 50-59: 133 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Sweden 

Prevalence: Overall: 27,700 / 100,000 By type: Stress incontinence: 15,70Urge incontinence: 2,000 / Mixed incontinence: 5,300 Unspecific incontinence: 4By severity: Daily leakage: 3,500 / 100Once a week: 4,900 / 100Once a month: 4,100 / 100Seldom: 15,200 / 100,000 

Schulman, 1997192Cross-sectional Adjusted by: 

Subjects were selected randomly using a sampling technique based on the Multi Method Multi Stage 

program. Quotas were established based on age, 

Age: 30-34: 699 (13.3%) 35-49: 1,792 (34%) 

Prevalence: 

Overall: 10,900 / 100,000 By Gender: 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F180 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Age Gender Parity Professional status Level of evidence: III

sex, and profession. 

Response rate: 89% (n=5,269) Data source: Self-completed questionnaires Urinary incontinence was determined by participant’s responses to the following: “Arriving too late to the toilet” (urge incontinence), “losing urine when laughing or coughing too much” (stress incontinence), “continuously losing some urine” (permanent incontinence), “losing some urine after micturition” (postmicturition incontinence). 

50-64: 1,478 (28%) 65+: 1,299 (24.7%) 

Gender: Male: 2,499 (47.4%) Female: 2,770 (52.6%) Race: Not reported Ethnicity: Not reported Residency: Belgium residents 

Male: 5,200 / 100,000 (5.2Female: 16,300 / 100,000 By type (Based on personStress incontinence: 42,00Male: Not reported Female: 53,000 / 100,000 Urge incontinence: OveralMale: 45,000 / 100,000 (4Female: 55,000 / 100,000 By severity (Based on perincontinent): Considered “bothersome:” Considered “more or less 100,000 (70%) Permanent incontinence: 3Several daily episodes: 17One episode a day: 8,500 2-3 weekly episodes: 18,62-3 monthly episodes: 34,No response: 17,500 / 100

Thom, 1997193Adjusted by: Age Race BMI Parity Hysterectomy before age 45 Estrogen replacement Parturition variables (parous women only) Level of evidence: III

Subjects were selected from a random sample of women aged 60 years and older who were members of Kaiser Permanente Medical Care Plan of Northern California. 

Response rate: 74.7% Data source: Self-reported, mailed questionnaire Incontinence was defined as “at least one episode of incontinence in the past 12 months.” Stress incontinence was, “incontinence triggered by one or more activities associated with increased intraabdominal pressure, with leakage usually occurring immediately and without a sense of urgency.” Urge incontinence was defined as, “experiencing a sense of urgency prior to the incontinence.” Those with both types had mixed incontinence. 

Age: Mean: 69.6 (SD: 7.0) 

Gender: Female Race: White: 77% Hispanic: 5% Black: 8% Asian: 6% Other: 5% Ethnicity: Not reported Residency: Northern California 

Prevalence: Overall: 72,600 / 100,000 By type: Stress: 16,900 / 100,000 (Urge: 23,900 / 100,000 (2Mixed: 23,600 / 100,000 (2Other: 8,300 / 100,000 (8.By Severity: Less than once/month: 14Monthly: 23,900 / 100,000 Weekly: 21,800 / 100,000 Daily: 12,200 / 100,000 (1

Brown, 1996194Cross-sectional Adjusted by: Age, 

From population-based listings in 4 areas, previously participating in a study on osteoporotic fractures. Response rate: Not reported (n=7,949) 

Data source: interview, self report questionnaire, and 

Age: 70+ Mean: 76.9 (SD: 5.0) 

Gender: Female 

Prevalence 

Overall 

Severity Pre

Daily 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F181 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Menopausal status, Hysterectomy, BMI, Poor health, COPD, Stroke, Diabetes, CHF, Parkinson, Oral estrogen, Diuretics, Coffee, Smoking, Alcohol consumption, Exercise, Gait speed, Muscle strength Level of evidence: III 

physical exam. 

UI as, “During the last 12 months, have you ever leaked or lost control of your urine?” 

Race: Not reported 

Ethnicity: Not reported Residency: Baltimore, Minneapolis, Monongahela Valley by Pittsburgh, and Portland, USA 

Infrequent 

Total 

Umlauf, 1996195Cross-sectional Adjusted by: Age, Ethnicity Functional status Prostate problems Surgery, Diuretic use Caffeine use, Nocturia Symptoms of urinary retention Level of evidence: III

Selected from men ≥55 years enrolled in a hospital 

based senior citizens group.

Response rate: 28% (n=1,490) Data source: Mailed, self-reported questionnaires Incontinence was defined as, “Uncontrolled urine leakage during the month before the survey.” 

Age: ≥52 years (Mean: 71.6) 

Gender: Male Race: Not reported Ethnicity: White, Black, Latino, Other Residency: USA 

Prevalence: Overall: 29% By age: 52-64: 19.7% 65-74: 26.1% 75-84: 38.1% 85-94: 31.4% 95-99: 66.7% 

Seim, 1995196Cross-sectional Adjusted by: Age Level of evidence: III 

Subjects were selected from all women ≥20 years. 

Response rate: 77% (n=1,820) 

Data source: Self-reported mailed questionnaires Incontinence was defined as, “Any frequency or amount of leakage.” 

Age: 20 years and older 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Rural community, Rissa Norway 

Prev

Overall By type Stress All other types Severity Slight or moderate Severe Unknown 

Kutner, 1994197Cross-sectional Adjusted by: Age, Gender Marital status, Ethnicity, Education Cognitive functioning Depression 

Selected from data provided by the National Institute on Aging, in cooperation with FICSIT and NCNR (community dwelling elderly persons). (n=352) Response rate: Not reported 

Baseline data from the Frailty and Injuries: Cooperative Studies of intervention study. Incontinence as “≥1episodes/week of loss of urine 

Age: Mean: 77.1 

Gender: Male and Female Race: Not reported Ethnicity: Not reported 

Prevalence: Overall: Male: 4.5% Female: 17.9% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F182 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Chronic health conditions Level of evidence: III

control.” Residency: USA 

Mommsen, 1994 198Cross-sectional Adjusted by:, Age, BMI, Menopausal status, Parity Abdominal or gynecologic surgery Cystitis, Occupation Level of evidence: III

Subjects were selected from an age-stratified random sample of women 30-59. Response rate: 84.5% (n=2,631) 

Data source: Self-reported, mailed questionnaire. Incontinence as, “Experiencing UI during the year 1987.” 

Age: 30-59 years 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Aarhus. Denmark 

Prevalence: Overall: 17% By Type: Stress: 15% Urge: 9% Mixed: 7% 

Brocklehurst, 1993 199Cross-sectional Adjusted by: Age Sex Recency of symptom Level of evidence: III 

Randomly selected in 3 geographically stratified points. Response rate: Not reported (n=4,007) 

Data source: home interviews by trained interviewers. UI as yes to question about “bladder problems e.g. leaking, wet pants, damp pants.” 

Age: 30 years and older 

Gender: Male and female Male: 47% Female: 53% Race: Not reported Ethnicity: Not reported Residency: Great Britain 

Male: 

Age 

category 

Prevalence: 

Ever 

Pr

y

30-49 2 50-59 5.4 60+ 13.3 Total 6.6 

Female: 

Age 

category 

Prevalence 

ever 

Pre

y

30-49 10.9 50-59 15.4 60+ 16.8 Total 14 

Lagace, 1993200Cross-sectional Adjusted by: Age Gender Level of evidence: III

Selected from all ≥20 years seeking health care for 

any reason at 5 family practices during an 11 week period. Response rate: 77.8% (n=2,830) 

Data source: Self-reported, anonymous questionnaire UI as, “Any degree of incontinence in the past 12 months.” 

Age: ≥20 years Gender: Male and female Race/ ethnicity: Not reported Residency: Upper Peninsula Research Network of Michigan) 

Prevalence: 33% By gender: Male: 11% Female: 43% By impact on life: Consideproblem” (For purposes of was also considered “Signseverity): Male: 5% Female: 23% 

Milsom, 1993201Cross-sectional Adjusted by: Age Parity 

Subjects were randomly selected from all women in the city of Goteborg, Sweden using the population register. Women were sampled from birth cohorts 1900, 1905, 1910, 1915, 1920, 1930, and 1940. 

Response rate: 74.6% (n=7,459) 

Age: 46-86 years old Gender: Female Race: Not reported Ethnicity: Not reported 

Birth cohort 

1900 1905 1910 1915 1920 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F183 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Oral contraception Hysterectomy Menopausal status Level of evidence: III 

Data source: Self-reported mailed questionnaires. 

Incontinence was defined as, “inappropriate leakage of urine,” and was validated by a sub sample of women by objectively confirming by a 48 hour pad test, micturition lists, and a cough provocation test. 

Residency: Goteborg, Sweden 

1930 1940 

Birth cohort 193

Yrs Oral Contracep

0 

1-3 4-6 

7+ 

Parity 

0 1 2 

3+ 

Premenopausa

Postmenopausa

Birth cohort 194

Years Oral Contrace

0 

1-3 4-6 

7+ 

Parity 

0 1 2 

3+ 

Premenopausa

Postmenopausa

Birth cohort Hyste

1900 

 

1905 

 

1910 

 

1915 

 

1920 

 

Total 

 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F184 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Kok, 1992202Cross-sectional Adjusted by: Age Mobility Frequency Nocturia Urgency Fecal incontinence Level of evidence: III

Subjects were recruited from women ≥60 years. A 

random sample of 30 women born each year was obtained from the population register. 

Response rate: 69% (n=719) Data source: Self administered postal questionnaires. Incontinence as, “Involuntary loss of urine at least twice a week.” 

Age: 60 years and older 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Amstelveen, Netherlands 

Age group Prevale60-64 65-69 70-74 75-79 80-84 85-89 90+ Overall 

Rekers, 1992203Cross-sectional Adjusted by: Age Marital status Menopausal status Genito-urinary symptoms Pelvic area surgery Vaginal deliveries Level of evidence: III

Subjects were selected from a stratified sample of women drawn from the Bureau for Population Registration in the Netherlands. 

Response rate: 67.7% (n=1,299) Data source: Self-reported, mailed questionnaires “Serious incontinence was defined as incontinence occurring at least once a week and in larger amounts than a few drops of urine. All other incontinence was deemed to be minor.” 

Age: 35-80 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Zoetermeer, Netherlands 

men

Prevalence (Overall) Frequency: 

<1/month >1/month-<1/week >1/week-<1/day >1/day Amount lost: Drops only A little  A lot Type: Stress Urge Mixed Unknown 

Burgio, 1991204

Prospective cohort Adjusted by:  BMI, Parity Race, Caffeine intake Alcohol intake, Smoking Physical activity, Age Menopausal status Hysterectomy Gynecological surgery Level of evidence: II-2B

Subjects were selected from participants in the University of Pittsburgh Healthy Women Survey, a 5-year prospective study. Participants were recruited from women with driver’s licenses in selected zip codes of the Pittsburgh area. 

Response rate: 60% (n=541) Data source: Nurse administered interview questionnaire Incontinence was defined as, “Ever leaked even a small amount of urine involuntarily.” 

Age: Mean: 47 years 

Gender: Female Race: White: 90.6% Other (Not reported): 9.4% Ethnicity: Not reported Residency: Pittsburgh, USA 

Prevalence % 

Overall Stress Mixed Urge Uncategorized Frequency PrevaNever <1/month >1/month >1/week 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F185 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Daily 

Ju, 1991205Cross-sectional Adjusted by: Age Gender Ethnicity Level of evidence: III

Selected from all residents, ≥65 years living in a public housing estate. Data obtained from the National Registry Department. Response rate: 80.4% (n=919) Data source: At home interviews Incontinence was defined as, “Leakage of urine 2 or more times in the past month.” 

Age: 65+ 

Gender: Male and female (Male: 47.3%, Female: 52.7%) Race: Not reported Ethnicity: Chinese: 83.5% Malay: 9.7% Indian: 6.6% Eurasians: 0.2% Residency: Singapore 

Prevalence: O

Male: 4.4% By age group: 65-69: 3.1% 75-79: 6.7% 85+: 9.8% By ethnicity: Chinese: 5.2% Indian: 1.6% By type: Pure urge: 1.3% 

Lagro-Janssen, 1990206Cross-sectional Adjusted by: Age, Marital status, Parity, Education, Employment Perceived health status, Hypertension, Diabetes, COPD, Obesity, Varicose veins, CHF Symptoms of loco motor system Hysterectomy Level of evidence: III

Selected from 2,400 randomly selected practice files of 75 general practitioners. Response rate: 60% (n=1,442) 

Data source: Self reported data from home interviews conducted by trained interviewers. Urinary incontinence defined as, “involuntary loss of urine more than twice a month.” No attempt was made to classify based on type. 

Age: 50-65 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Eastern Netherlands 

 PreOverall By Severity: None Mild Moderate Severe 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F186 

Author 

Sample 

Subject Selection, Response Rate, Data Source, 

Measurement Methods(survey, screening, case 

finding, definition of incontinence) 

Subject Age, 

Gender, Race, 

Ethnicity, Residency 

Prevalence (%) of Urinar

and by Type, Severity

Molander, 1990207Cross-sectional Adjusted by: Age Urinary tract infections Other urogenital symptoms Estrogen treatment Level of evidence: III

Subjects were selected from a random sample of women born in 1900-1920 at five-year intervals in the city using the population register. Response rate: 70.1% (n= 4,206) 

Data source: Self-reported, mailed questionnaires UI definition on the mailed form was not reported. However, the first 300 women to report UI were invited to attend a clinic where UI was confirmed by detailed medical history, examination, a 48 hour pad test, micturition lists, and a cough provocation test. 

Age: 65-84 years 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Goteborg, Sweden 

Birth cohort 1900 

1905 1910 1915 1920 

Total Frequency Daily 2-3 times/week 1/week 1-3 times/month By Type Stress Urge Mixed 

Herzog, 199041Prospective cohort Adjusted by: Age Sex General health status Level of evidence: II-2C

Subjects all non-institutionalized persons ≥60 years in a stratified probability sample. Response rate: 66% (n=1,956) 1 year follow-up: 69% 2 year follow-up: 72% 

Data source: At home interviews by interviewers trained at the U of Michigan School of Public Health. UI as, “any uncontrolled urine loss within the previous 12 months.” 

Age: 60 years and older 

Gender: Male and female Males: 41% Females: 59% Race: Not reported Ethnicity: Not reported Residency: Washtenaw County, Michigan 

Gender Baseline pMale 18Female 37 PrevalencMale Female 4 PrevalencMale 2Female 

Lagro-Janssen, 1990206

Cross-sectional 

Adjusted by: Age, Marital status, Parity, Education, Hysterectomy, Employment, Perceived health status, Hypertension, Diabetes, COPD, Obesity, Varicose veins, CHF, Symptoms of loco motor system Level of evidence: III 

Subjects were selected from 2,400 randomly selected practice files of 75 general practitioners.

Response rate: 60% (n=1,442) Data source: Self reported data from home interviews conducted by trained interviewers UI defined as, “involuntary loss of urine >2/month.” No attempt was made to classify based on type. 

Age: 50-65 

Gender: Female Race: Not reported Ethnicity: Not reported Residency: Eastern Netherlands 

Prevalence: 22.5% By impact on life: “Not worried about it”: 77.8By severity: Mild: 8.0% Moderate: 7.8% Severe: 6.7% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1-c. Prevalence of UI in adults in the community (continued) 

F187 

Multiple logistic regression of ’long term’ UI and delivery mode history67

Incontinence 

Variable Total N % 

Odds 

ratio (95% CI) P 

Delivery mode history 

All other histories 2,707 1263 (46.7) 1.0 Reference 

Only caesarean section(s) 

435 141 (32.4) 0.50 (0.40-0.63 0.001 

Any forceps 1,029 480 (46.6) 0.96 (0.83-1.11 0.567 Maternal age at first birth <25 1,432 568 (39.7) 1.0 Reference 0.001 25-29 1,697 766 (45.1) 1.34 (1.15-1.55 0.001 30-34 835 427 (51.1) 1.88 (1.57-2.25 0.001 >35 207 123 (59.4) 2.98 (2.18-4.07 0.001 Number of births One 528 202 (38.3) 1.0 Reference 0.001 Two 2,202 993 (45.1) 1.30 (1.07-1.59 0.001 Three 1,025 490 (47.8) 1.61 (1.29-2.02 0.001 Four or more 416 199 (47.8) 1.73 (1.31-2.27) 0.001 Number of women 5 4171 Number symptomatic 5 1884 Symptoms are yes at 6 years 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F188 

F1d. Prevalence and incidence of fecal incontinence in adults 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Uustal Fornell, 1996 208Comparative case 

control 

51 Females with rupture of anal sphincter during vaginal delivery. 31 Females without rupture of anal sphincter during vaginal delivery, rupture groups were subdivided into incomplete sphincter rupture and complete sphincter rupture for some analyses. Methods: Questionnaires at 6 months after delivery.Definition: 6 point scale, 6= complete continence, 1 = total incontinence, incontinence of gas, liquid stool, solid stool, soiling, no operational definitions were given. 

Age:With Rupture, Median= 27 years, Range=20-38 years, Without rupture, Median=26 years, Range=20-35 yearsGender: Female

Residency: Sweden

Incontinence of Liquid Stool 16% of the 51 with a rupture 13% of the 31 without a rupture Liquid Stool on the 6 Point Scale Unable to determine median severity scorMedian severity for incomplete rupture groMedian severity of liquid stool incontinenc4.5 Solid Stool = 0% per test (These results above are presented by bo

Pescatori, 1990209

Prospective, observational Adjustment For: No determination of whether patients had fecal incontinence pre-operatively was reported. 

207 patients who underwent restorative proctocolectomy and ideoanal reservoir between March 1980 and May 1989 who were in the Italian registry, 156 patients where studied. Definition: Disordered continence, occasional soiling of mucus or feces, permanent soiling of mucus or feces, total minor leak, total major leak. None of these were operationally defined; "totals" appear to be mucus and feces 

Age:<45 years (n=123) >45 years (n=33)Residence: Italy

Fecal Soiling: Soiling in those <45 years old=6% of 123 Soiling in those >45 years old=15% of 33 Bivariate analysis of risk, n = stool frequen70 patients with fecal soiling, of those with 108 70 patients with fecal soiling, of those with 

Pouchitis: 22% (4/18) patients who had pouchitis had without pouchitis (8/138) had fecal soiling. No significant difference in any risk. 

Belmonte-Montes, 2000210Prospective, descriptive, observational Adjustment For:Females with a history of anal sphincter damage, diabetes, neurological disease, needing a C section, or history of 

98 primiparous females of obstetrics out-patient clinic of medical specialties, Center of Mexican army and air force between May of 1996-1999. Methods: Interview, clinical exam, and endo-anal ultrasound that were done 4-6 weeks before and 6 weeks after delivery.Definition: Incontinence of gas, mucus, liquid and solid stool, frequency >1 x 1 week, >2 x 1 month, 

Age:Average = 22.4 years SD = 3.56, range = 16-34Gender: all FemaleResidency: Mexico

Fecal Incontinence 21 had some fecal incontinence after delivare mixed in here so not included. "Major" fecal incontinence later defined as was in 5 women. Risks: 14 women with a sphincter defect incontinence but 7 did not. Results state thbetween sphincter defect on ultrasound anno "r" or other statistic is reported. 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F189 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

previous anarectal or vaginal surgery were excluded. 

1 x 1 month 

Ho, 1995211

Cross section Listed as not eligible 

602 consecutive patients who had a curative resection for colorectal cancer >12 months prior to survey. 

Methods: mailed questionnaire.Definition: used grading classification, grade 3 = occasional liquid soiling, 4 = frequent liquid or mild soiling, 5 = incontinence of solids. 

Age: x = 64.5 years, SEM = .7

Gender:F = 41.3%, M = 58.7%Residency: Singapore

No overall % was reported. After R hemicolectomy: Grade 3 = 16.4% After L hemicolectomy: Grade = 9.6%, GraSigmoid colectomy: Grade 3 = %.4%, GraLow anterior resection: Grade 3 = 19.9%, of 143 patients 

O'Keefe, 1995212

Cross sectional Adjustment For:data were adjusted to age and gender specific proportions in 1980, US census 

Random sample of 704 Olmsted County residents > 65 years old 

530 responded, 478 completed section containing fecal incontinence information Method of Measurement- mailed survey.Definition: fecal incontinence as leakage of stool once per week or more or use of a pad to prevent soiling. The second part of the definition doesn't require leaking, only an intent to prevent it. 

Age: x = 75 years, range = 65-98Gender: 49% femaleResidency: Olmsted County, MN

Fecal incontinence Overall + 8.2% (5.5, 10.8), 95% CI Men = 8.1 % (4.3, 11.8) Female = 7.9 (4.4, 11.4) Impact on life Functional status and health of those with from those with any of the GI condition ansignificantly different from controls (no p vOther Findings: 16% of those with diarrhea had fecal inconhad fecal incontinence, no denominators w

Hinds, 1990213

Point prevalence 

Every 4th person on mailing list of National MS Society of Allegheny County, 78 persons in Allegheny hospital work force non MS controls. Methods: mailed questionnaire, 1 follow up mailed questionnaire to MS patients with fecal incontinence Definition: Involuntary passage of stool at least once during preceding 3 months 

Age: 280/with MS 339 responded, 78 non MS, age MS = 48 years (19-77), non MS = 42 years (22-64)Gender: Female = 77% of MS, Female = 78% non MS

Residency: Allegheny County PA

Prevalence of Fecal Incontinence Overall MS = 51% Mild MS = 25% Non MS = 4% 50/147 MS patients responded to follow umost often when stools were semi-formed 

Fecal incontinence frequency: daily = 2%, 22%, ≤1/week - 7.33 months = 23%, once 

Kok, 1992202

Survey, point prevalence 

1049 questionnaires were mailed to women >60 years in Amstelveen, 

Netherlands; a random sample of 30 women born each year was selected Methods: Mailed survey

Age: 60-84 yearsGender: FemaleResidency: Amstelveen, 

Fecal Incontinence; <85 = 4.2% of 625, ≥8Urinary Incontinence; daily = 14% (n = 9660-85 years, fecal incontinence = 8 (8.5%incontinence, fecal incontinence = 11 (2.9incontinence 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F190 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Definition: Occasional involuntary loss of feces 

Netherlands >85 years, fecal incontinence = 9 (21.4%) 

incontinence, fecal incontinence = 15 (12.

incontinence. 

Talley, 1992214

Survey, point prevalence Adjustment For: age and sex adjusted using 1980 US white population 

Age and sex stratified random sample of non-institutionalized residents in Olmsted Country MN aged 65-93 years. Methods: mail questionnaire

Definition: Stool leakage; clinical significant incontinence was defined as once a week or more, or if wearing a pad is needed 

Age: not reported

Gender: not reportedRace and Ethnicity: all 

whiteResidency: Olmsted County, MN

Fecal Incontinence; Once/week = 3.7% (11/ week and needs to wear a pad = 7% (4incontinence- 6.1% (3.3-8.8) Of the 7% : Fecal Incontinence and constipation w/o oFecal incontinence and constipation with oFecal Incontinence and diarrhea = 42% Fecal Incontinence without constipation or Age Adjusted Women: Fecal Incontinence >once/week = 3.1 (.39Fecal Incontinence and pad = 6.7% (2.9-1Age Adjusted Men: Fecal Incontinence >once/week = 4.5% (1Fecal Incontinence and pad = 4.6% (1.4-7

Hojberg, 2000215

Cross sectional 

All women getting routine antenatal cure at Aarhus University Hospital from January 1993-April 1996. 7,557 completed questionnaire Methods: QuestionnaireDefinition: fecal incontinence as involuntary loss of flatus, liquid, or solid stool in the past year. 

Age:15-24 years = 1302 (17%), 25-29 = 3162 (42%), 30-34 = 2292 (30%), 735 = 801 (11%)Gender: all female

Residency: Denmark

Fecal Incontinence: Liquid Stool = 2.3% Solid Stool = .06% Note- Multiple logistic regression was don

Faltin, 2001216

Cross sectional 

All women who attended the maternity outpatient clinics at Geneva University Hospital in Switzerland from August 1st to September 30th, 1996. 1,228 responded Methods: Structured questionnaireDefinition: fecal incontinence as involuntary loss of solid or loose stools or flatus occurring >once/month, asked to report type of 

incontinence: flatus and/or liquid and/or solid stool 

Age: not reported for whole sampleGender: All femaleResidency: Switzerland

Fecal Incontinence M = 38 had solid or loose stools: 38/99 who had any anal incontinence = 38Note: 8% of the 1228 respondents had an

Kirk, 1997 217Cross sectional 

Adjustment For: stratified sampling by 

171, patients with spinal cord injury >1 year duration. 

Source: discharge list from acute rehabilitation, inpatient facility and an 

Age: x = 39.5 years, SD = 14.5, range= 18-81 yearsGender: 75% male, n = 

Incontinence 30% had incontinence in the past month 65% had incontinence in the past year (only a bar graph reported findings, no exa
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F191 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

duration of spinal cord injury, 1-5 years spinal cord injured = 85 points, 75 years = 86 points 

advertisement in newsletter of local chapter of National Spinal Cord Injury Association.Methods: phone survey

Definition: the inability to control 

bowel elimination to achieve voluntary, predictable, and spontaneous fecal evacuation. Paraplegics = 47.4% (n = 81), tetraplegics = 52.6% (n = 90) 

128Residency: United States

Total number of incontinence problems pemedian = 0, range = 0-30 

Curless, 1994218

Cross sectional comparison of cases and controls 

273 with colorectal CA selected consecutively from 2 hospitals’ histology records and surgical admission lists since 1989. 273 controls matched for sex and age + 2 

years, from the general practitioner’s register; unrelated to cases, excluded for colorectal adenoma, carcinoma or inflammatory bowel disease. Methods: Interview 

Definition: none reported 

Age: median age overall = 68 years, Range = 25-93 years. 123 cases (45%) >70 

("old"), 125 controls (46%) >70 years, "young" <70yearsGender: 153 males/120 females in each group Race: all whiteResidency: England

Fecal Incontinence 27/150 patients of young cases (< 70) 0/148 patients of young controls 23/123 of old cases 8/125 of old controls Odds ratio (95% confidence interval) for y32.3 (8.5, 121.9); for old cases versus con

Enck, 1991219 138 controls, employees of 

government office in Dusseldorf without any symptoms per a questionnaire in past month. Patient groups considered at risk for fecal incontinence were consecutive patients with lower gastrointestinal complaints suggestive of carbohydrate mal-absorption referred for hydrogen breath testing; N = 29, x age = 39, N = 16; consecutive patients with inflammatory bowel disease in outpatient clinic, N = 108, x age = 31.2 years, N = 39; consecutive patients with diabetes from inpatient and outpatient clinic of diabetes research institute; type 1 diabetes, N = 90, x age = 32.6, N = 41; Type 2 diabetes, N = 109, x age = 

Age: controls x age = 37.7 years, range = 19-60 yearsGender: sex of controls male = 73, female = 65Residency: Germany

Fecal Incontinence Controls with any fecal incontinence = 5% incontinence = (1.4% m = 2) Inflammatory bowel disease with any feca>mild fecal incontinence = 12.9% (n = 14) Type 1 diabetes with any fecal incontinencincontinence = 1.1% (m = 1) Type 2 diabetes with any fecal incontinencincontinence = 4.5% (n = 5) Lower gastrointestinal patients with any fe33), >mild fecal incontinence = 9.7% (n = Upper gastrointestinal patients with any fe6), >mild fecal incontinence = 6.9% (n = 2any fecal incontinence in inflammatory bow.001, >mild fecal incontinence 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F192 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

62.4, N = 47 Methods: QuestionnaireDefinition: Uncontrolled loss of stool during day or uncontrolled loss of stool during night, or fecal soiling. 1 of the 3 needed, if only fecal soiling fecal incontinence considered "mild". 

Franssen, 1997220

Cross sectional Adjustment For: Patients who developed a stroke during follow up were excluded 

784 Patients in an ongoing study of aging and Alzheimer's disease. Source: Findings are from the most recent evaluation regardless of baseline or follow upMethods: Interview

Definition: Incipient incontinenceurinary incontinence and/or fecal incontinence that is increasingly apparent but not yet permanent or needing assistance by a caregiver in toileting to prevent incontinence. Note: Results did not separate urinary incontinence only from findings so incipient incontinence is ineligible to be included. Permanent double incontinence = score of 7a or greater on fast scale meaning always doubly incontinent without external intervention. 

Age: Median age = 72.2, SD =9.5Gender: N = 283 and F = 501Race: 90% Caucasian (N = 709), 8% African American (N = 63), 1,5% = other (N = 12)Residency: United States

Permanent Double Incontinence 9.6% of females and 5% of males Of the 244 normals (fast score 1 and 2) or and 4) none had double incontinence. Of the 470 who had Alzheimer's (fast scordouble incontinence. 

Fine, 1997221

Cross sectional 

78 patients with celiac sprue treated with a gluten free diet >12 months, 11 

patients who qualified agreed to further studies Methods: Mail survey or telephone interview, patients who reported having diarrhea were asked to undergo further studyDefinition: Self report of fecal incontinence by history or inability to hold a liquid enema 

Age: x and median age = 52 years, range = 19-77 years Gender: 59 female, 19 maleResidency: Texas, United States

1/11 patients had fecal incontinence 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F193 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Oberwalder, 2006222

Cross sectional, retrospective 

Patients who underwent anal sphincter repair between 1988 and 2000 and had 3 months of follow-up, N= 131, 38 had external anal sphincter and internal anal sphincter defects, 93 had external anal sphincter defect only Methods: Medical record review

Definition: Fecal IncontinenceCleveland Clinic, Florida, incontinence score- 0 = continent, 20 = completely incontinent, score 0-10 = post-operatively success, 11-20 = post-operatively failure 

Age: EAs and IAs = 48.3 yearsGender: All femaleResidency: United States

Incontinence Score = 16.1 in external anasphincter group. IS = 16.7 in EAs only, group not significanNo significant difference in fecal incontineoperatively. 68.4% had success in external anal sphingroup. 55.9% had success in external anal sphin

Rose, 2002223

Cross sectional 

150 patients undergoing laproscopic or laproscopic assisted surgery for rectal prolapse in 1995 Definition: "Incontinence" since problem is rectal prolapse and would assume fecal incontinence. 

Age: Range- 52-91 years, Females = 64.5 + 11.3

Gender: 131 females 

Pre-operatively m = 46 (30.7%) 

Campbell, 1990224

Cross sectional 

Residents >65 years in statutory residences (n = 157), voluntary residential homes (n = 60), private residence home (n = 55), private nursing home (n = 94), hospital geriatric continuing care words (n = 141) Methods: SurveyDefinition: (type unspecified) 0 = no disability, 2 = maximum disability. 

Age: 70% were >80 

years and more than half of these were >85 

years

Incontinence Statutory residence; 0 = 55.6%, 1 = 32.7%Voluntary residential homes; 0 = 85%, 1 = Private Residence; 0 = 69.1%, 1 = 21.8%Private Nursing Home; 0 =55.3%, 1 = 12.Hospital Wards; 0 = 13.5%, 1 = 14.9%, 2 

Klotz, 2002225

Cross sectional 

Tetraplegic spinal cord injured patients participating in a multicenter epidemiological study who are >16 

years at injury and >18 years at survey

Methods: Survey

Definition: "Have you had any embarrassing bowel leakages?" (never/sometimes/often) "Have you ever had any awkward urinary leakages?" (never/sometimes/often) 

Age: (at survey) = 43.6 (13.5) x(SD)Gender: M = 80%Residency: France

Urinary incontinence none = 44% (m = 700), sometimes = 37% 301) Fecal Incontinence None = 63.5% (m = 1016), sometimes = 3= 72%) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F194 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Marcello, 1993226Cohort 

Patients who had construction of an ileo-anal pouch from 6180-12191 N = 460 Methods: Interview at office visit or buy phone and mail questionnaireDefinition: "leakage" is reported, no question re: fecal incontinence is reported that was used in interview or questionnaire 

Age: mean (SD) = 31 (9)Gender: Male = 251 (55%)

Incidence of fecal incontinence Overall fecal incontinence after 1 year = 1Fecal incontinence 1-3 months after surgeyears after surgery = 10% of 326 patients, of 137 patients 58% (n = 18) patients soiled only at night Frequency of leakage occurred 3 + 2 days 

Note: Pre-operative fecal incontinence wa

Giordano, 2002227

Cohort 

151 women who had anterior over lagging repair because of obstetric injury, 115 had no previous repair, 36 had a previous repair Methods: telephone, interview or mail questionnaireDefinition: Cleveland Clinic Florida fecal incontinence score, incontinence score between 0-5 = "good" outcome, 6-10 = "adequate", 11-20 = "poor" outcome 

Age: median = 46 years, Range = 20-68 yearsGender: FemaleResidency: United 

States (Florida)

Incidence of fecal incontinence No previous repair (n = 115), pre-operativoperative incontinence score = 5 (p < .000Previous repair, pre-operative incontinencincontinence score = 7 (p <.0001) Duration of incontinence in mos. (unclear operative or post-operative in those with pNo previous repair group = 96.5 (1-456) mPrevious repair group = 60 (6-468 mos.) m

Mazouni, 2005228Cohort 

Primiparas who underwent instrumental childbirth delivery, N = 159 responded to questionnaire about fecal incontinence. Methods: Questionnaire by mail or telephone interviewDefinition: Solid and/or liquid stool incontinence buy question on questionnaire was not reported. 

Age: 29.4 years

Gender: FemaleEthnicity: African = 13.2%, European = 59.8%, Maghreb = 27%Residency: France

Incidence of Fecal Incontinence New fecal incontinence = 8.8% 

Guenin, 2005229

Cohort 

Patients who had conventional hemorrhoidectomy between 1/1/93 - 12/31/97, N = 514 Methods: Record review then mail questionnaire for fecal incontinenceDefinition: Question and answer on survey "Do you have loss of feces (soiling)?" Not present, light, moderate, or severe 

Age: x= 52 years Range 22-96 yearsGender: 195 females

Prevalence of fecal incontinence Fecal incontinence light in 86 (21.2%) Moderate in 25 (6.1%) Severe in 4(.98%) No fecal incontinence in 291 (71.7%) 

Tocchi, 2004230

Cohort 

164 patients treated for chronic anal fissure with surgery 

Age: x= 37 years 

Fecal Incontinence Early fecal soiling occurred in 15 patients 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F195 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Methods: Interview and physical exam

Definition: No definition of fecal incontinence was reported, "early" fecal incontinence- present within 1 month after surgery and spontaneously resolved, "late" fecal incontinence- occurred after 1 month after surgery and required some type of corrective procedure 

Range 18-44 yearsGender: 93 malesResidency: Italy

restored within 3 months in 12/15 patientsNote: there is no report of pre-operative co

Wagenius, 2003231

Retrospective casecontrol Adjustment: Case and controls matched for age parity, vaginal delivery birth weight, and year of birth 

218 women with a history of obstetric anal sphincter rupture and repair between 1994-1999, 436 women with no rupture Methods: mail questionnaireDefinition: no definition reported 

Age: Median(range) = for total n (534) = 29(18-42) years, cases n = 186 = 30(18-40) years, controls m = 348 = 29(18-42) yearsGender: All femaleResidency: Sweden

Urinary Incontinence Cases = 24 (13%), Controls = 33 (9%) Not significant OR(ci) = 1.41(.81-2.47) Fecal incontinence of liquid stools Cases = 39 (21%), Controls = 26 (7%) p < Fecal incontinence of solid stool Cases = 8 (4%), Controls = 8 (2%) Not Significant = 1.91 (.71-5.170) 

Quander, 2005232

Cross sectional 

Chicago Health and Aging Project = 6,099, 1993-1997 time period. Methods: In-home interview.

Definition: Interview question and answer = "In the past few months, have you ever lost control of your bowels when you didn't want to?" 

Age: 65-74 years = 59%, 75-84 years = 30%, >85 years = 11%Gender: 61% femaleSubject Race and Ethnicity: 62% Black, N = 6 American Indian, N = 9 Pacific Islander, N = 41 HispanicResidency: United 

States

Fecal Incontinence in 585 (9.6%) Multivariate analysis (logistic regression) afecal incontinence = 1.7 times greater in d1.4, 2.1) and 2.8 times greater in stroke vs3.5) Medication use adjusted for sex, age, racein multivariate analysis. Antidepressants, 21% using, 1.9(1.2, 3.0) Antipsychotics, 33% using, 3.9(2.5, 6.2) Narcotics, 17% using, 1.7(1.2, 2.5) Hypnotics, 26% using, 3.1(1.8, 4.8) Antiparkinson, 33% using, 4.3(2.5, 3 Anticonvulsant, 22% using, 1.9(1.9, 3.2) Income and Education and Fecal IncontinFecal incontinence income < $10,000 = 14> $20,000 = 6.8%, x^2 = 65.5 p <.0001 Fecal incontinence in people with 0-8 yeayears education = 8.8%, >13 years educa"No significant difference in prevalence of women once adjusted for age". "In prevalence of fecal incontinence with a
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F196 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

than whites (p = .0006)". Among those 85 years and older, fecal Inc~17%, white Males = 19%, black females Fecal incontinence in stroke patients = 21.0001, diabetics = 13.2%, Non-diabetics = 

Schweitzer, 2005233

Retrospective, descriptive 

128 women who had surgery for pelvic organ prolapse. Source: 3 hospitals

Methods: postal questionnaire

Definition: no definition reported; findings report urinary incontinence after surgery 

Subject Age: N = 112 women ≥80 years, responded (88%), x(range) = 83(80-92) yearsGender: FemaleResidency: Netherlands

Urinary Incontinence Strenuous urinary incontinence = 14% (12Urge urinary incontinence = 10% Mixed urinary incontinence = 31% No urinary incontinence = 40% Unknown = 5% Note: 36% n = 46 patients had "incontinen

Sangalli, 2000234

Retrospective, descriptive, and cohort 

448 women who had a partial (30) or complete (40) tear during delivery between January 1982 and December 1983, 178 responders; 129 had 3rd degree tear, 49 had 4th degree tear Methods: Telephone interview >10 years after delivery Definition: fecal incontinence response was recorded only if the women perceived the incontinence as bothersome 

Age: x = 27.7 years in 1982/83, in 1995 age = x = 40.7 years, range = 32-54 yearsGender: FemaleResidency: Switzerland

Fecal Incontinence Of the 129 with 3 degree tears, 6.2% (n = liquid stools and 0.8% (n = 1) had fecal incOf the 48 with the 4 degree tears, 10.2% (

liquid stools and 6.1% (n = 3) had fecal incAll were non-significant 

Siproudhis, 2005235

Cross sectional 

10,000 people >15 years received a household survey in May-June 2003, N = 7,196 responded, 2,915 had anorectal problems Methods: mail questionnaire.

Definition: (question and answer) "During the past 12 months have you ever experienced an uncontrolled anal leakage of stool?" Quality of life = 10cm visual analog scale for professional life, social life, sexual/partner life, family life 

Subject Age: mean age(SD) = 45.8(23.1) years, 2,388 <35 years, 2,332 >54 years 1,440 >65 years (20%)

Gender: 3,455 malesResidency: France 

Fecal incontinence = 513/2,915 (17%), 51Usual stool consistency in those with fecaLoose = 18%, Hard = 20%, Very hard = 5%(findings reported in graph only) Stool consistency of people with fecal incowithout any anorectal problems, p <.01 Usual stool consistency in those with no pLoose = 7%, Hard = 3%, Normal = 50% Frequency of Fecal Leakage ≥1/day = 11 (2.2%) 1/day to 1/week = 25 (

(8%), <1/month = 420 (82%), not applicabQuality of life for "incontinence" includes gto determine effect of fecal incontinence o

Buchanan, 2002236 N= 79, 418 admission MDS forms of 

Nursing Home residents with Parkinsons's disease from June 23, 

Age: x = 79.7 years, SD = 9.0Gender: 48.4% male

Prevalence of fecal incontinence = 48% Prevalence of urinary incontinence = 39% Frequent urinary incontinence = 16.8%, 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F197 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

1998 - September 12, 2000 Methods: MDS data

Definition: MDS items for bladder and bowel incontinence 

Subject Race: white = 89.4%, black = 5.1%, Asian = 1.4%, American Indian = 4%

Occasional urinary incontinence = 9.8% Frequent fecal incontinence = 8.6% Occasional fecal incontinence = 6.5% 

Stenzelius, 2007237

Cross sectional 

N = 248, age > 75 years 

Methods: Postal questionnaire to people who reported they had fecal incontinence in past 3 months on a different (previous) questionnaire.Definition: No definition reported 

Subject Age: x = 82, SD = 5.19Gender: Female = 142, Male = 106Residency: Sweden

Fecal Incontinence. Fecal Incontinence in 56.4% of respondenDaily/weekly fecal incontinence: Women = 18.6% Men = 4.9% (p = .01) Overall = 12.8% non-significant Large or medium amount of fecal incontinMen = 6%, p = .01 Overall = 43.6% non-significant Fecal incontinence did not have significan

Sullivan, 1992238

Cross sectional 

N = 109 runners who ran an average of 18 miles per week in a runners club; inclusion criteria was running 3 times per week. Methods: Questionnaire.

Definition: none. 

Age: 39 + 13 Male, 

 34 + 9 FemaleGender: Male = 78, Female = 31Residency: Canada

Fecal Incontinence in 12% (n = 13) 10 males, 3 females during or after runnin

Otegbayo, 2006239

Cross Sectional 

Consecutive patients with stroke selected over 18 months (N = 54), controls = normal, volunteers or inpatients (N = 46) without fecal incontinence. Methods: Interview or chart. 

Age: Stroke patients = 58.7 (10.6) control = 52(10.9)Gender: Stroke male = 46.3%, control male = 69.6%Residency: Africa

Prevalence of Fecal Incontinence Stroke = 5.6% Control = 0% P = .10 No difference in % fecal incontinence by tyhemorrhagic, p = .20) or right vs. left side 

Ween, 1996240

Cross Sectional 

Consecutive admissions of stroke patients to Braintree Hospital in 1993; N = 423 Methods: Chart reviewDefinition: Report of incontinence by nurses on flow sheet in chart 

Age: 73 + 12

Gender: 55% female

Prevalence of incontinence 41% were incontinent at admission Only bivariate analyses were reported primUrinary incontinence was associated with Fecal incontinence was associated with ur(80%) and dysphagia p < .0001 (81%) Fecal incontinence was associated with fumeasured by an AFIM score, p < .0001 of those with an AFIM score = >80, 1% haIf AFIM score 60-80, 17% had fecal incontIf AFIM score 40-60, 66% had fecal incontIf AFIM score <40, 94% had fecal incontin
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F198 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Urinary incontinence on admission was as50% of residents admitted with incontinendischarge 

Bharucha, 2005241

Cross-Sectional Adjustment For: Results were adjusted by age and the 2000 US white female population on the US census 

2800 of 5300 women (53%) responded to survey; sample included NH residents women were >

20 years old Methods: Questionnaire to age stratified random sample of women in a Rochester epidemiology projectDefinition: QA: "In the past 12 months have you experienced accidental leakage of solid or liquid stool? Fecal Incontinence severity score was calculated (max score = 13) using a summative scale: an MD assigned a severity score to selfreported fecal incontinence symptoms, no question was reported for any fecal incontinence history Quality of Life: 15 domains with 4 levels 0 = none, 1 = mild, 2 = moderate, 3 = severe Quality of Life: QAs were not tested for validity or reliability 

Gender: All femaleSubject Race: White

Residency: Olmsted County, MN

Prevalence of Incontinence Age adjusted fecal incontinence prevalenc- 13.1) Prevalence of any fecal incontinence histo

Fecal incontinence frequency m = 503 < 1 per month 55%, adjusted prevalence 61 per month 24%, adjusted prevalence 2.91 per week 12%, adjusted prevalence 1.4Several times a week 9%, .9(.6-1.2) Daily 2%, adjusted prevalence .2(.1-.3) Amount m = 502 Small (stain underwear only) 60%, 7.3(6.5Moderate (need to change underwear but Large (change outer clothing) 7%, 0.8(0.523% of respondents reported fecal incontiimpact on quality of life in > 1 domain; thein impact of fecal incontinence on specific 

Johannsson, 2002242 556 consecutive patients who had 

Milligan-Morgan hemorochoidectomy at 4 clinics in Sweden between 1987-1995; 40 died, 9 lost to follow up so 507 received questionnaires - ok Methods: Questionnaire mailed

Definition: Anal incontinence 

Age: x = 51 years, range = 20-82Gender: Male = 231 (55%), Female = 187 (45%)Residency: Sweden

Prevalence of Fecal Incontinence overall 56 were incontinent of liquid feces 11 were incontinent of solid feces 72 were incontinent of gas Note: pre-operative incontinence was not 25 patients who leaked liquid stool related 

6 who leaked solid stool related it to surge

Karasick, 1997243

Retrospective cross sectional 

Cases of 354 consecutive female patients who had fluoroscopically guided defecograpy between March 1986 and March 1996 Methods: Chart review for fecal incontinence telephone interview for OB history and surgery

Age: X(SD) = 57.7(16.3) yearsGender: All femaleResidency: United States

Prevalence of Fecal Incontinence 40% m = 108 No multivariate analysis of risks only corre
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F199 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Definition: Fecal Incontinence = widened anal canal (> 2 cm) with barium leakage at rest 

Cavaliere, 1995244

Retrospective chart review Adjustment For: Follow up was 50 months

Records from Cleveland Clinic and Mayo clinic, 178 patients undergoing protocsigmoidscopy and manual colorectal anastomsis for rectal cancer 1981-1990 study n = 68 Methods: QuestionnaireDefinition: Not reported

Residents > 65 years in 241 nursing 

homes or hospitals; (N = 6,079) number of acutely ill = 627 

Age: not reported 

Gender: not reportedResidency: not reported

Incidence of Fecal Incontinence 57% m = 18 had fecal incontinence Note: Whether patients had fecal incontinereported Prevalence of Incontinence Urinary incontinence = 27% 

Peet, 1995245

Cross Sectional 

Methods: "Census" probably means 

"observation"Definition: none reported 

Age: x = 82.7 years, SD = 7.8 yearsResidency: Leicester, 

UK

Fecal Incontinence = 1.8% Urinary incontinence and fecal incontinencNote: I did not include those with a urinary incontinence Residents > 65 years in 241 nursing home

Fialkow, 2003246

Adjustment For: Exclusions 

University of Washington Medical Center - Roosevelt Urology and Urogynecology Clinic; All new adult community patients to clinic between 6/13/2000 and 7/1/2002 were sent a questionnaire; ages 18-90 years Methods: questionnaire, N = 7732

Definition: Wexner scale of fecal incontinence severity I-QOL for urinary incontinence QoL 3 day voiding diary for urinary incontinenceUrinary incontinence severity was measured by questions on questionnaire on 5 point Likert scale 1 = mild, 5 = severe SF12 measured functional status 

Age: x = 55.9, SD = 14.3Gender: all female

Subject Race: 80% 

whiteResidency: United States

Prevalence of Incontinence Fecal incontinence n = 18 Urinary incontinence m = 342 Double incontinence m = 65 mean (SD) Wexner Score for fecal incontiUrinary incontinence severity score = 3.1(I-QOL total score; urinary incontinence = 646.4, p = < .001 I-QOL avoid/limit score; urinary incontinen= 43.8, p = < .001 I-QOL psychosocial; urinary incontinence 53.2, p = < .001 I-QOL embarrassment; urinary incontinen= 37.9, p = < .001 SF-12 PCS12 (physical); fecal incontinenc42.4, double incontinence = 38.6, p = .027 SF12 MCS12 (mental); fecal incontinence 50.4, double incontinence = 46.4, p = .032 

Bek, 1992247 152 women who had a complete 

obstetric tear of anal sphincter at 1 hospital and 121 responded, 56 had another vaginal delivery so study 

Age: not reported

Residency: Denmark

Prevalence of Incontinence Fecal incontinence after tear N = 3 but fecal incontinence was only tranFecal incontinence after next delivery m = 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F200 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

sample equals these - 56 Methods: questionnaire by mail

Definition: anal incontinence included flatus but separated fecal soiling results for incidence but not for repression analysis, those results are not includedNote: incontinence before sphincter tear was not reported 

Goode, 2005248

Cross Sectional 

Medicare lists of 5 counties (3 rural, 2 urban) of west central Alabama; N = 1,000 community living people Methods: interview using a structured questionnaireDefinition: Fecal incontinence = affirmative response to QA: "In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?"Mild fecal incontinence = < 1 x 1 month Urinary incontinence definition was not reported 

Subject Race: Stratified as 25% black female, 25% black male, 25% white female, 25% white maleResidency: Alabama, U.S.

Prevalence of fecal incontinence Overall fecal incontinence = 12% 12.4% = male 11.6% = female 11.2% = white male 13.5% = African American male 14% = white female 9.2% = African American female no significant difference 77.6% of women with fecal incontinence awithout fecal incontinence p = .001 50% of men with fecal incontinence had uwithout fecal incontinence p = .02 Moderate /severe fecal incontinence in m and no difference by race p = .57 In Women Chronic diarrhea OR = 4.55(2.03-10.20) Urinary incontinence OR = 2.65(1.34-5.25Hysterectomy and oopharectomy 1.93(1.0Poor self perceived health status 1.88(1.0Comorbidity scale OR = 1.29(1.07-1.55) In Men Chronic diarrhea OR = 6.08(2.29-16.16) swelling in feet and legs OR = 3.49(1.8-6.TIA 3.11(1.3-7.41) Depression score > 5 OR = 2.83(1.27-6.2Lives alone OR = 2.38(1.23-4.62) Prostate disease OR = 2.29(1.04-5.02) Poor self perceived health 2.18(1.13-4.20
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F201 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Bergmark, 2002249

Cross Sectional 

332 women registered at 7 departments of gynecologiocal -oncology having early cervical cancer between November 1996 and May 1997; N = 256 responses (77%) Methods: QuestionnaireDefinition: 6 category response distress about symptom was reported onlyDistress about fecal leakage by women treated with surgery alone: much = 2% (2/93); moderate = 3% (3/93) Distress after treatment with radical radiation alone: much = 10% (2/20); moderate = 15% (3/20) 

Age: x(SD)age = 51(.77)Gender: all female

Residency: Sweden

Impact of incontinence on life. Women treated with surgery and external leakage (distress). Much distress = 14% (11/78) Moderate distress = 19% (15/78) 

Guren, 2005250

Cross Sectional 

Patients in Norwegian Rectal Cancer Registry who had anterior resection for rectal cancer between 11/03 and 12/01; N = 319 respondents 80% Methods: Mail questionnaire 

Age: Median = 73, Range = 39-94 yearsGender: Male = 179, Female = 140Residency: Norway 

Prevalence of Fecal Incontinence Incontinence of loose stools Anastomsis level < 3 cm 

Never = 12 < 1 per week = 7 1-6 per week = 8 Every day = 3 Anastomosis level 4.6 cm Never = 51 < 1 per week = 30 1-6 per week = 23 Every day = 4 Anastomosis level 7-8 cm Never = 28 < 1 per week = 15 1-6 per week = 3 p = .07 Incontinence of solid stool Anastomosis level < 3 cm 

Never = 19 < 1 per week = 7 1-6 per week = 2 Every day = 2 Anastomosis level 4.6 cm 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F202 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Never = 87 < 1 per week = 14 1-6 per week = 9 Every day = 3 Anastomosis level 7.8 cm Every day = 0 p = .01 

Gunther, 2003251

Comparative, cohort, retrospective 

All patients seen in clinic who underwent operation for familial adenomatous polyposis between 1971 and 2000; N = 151 candidates data available for 59 patients Methods: Telephone interview

Definition: Jorge-Wexner least-worst score (0-4 scale) and Jostarndt score (0-6 scale)2 surgeries compared: IRA (ileorectal anastomosis) N = 22: IPAA (ideal pouch anal anastomosis) N = 37 Note: No risks or quality of life could be reported because they used total Wexner and Jostarndt scores which include incontinence of gas 

Age: IRA x age = 53 years; IPAA = 45 years

Gender: IRA: Male = 11, Female = 11; IPAA: Male = 22, Female = 15

Residency: Germany

Incidence of Fecal Incontinence Wexner Score for incontinence for liquid s

Wexner Scores for Incontinence of Solid SJostarndt score for incontinence of liquid sJostarndt score for incontinence of solid s

Adolfsson, 1998252

Cohort, comparison Adjustment For: Analysis adjusted for age as a 3 category variable 

CA (prostate cancer) group: men aged 50-80 years diagnosed in 1992 with prostate cancer with prostate cancer in Stockhold region in CA and population. Control Group: men in population registry in Stockholm randomly selected in a stratified fashion to have an age distribution similar to CA patients; mailings N = 431 men with CA, N = 435 men without CA Respondents: 342 men with CA (79%) and 314 controls (72%) Methods: Mail questionnaire

Definition: Not defined specifically, 1 question of questionnaire 

Gender: All maleResidency: Sweden

Prevalence of Incontinence Fecal leakage in men with prostate cance(13/292) Urinary leakage in men with prostate canc

14% (42/291) Relative risk for fecal leakage: men with pcontrol men = 1.0 Note: multiple variable analysis was not pe
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F203 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Ellerkmann, 2001253

Descriptive 

237 consecutive patients with symptomatic pelvic organ prolapse who were examined within a 24 month period Methods: Questionnaire at clinic

Definition: Likert scale was used for incontinence severity, 0 = none, 3 = severely 

Age: x = 57.2 years, range 23-93 yearsGender: all female

Prevalence of Incontinence Urinary incontinence = 73% of whom 13% incontinence; 5% urge urinary incontinencincontinence Fecal incontinence = 31% 46 women with fecal incontinence (63%) swith normal activities 

Garcia-Aguilar, 1996254Cross Sectional 

864 patients with open (N = 521) vs. closed (N = 343) sphincterotomy were surveyed and 63.5% (N = 549) responded of whom 62/2% had open technique Methods: Questionnaire Definition: soiling of underclothing and accidental bowel movementNote: pre-op fecal incontinence rates were not reported 

Age: x = 44 years, open = 44 years, closed = 44.7 yearsGender: of all patients females = 57%Residency: United States

Incidence of Fecal Incontinence in "open" surgery: soiling of underclothing 

closed surgery (p < .05) Accidental bowel movement occurred in 1vs. 3.1% of closed (p < .05) 

Amdur, 1990255

Retrospective 

225 patients treated by external beam irradiation at the University of Florida between 1964 and 1982 for localized adenocarcinoma of the prostate Methods: Chart reviewDefinition: moderate = requiring a minor surgical procedure or significant medical management and/or producing minor disabilitysevere = resulting in major surgical procedure or causing significant disability 

Age: no demographic information givenGender: All male

Incidence of fecal incontinence Moderate fecal incontinence = 5 patients Severe fecal incontinence = 2 patients Note: baseline prevalence of fecal incontin

Sobhgol, 2007256

Cross Sectional 

N = 319 women at 2 clinics aged 15-49 years, married, non-pregnant, non-breast feeding Methods: Questionnaire by interview in clinicDefinition: Not defined 

Age: 15-49 years x(SD) = 33.8(8.3)Gender: All femaleResidency: Iran

Prevalence of Fecal Incontinence Fecal incontinence in women with dyspare3/179 = 1.7% Fecal incontinence in women without dysp

Drossman, 1993257

Cross Sectional 

Purchased mailing list of consumer households in 48 US states; stratified probability random sample of 8250 households quotas of sampling were 

Age: x(SD) = 49(15.1) years Gender: 51% female

Subject Race: 

Prevalence of Fecal Incontinence Fecal soiling = 7.1% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F204 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

according to age, gender, income, household density and size was selected; 5430 respondents (66%) Methods: Mail surveyDefinition: Results reported as fecal soiling and gross incontinence 

Database lease represents white households Residency: United States 

Nicholls, 1990258

Cohort 

205 patients operated on during 1977 to 1987 for ulcerative colitis, familial 

adenomataus polyps or functional 

bowel disease; 3 pouches were constructed: S, J, W Methods: Patient chart

Definition: Not reported 

Age: 33.5(12-16), x(SD) yearsGender: 116 males, 89 femalesResidency: London, England

Incidence of Fecal Incontinence Fecal leakage occurred in 2/174 Note: preoperative fecal incontinence was 

Crook, 1996259

Cross Sectional 

202 prostate CA patients treated consecutively from 3/87-2/93 who had a minimum of 1 year follow up N = 192 95% response Methods: Mail questionnaire

Definition: Fecal incontinence and urinary incontinence were not defined 

Age: x = 70 years, range = 49-87 yearsGender: All maleResidency: Canada

Prevalence of Fecal Incontinence Prevalence of "Bowel incontinence" 13-23 months after treatment = 8% 24-35 months after treatment = 8% 36-47 months after treatment = 8% 48-59 months after treatment = 9% Prevalence of Urinary incontinence daily 13-23 months after treatment = 14% 24-35 months after treatment = 19% 36-47 months after treatment = 18% 48-59 months after treatment = 16% > 60 months 25% 

Prevalence of Urinary incontinence > 1 Tb

13-23 months = 9% 24-35 months = 7% 36-47 months = 8% 48-59 months = 8% >60 months 10% 

Schwartz, 2002260

Cross sectional, comparative Time between end of treatment and interview was x = 286 days; range = 0-965 days. 

Part of a case-control study o occupational risk factors and prostate cancer; letters were sent to 501 men in a population based cancer registry. (79.4%) 398 cancer patients and 181 controls were interviewed. Those with radical prostatectomy (RP) were compared to those with radiation treatment (RT). 

Age: Gender: All maleResidency: Wayne County, MI

CA group Age 50-59 RP = 39/130 (30%) RT = 13/115 (11.3% Controls = 47/181 (26%) Age 60-69 RP = 80/130 (61.5%) RT = 46/115 (40%) Controls = 89/181 (19.2%) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F205 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Convenience samples of controls from the parent study were invited to participate or some were randomly selected from Medicare recipients . 

Age > 70 RP = 11/130 98.5%) RT = 56/115 (48.7%) Controls = 45/ 181 (24.8%) P value < .001 Race - Black RP = 58 (44.6%) RT = 60 (52.2%) Controls = 72 (39.8%) Race - White RP = 69 (53.1%) RT = 52 (45.2%) Controls = 101 (55.8%) Race - Other RP = 3 (7.3%) RT = 3 (2.6%) Controls = 8 (4.4%) Stool Leakage at baseline and past treatmStool Leakage Baseline RP group = 1.5% Post treatment = 6.2% p = (.049) Baseline RT group = 2.6% Post treatment = 18.3% p = .001 Any urinary incontinence Baseline RP group = 19.2% Post treatment = 53.8% Baseline RT group = 25.2% Post treatment = 37.7% p = .047 Multivariate Results of Treatment type and 

Bowel Incontinence (RT vs. RP) All Odds ratio = 3.61 95% CI = 1.54-8.47 White Odds ratio = 4.88 95% CI = 1.19-19.96 Black Odds ratio = 2.38 95% CI = .77-7.34 Urinary Incontinence (RP vs. RT) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F206 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

All Odds ratio = 2.87 95% CI = 1.52-5.44 White Odds ratio = 6.59 95% CI = 2.09-20.80 Black Odds ratio = 2.38 95% CI = 1.00-5.67 

Talley, 1992214

Cross sectional Adjustment For: age and sex adjusted to population of whites in US in 1980 census. 

Random sample of 500 persons who attended Mayo Clinic in 1987-1990. Stratified by age (equal numbers in 5 year age groups) and gender (equal numbers in each age groups) Methods: Postal questionnaireDefinition: Fecal incontinence as stool leakage; clinically significant fecal incontinence as leakage >1 

time/week or need to wear a pad.Note: even though fecal incontinence definition as >1 time per week results 

are reported as >1 time/week. 

Age: >65 yearsN = 328 (66% response rate)Subject Race: White only Residency: Olmsted County, MN

Prevalence of fecal incontinence Fecal Incontinence >1 time/week = 3.7% (Fecal incontinence >1 time/week or need Fecal Incontinence >1 time/week Age adjusted fecal incontinence in femaleAge adjusted fecal incontinence in males Overall age and sex adjusted = 3.7(1.6-5.Wears a Pad. 

Gurbuz, 2005261

Cross sectional 

Methods: QuestionnaireDefinition: Answer 1021 patients who were admitted to gym clinic of authors between 3/01 and 4/02 (N = 1021) agreed to complete questionnaire about urinary incontinence and fecal incontinence (92.6%). of yes to question: Do you currently have some involuntary loss of urine? Fecal incontinence question: Do you accidentally lose stool from the rectum, occurring once a month or more frequently? 

Age: x = 42.48 years, SD = 10.6 years

Gender: All femaleResidency: Turkey

Age adjusted fecal incontinence in femaleAge adjusted fecal incontinence in males Overall age and sex adjusted = 6.1(3.3-8.M for fecal incontinence = 1017 patients oprevalence = 3.1% (N = 32); had enuresis Fecal incontinence: Yes = 13(5.7%),No = 19(2.4%),Total = 32Urinary incontinence: Yes = 181(79%),No = 678(85.6%),Total = Stress urinary incontinence: Yes = 28(12.2%), No = 51(6.4%), Total = Urge urinary incontinence: Yes = 11(4.9%), No = 39(5%), Total = 50(Mixed urinary incontinence: Yes = 9(3.9%), No = 24(3%), Total = 33(3

Hahnloser, 2004262

Comparative Adjustment For: 

Females <40 years at time of ideal pouch anastomosis for ulcerative colitis between 1981 and 1995 (N = 

Gender: All femaleResidency: Mayo clinic 

Fecal Incontinence in those with ≥1 vagina

No fecal incontinence Vaginal delivery = 76, C section = 85 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F207 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Multivariate analyses did not compare groups 

544), 83% response rate (450 responded), 135 had pregnancies. Methods: Mail questionnaire

Definition: None reported 

in Minnesota and Zurich hospital in Switzerland

Occasional fecal incontinence Vaginal delivery = 20, C section = 13 Frequent fecal incontinence Vaginal delivery = 4, C section = 2, p = .3 Fecal incontinence during the day before None = 79, Occasional = 20, Frequent = 1 Fecal Incontinence during the day first follNone = 77, Occasional = 21, Frequent = 1Fecal incontinence during the day - most rNone = 64, Occasional = 36, Frequent = 0Fecal incontinence at night before pregnaNone = 59, Occasional = 33, Frequent = 8 Fecal incontinence at night - first follow up None = 52, Occasional = 39, Frequent = 9 Fecal incontinence at night - most recent fNone = 37 

Dayton, 1996263

Cohort 

Patients who underwent ideal pouch anal anastomosis between 1983 and early 1996; N = 355. Methods: Prospective collection of data then review of data registry.

Definition: Not defined 

Age: <55 years = 423; >55 years = 32Residency: Utah, USA

Occasional = 63 Frequent = 0 p = .06 Percent with Daytime Incontinence At 3 months, < 55 years Occasional = 6 Often = 2 Daily = 2 Never = 90 At 3 months, > 55 years Occasional = 26 ** Often = 5 Daily = 0 Never = 68 ** At 6 months, < 55 years Occasional = 4 Often = 2 Daily = 1 Never = 93 At 6 months, > 55 years Occasional = 10 Often = 10 * Daily = 1 Never = 93 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F208 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

At 12 months, < 55 years Occasional = 4 Often = 1 Daily = 2 Never = 93 At 12 months, > 55 years Occasional = 6 Often = 0 Daily = 0 Never = 94 Percent with Night Incontinence At 3 months, < 55 years Occasional = 24 Often = 6 Daily = 3 Never = 68 At 3 months, > 55 years Occasional = 42 Often = 21** Daily = 5 Never = 32** At 6 months, < 55 years Occasional = 18 Often = 8 Daily = 4 Never = 70 At 6 months, > 55 years Occasional = 22 Often = 33** Daily = 0 Never = 44* At 12 months, < 55 years Occasional = 17 Often = 4 Daily = 5 Never = 74 At 12 months, > 55 years Occasional = 16 Often = 15** Daily = 10 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F209 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Cukier, 1997264Cross Sectional and comparative 

Patients with a diagnosis of IBS or IDI (Idiopathic detrusor instability) during 1993-95 at 1 hospital; controls were recruited from the day surgery unit N(controls) = 55 responses N(IBS or IDI) = 49 responses Methods: Mail questionnaire 

Residency: UK Never = 60 

* = p <.05 ** = p <.01 Incontinence of Solid Stool Male IBS = 0/23 Female IBS = 3/41 (7%) Male IDI = 2/20 (10%) Female IDI = 5/25 (20%) Male controls = 0/23 Female controls = .31 Incontinence of Liquid Stool Male IBS = 0/23 Female IBS = 1041 (24%) Male IDI = 6/20 (30%) 

Lovatsis, 2002265Retrospective chart review 

293 patients who had sacrospinus vault suspension at 1 hospital between 11/93 and 12/98 Results report anal incontinence that includes flatus but a subgroup with fecal incontinence of solid stool 

Age: X = 61.7 years; Range = 30-88 yearsGender: All femaleResidency: Toronto, Canada

Female IDI = 6/25 (24%) Male controls = 0/23 Female controls = 0/31 Severity of fecal and urinary incontinence 30 patients who had fecal incontinence of reported a "cure" - no fecal incontinence aAn additional 4 who had fecal incontinencchange after surgery 

Menter, 1997266Cross Sectional 

Patients injured >20 years who 

received rehab at spinal center at 1 of 2 hospitals who participated in a study in both 1990 and 1993; m = 221. Methods: Questionnaire and chart reviewDefinition: Fecal incontinence = bowel movement of any consistencyincluding diarrhea like stool- occurring without preparation or intent and not due to recent GI acute illness such as influenza or food poisoning and not attributable to recent food intake such as spicy foods, etc. 

Age: Tetraplegia, ABG(m = 65), age = 51 yearsParaplegia, ABC = 56.3 years (m = 109) Tetraplegia or paraplegia grade D (n = 47), age = 56.6 years Residency: UK

Prevalence of Fecal Incontinence Bowel accidents (FI) Tetraplegics n = 19(29%) Paraplegics n = 30 (27.5%) All DS n = 11(23.4%) Total = 60/221 (27.1%) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F210 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Gupta, 2005267

Retrospective 

1,000 patients with grade III or IV hemorrhoids treated with radio frequency ablation followed by plication. Methods: Chart review 

Age: x(SD) = 39.8, (13.6) yearsGender: 524 femalesResidency: India

Fecal incontinence = 0% 

Malone, 1996268

Cross sectional 

144 patients with Spina bifida randomly selected from database of spina bifida association, 109 analyzed. Methods: Questionnaire by mail

Definition: as 'Soiled' which represented urinary incontinence or fecal incontinence, 

Age: x = 23.5 years range = 9-47.8 yearsGender: 67 female 42 maleResidency: UK

Prevalence of Incontinence 55/104 (53%) regularly soiled (urinary or fFecal and urinary incontinence = 31 (30%Fecal incontinence only = 24 (23%) Urinary incontinence only = 24 (23%) Moderate Soiling = 25 (45%) Severe Soiling = 18 (33%) 

Helgason, 1996269

Cross sectional and comparative 

450 men in 1992 in Stockholm, 50-80 years who had diagnosis of prostate cancer and same number of men randomly selected from same geographic area. N = 314 controls analyzed N = 342 prostate CA analyzed Methods: Mail questionnaire

Definition: Not defined 

Age: Prostate cancer x = 72 years Range = 51-80Controls x = 68 years Range = 50-80 years Gender: Men onlyResidency: Sweden

Prevalence of Incontinence Fecal incontinence in prostate cancer men Urinary incontinence in prostate cancer mFecal incontinence in control men = 6/292 Urinary incontinence in controls = 10/291 

Buchanan, 2002270

Cross sectional and comparative 

14,009 admission MDS records from 6/22/98 - 12/31/2001 in NY state Definition: MDS items 

Age: x(SD) age of MS Residents = 57.5 (13.9) years All others = 76(15.3) yearsGender: MS residents = 70.3% female All other = 62.4% femaleResidency: NY state

Prevalence of Incontinence Bowel continence in MS residents Fecal incontinence = 39.1% Frequent fecal incontinence = 7.5% Occasional fecal incontinence = 5.5% Usual continence = 5.6% Continent = 42.3% Urinary incontinence in MS residents Urinary incontinence = 21.4% Frequent urinary incontinence = 9.3% Occasional urinary incontinence = 5.6% Usual continence = 4.8% Continence = 59% All others (non MS) Fecal incontinence = 22.5% Frequent incontinence = 6.8% Occasional incontinence = 5.2% Usual continence = 5.7% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F211 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Continent = 59.8% Urinary incontinence = 19.1% Frequent incontinence = 11.9% Occasional incontinence = 7.7% Usual continence = 7.2% Continence = 54% White Non Hispanics: MS = 85.1%, All othBlack: MS = 11.4%, All others = 11.4% Hispanic: MS = 2.3%, All others = 4.8% American Indian/Alaska native: MS = ≤11%Asian: MS ≤1%, All others = 1.9% 

Zorzon, 1999271 108 patients with MS consecutively 

selected from a clinic, 97 patients with chronic disease (arthritis, lupus, ankylosing spondylitis) seen in rheumatic diseases center, 110 healthy volunteers (health professionals and friends/relatives of patients and investigators). Methods: Structured interview

Definition: no definition of fecal incontinence or urinary incontinence was reported 

Age and Gender: MS patients; 70 females; x(SD) age = 40.5 (11.2) yearsChronic disease patients; 65 females = 41(11.9) years Healthy controls; 71 females = 41.1 (12.6) years

Prevalence of Incontinence MS patients Urinary incontinence = 31 (28.7%) Female = 18 (25.7%) Male = 13 (34.2%) Fecal Incontinence = 10 (9.3%) Female = 9 (12.9%) Male = 1 (2.6%) Chronic Disease patients Urinary incontinence = 3 (3.1%)* Female = 2 (3.1%)* Male = 1(3.1%)** Fecal incontinence = 0** Healthy Controls Urinary incontinence = 2 (1.8%)* Female = 2 (2.8%)* Male = 0 Fecal incontinence = 0* *p < .0001 **p .01 

Nelson, 1995272

Cross sectional 

The population in Wisconsin sampled in the Wisconsin Family Health Survey, 6959 individuals and 2570 households responded. Methods: Phone interviewDefinition: "Have you or anyone in your household experienced unwanted, unexpected or embarrassing loss of control of 

Age: >65 yearsGender: 30% men 63% female

Incidence of Fecal Incontinence 153 were incontinent of stool or gas (anal incontinent of solid stool; 54% of 153 were Note: risk factors were reported for anal inhere. 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F212 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

bowels or gas?" although fecal incontinence was outcome, results are reported separately for stool and gas incontinence. 

Giebel, 1998273

Cross sectional 

Sample size = 500: 275 consecutive patients from the emergency department, 62 hospital employees, 115 patients who had arthroscopies, and 48 relatives of the above groups. Methods: Questionnaire 

Residency: Germany Prevalence of fecal incontinence 

35.1% had soiling of underwear, more freqmen and women not reported 4.8% were unable to control solid stool 6.6% were unable to control pasty stool 6.7% were unable to control liquid stool Lack of control of pasty and liquid stool lesand p <.01 

Brandeis, 1994274

Fecal incontinence was measured crosssectionally, this was a prospective cohort study of pressure ulcers 

Residents >60 years old admitted to national Healthcare Nursing homes during 1988 and 1989. Sample = 4,232 people Definition of Incontinence: Fecal incontinence as accidental loss of feces greater than once per week.Urinary incontinence as accidental loss of urine greater than once per week. 

Age: mean 81 + 8 years old

73% female

Prevalence of Incontinence 48% of residents had fecal incontinence 57% had urinary incontinence at baseline 

Longstreth, 1993275 Members of a large health 

maintenance organization (HMO) having a routine health exam. Response rate = 64.9%, 1,264 of 1,956 responded, fecal incontinence information was available on 1,195. Methods: QuestionnaireDefinition: "Do you ever lose control of your bowels (including soiling your underwear)?" 

Age:Mean = 51.8 years Gender: 54.3% femaleSubject Race: White = 82.1% Asian = 4.7% Black = 4.5% Other = 2.1% Hispanic = 6.6%Residency: California

Prevalence of Fecal incontinence Number of men with fecal incontinence = Number of women with fecal incontinence 

Khullar, 1998276

Cross sectional 

All women referred to a urodynamic clinic during a 4 month period; sample size = 465 Methods: Postal questionnaire and interview

Definition: "Do you leak from the 

back passage?" liquid, solid, or flatus 

 26% (N = 121/465) had fecal incontinence 

questionnaire 15% (N = 71/456) had fecal incontinence tasked on interview Note: fewer women admitted having fecal mail study 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F213 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Edwards, 2001277

Cross sectional 

Random sample of 1,000 people aged 65 and older from each of 3 Family Health Service registers; sample = 2,818 Methods: Interview

Definition: Fecal incontinence as "Do you have any difficulty controlling your bowels?"Urinary incontinence as "Do you ever wet yourself if you are unable to get to the lavatory as soon as you need to, or when you are asleep at night, or when you cough or sneeze?" 

Age: 58% were 65-74 years and 42% were >75 

yearsGender: 61% femaleResidency: England and Wales

Prevalence of Incontinence 2% of those 65-74 years old had fecal inco3% of those ≥75 years had fecal incontine

1% of men and 4% of women had fecal in18% had urinary incontinence. 1% of 1,099 men and 2.5% of 1,695 womeincontinence. 69% of those who had fecal incontinence those without fecal incontinence had urinaNote: only bivariate analyses were done a

Lynch, 2001278

Cross sectional 

1,500 adults randomly selected from the electoral roll; response rate = 48%, 717 respondents. Methods: Postal questionnaire 

Age: Median = 46 years, Range = 18-70Gender: 388 males 329 femalesResidency: New 

Zealand

Prevalence of Fecal Incontinence Fecal incontinence of solid stool was in 70Fecal incontinence of liquid stool was in 9

Perry, 2002279Cross sectional 

15,904 people aged 40 or more randomly selected from households in patient registry of the health authority. 10,116 surveys were analyzed Methods: Postal questionnaire

Definition: Major fecal incontinence 

= soiling of underwear, outer clothing, furnishing or bedding several times per month or moreMinor fecal incontinence = staining of underwear several times a month or more 

Age: Range = 40-80+Gender: 54% femaleSubject Race: White = 93.2% South Asian = 5.7%, Other = 1.1%

Residency: UK

Prevalence of monthly or more leakage wMen soiling underwear = 9.6% vs. women Prevalence of major fecal incontinence = Prevalence of minor fecal incontinence = A lot of impact on life Major fecal incontinence = 51.7% Minor fecal incontinence = 16% None or a little impact Major fecal incontinence = 48.3% Minor fecal incontinence = 84% 

Okonkwo, 2002280Cross sectional 

Patients who presented to the gynecology clinic (N = 3963) in 3 states in Nigeria and whose symptoms were not related to pelvic organ prolapse. Methods: Structured questionnaire 

Age: Range = 20-50+ years

Gender: All female

Residency: Nigeria

Prevalence of fecal incontinence of liquid = 2.17% Parity had no relation to fecal incontinence 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F214 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Henningsohn, 2002281Cross sectional 

Patients who had urinary bladder cancer treated with radical radio therapy before 1995 (N = 58); patients with radical cystectomy and urostomy (N = 251; and people randomly selected from general population (N = 310) as controls. Methods: QuestionnaireDefinition: Fecal incontinence as 

fecal leakage at least every month. 

Age and Gender: age of radio therapy group (mean + standard error 

of mean) at follow upMale = 78.1 + 0.8, 

Female = 80.5 + 1.2 

Cystectomy: Male = 73.6 + 0.5 Female = 76 + 0.7 Controls: Male = 75.6 + 0.4 

Female = 76.8 + 0.6

"Fecal leakage at least every month" Radiotherapy group prevalence = 8/48 (17Cystectomy group = 16/169 (10%) Controls = 4/256 (2%) 

Sakakibara, 2001282 115 consecutive patients with 

Parkinson's disease seen at neurology clinic controls were 391 locals undergoing an annual health survey Methods: QuestionnaireDefinition: "Do you leak feces?" 

Age: controls = 30-69 years, Parkinson patients age = 35-69 yearsGender: controls = 271 males and 120 females, Parkinson patients gender = 52 men and 63 femalesResidency: Japan

Prevalence of Incontinence Parkinson Patients Fecal incontinence prevalence = ~6% in feStress urinary incontinence = ~38% in femUrge urinary incontinence = ~26% in femaControls Prevalence of fecal incontinence = 0% in fStress urinary incontinence = 30% in femaUrge urinary incontinence = 6% in females Note: findings are in bar graphs without va

Eason, 2002283Cross sectional 

Pregnant women who gave birth in 5 hospitals in 1995-1996 in Quebec Women were part of another study about perineal massage. Methods: Mail questionnaire 3 months after delivery, 1,198 received a questionnaire. 

Sample size = 949 women 

Incidence of Incontinence Fecal incontinence occurred in 3.1% overaFecal incontinence occurred at least once Fecal incontinence was present in 1.8% wthose with vaginal delivery Note: multivariate analysis for fecal incontsmall number affected 

Teunissen, 2004119

Cross sectional 

Patients >60 years old in 9 general practices from Jan. 1999-Aug. 2001 Methods: Questionnaire Definition: Urinary incontinence = involuntary loss of urine twice or more per month Fecal Incontinence = involuntary loss of feces twice or more per month Double Incontinence = Urinary incontinence + fecal incontinence 

twice or more per month. 

Age: ≥60 years or over Gender:Female = 3,159 Male = 5,748 Residency:Netherlands 

Prevalence of Incontinence Fecal incontinence of solid stool = 36% Liquid stool = 19% Mucoid stool = 45% Overall fecal incontinence = 6% Solid Stool Fecal Incontinence Men = 30% N = 41 Women = 42% N = 52 Liquid Stool Fecal Incontinence Men = 10% N = 13 Women = 29% N = 37 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F215 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Mucoid Fecal Incontinence Men = 60% N = 80 Women = 29% N = 37 Overall Urinary Incontinence = 19% Overall Double Incontinence = 3% 

Chen, 2003284 Taiwanese women in a community in 

August 1999-March 2001, sample size = 1,247 Methods: Door to door survey and 

interview Definition: Fecal incontinence = flatus incontinence and anal incontinence 

Age: mean = 43.2 years, SD = 15.1 Gender: All female Subject Race: All Asian Subject Residency: Taiwan 

Prevalence of fecal incontinence = 2.8% Prevalence of flatus = 8.6% Impact on life = 8.6% had fecal incontinentheir daily lives (N = 30 of 35) Note: risk factors were only reported for a

Goldberg, 2003285

Cross sectional 

Mothers of multiples attending the National Organization of Twins Clubs in 2001, Sample size = 733 Methods: Survey Definition: Fecal incontinence or flatal incontinence 

Age: median = 37, range = 22-75 years Subject Race:94% white 2.3% African American 0.6% Asian American, 1% Hispanic Residency: United States 

Fecal Incontinence in women with a C-secFecal incontinence in previous vaginal delIn multivariate analysis, age was the only incontinence increased by a factor of 2 peOverall fecal incontinence = 10% Fecal incontinence of liquid stool only = 5.Fecal incontinence of solid and liquid stoo

Chiarelli, 2003286

Cross sectional 

586 women who had an instrumental delivery and/or delivered an infant 4000g or more at teaching hospitals, 913 women were approached Methods: Survey Definition: Fecal incontinence (solid and/or liquid stool) at 12 months post partum 

Age:15-44 years Gender:All female Residency: Australia 

Fecal Incontinence Prevalence = 6.9% 2.6% had solid stool fecal incontinence anincontinence Risks for fecal incontinence at 12 months 

Urinary incontinence at 12 months post paOR = 6.03 CI = 2.37-15.33 Constipation OR = 2.46 (1.11-5.46) Joint hypermobility OR = 2.75 (1.05-7.19) 

Fenner, 2003287

Cross sectional, retrospective 

Primiparous women who delivered vaginally at a University Medical Center from 1/1/97 to 3/30/00; 2,941 were mailed and 943 completed the urinary questionnaire and 831 completed the bowel questionnaire Methods: Mail questionnaire about 

Age: mean = 27.34 years Gender: All female Residency: United States 

Incidence of urinary incontinence overall 0.42% had a worse major problem of urina5.41% had a worse occasional inconveniebladder control 21.74% had worse minor inconvenience 16.2% had urge urinary incontinence alon14.6% had mixed stress and urge urinary 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F216 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

urinary incontinence and fecal incontinence; charts were reviewed for anal sphincter tears Definition: Questions about urinary incontinence "I wet myself", "I may have an accident:, "I may leak urine in them" Note: I did not include results about fecal incontinence because there was no definition of fecal incontinence like for Urinary incontinence; findings were too vague describing "bowel function" or "bowel control" 

Korman, 2004288 150 consecutive patients who 

underwent radical retro-pubic (RRP) or radical perineal prostatectomy (RPP) and 75 age-matched controls who were biopsied; response rate was 89% N = 201 Methods: Questionnaire- the bowel function domain of the Expanded Prostate Cancer Index composite Definition: uncontrolled leakage of stool or feces 

Age: Age (years) and range RPP group = 61 (42-44) RRP group = 63 (32-35) Controls = 61 (35-39) Residency: United States 

Prevalence of Fecal Incontinence RPP group = 5.4% (4/75) RRP group = 6.4% (4/63) Controls = 4.8% (3/61) No significant difference 

Delaney, 2003289Cohort 

1,895 patients who had ileal pouch anal anastomosis (IPAA) and were followed for > 6 months Methods: Questionnaire Note: This study did not report fecal incontinence per se, they report never incontinence and seepage at night. 

Age:<45 years = 1,410/ and 766 male 46-55 years = 289/ and 174 male 56-65 years = 154/ and 100 male >65 years = 42/ and 31 male 

Bowel movement/night (1 year) <45 = 1.4 46-55 = 1.8 56-65 = 2.1 >65 = 1.9 Total = 1.5 P <0.001 Multivariable = 0.001 Never Incontinent (1 year) <45 = 78 46-55 = 68 56-65 = 54 >65 = 44 Total = 73 P <0.001 Multivariable ≤0.001 (3 year) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F217 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

<45 = 74 46-55 = 66 56-65 = 49 >65 = 36 Total = 69 P <0.001 Multivariable ≤0.001 (5 year) <45 = 69 46-55 = 52 56-65 = 48 >65 = 20 Total = 64 P <0.001 Multivariable ≤0.001 Seepage at night (1 year) <45 = 34 46-55 = 44 56-65 = 50 >65 = 44 Total = 38 p = 0.001 Multivariable = 0.001 (3 year) <45 = 31 46-55 = 37 56-65 = 46 >65 = 58 Total = 34 p = 0.006 (5 year ) <45 = 35 46-55 = 39 56-55 = 48 >65 = 64 Total = 47 p = .22 Multivariable = .013 

Lunniss, 2004290Retrospective cohort analysis. 

Patients referred to a tertiary center for physiological assessment of fecal incontinence between January 1995 and June 2002; sample size = 629 

Age: Median age = 53 years, range of 15-88 years (457 females) 

Prevalence of passive fecal incontinence = Urge fecal incontinence = 27% (N = 170) Post defecation fecal incontinence = 7% (
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1d. Prevalence and incidence of fecal incontinence in adults (continued) 

F218 

Author, Year, 

Design, Adjustment 

for Confounding 

Factors 

Subject Selection, Data Source, 

Methods to Measure Incontinence 

(survey, screening, case finding), 

Definition of incontinence) 

Subject Age, Gender, 

Race, Ethnicity, 

Residency 

Prevalence (%) or Incidence of Fecal In

Severity, and Impa

Methods: medical history and anorectal physiological assessment. Definitions of Incontinence: Passive fecal incontinence = fecal incontinence without patient's knowledge. Post defecation fecal incontinence = fecal incontinence related to defecation. Wage fecal incontinence = fecal incontinence with awareness. 

Median age:53 years Range of 14-92 years (154 males) 

Chou, 2000904

Cross Sectional and comparative 

Women who had surgery for pelvic organ prolapse and/or urinary incontinence between June 1996 and February 1996 by 4 OB-gynecologists enterocele group (E) = 77 NOE = 233 patients Methods: Questionnaire

Definition: Unreported 

Age: E = 67 median, range (31-90 years), No E = 59(28-83)Gender: All female

Prevalence of Fecal Incontinence in E = 12/72 (17%) no E = 31/215 Note: not all not E answered question 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F219 

F1e. Prevalence of combined urinary and fecal incontinence in adults 

Author, Year, Design, Adjustment 

for Confounding Factors 

Subject Selection, Data Source, 

Methods to Measure 

Incontinence (survey, screening, 

case finding), Definition of 

incontinence 

Prevalence (%) or Incidence of Combined Incontine

Severity, and Impact on Life 

Thomas, 2001291

Cross sectional. Adjustment for age, sex, cognitive 

function, alcohol abuse, diabetes, stroke, hypertension, cardiac SUS, respiratory problems, cancers, history of falling, current depression, hearing or visual impairments. Age: >65 years N = 4,178 

Canadian study of Health and Aging data set of 1990 of elderly > 65 years old, N=2,923 community living and institutionalized residents, 1, 255 = institutionalized Method of Measurement: Survey.Definition of incontinence: stool incontinence, urine incontinence. 

Stool Incontinence Adjusted Prevalence. No overall % was reported No dementia = 1.78 (.97-2.59) Cognitive impairment but no dementia = 4.60 (3.25-5.95Cognitive impairment with dementia = 31.9 (28.87-34.93Urine Incontinence Adjusted Prevalence No dementia = 13.34 (11.27-15.41) Cognitive impairment without dementia = 22.68 (199.99Cognitive impairment with dementia = 49.29 (46.05-52.5

MacArthur, 1997292

Cross sectional Age: not reported N = 760 100% female 

All women who delivered a baby between April and September, 1992 at a maternity hospital in Birmingham, United Kingdom, who had some adverse post partum symptoms were interviewed about fecal incontinence. Data Source: Interview for fecal incontinence took place a mean of 45 weeks after birth.Definition of Incontinence: Frank incontinence- "no warning that she needed to go" Soiling or staining on underwear, Urgency = felt the need to go but could not hold on. 

Fecal Incontinence Prevalence (present before child birth = 6.1%) Incidence (after childbirth) = 4% or 36 Total n = 36 Soiling = 36% Frank Incontinence = 19% Daily Symptoms not defined by type = 39% Symptoms on some days of the week = 36% 22% said fecal incontinence affected their life style Soiling only = 8% Frank incontinence only = 3% Urgency only = 53% Soiling and urgency = 19% Frank incontinence and urgency = 8% All 3 = 8% 

Point prevalence study of patients with clinical MS attending a clinic for management of symptomatic bowl dysfunction in the United Kingdom. Age range: 28-73 years (Mean = 47 years) N = 77 61% female 

Method of Measurement: Interview using a questionnaire Definition of FI: Current fecal incontinence = involuntary passage of stool at least once during preceding 3 months, Previous fecal incontinence = same definition except that occurred at least once more than 3 months previously 

Fecal Incontinence Current = 16/77 Previous = 23/77 Current and Urgency urinary incontinence = 16/77 Previous and urgency urinary incontinence = 23/77 

Buchanan, 2002293Cross section of residents in hospice care in the U.S. Average age: 76.4 (SD 13.9) 

Residents in hospice care, N = 40,622 Method of Measurement: MDS admission records

Bowel Incontinence; Continent = 43.6% Usually continent = 5.7% Occasionally incontinent = 5.7% 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1e. Prevalence of combined urinary and fecal incontinence in adults (continued) 

F220 

Author, Year, Design, Adjustment 

for Confounding Factors 

Subject Selection, Data Source, 

Methods to Measure 

Incontinence (survey, screening, 

case finding), Definition of 

incontinence 

Prevalence (%) or Incidence of Combined Incontine

Severity, and Impact on Life 

59% female85% white, 10% black, 1.1% American Indian, <1% Asian, 3% Hispanic 

Definition of Incontinence: MDS items for continence-bowel, continence-bladder 

Frequently incontinent = 7.4% Incontinent = 37.6% Bladder Incontinence Continent = 54.4% Usually continent = 5.9% Occasionally incontinent = 6.3% Frequently incontinent = 9.4% Incontinent = 24% 

Buchanan, 2001294Cross sectional study of nursing home residents with MS at time of their admission from 6/22/98 - 1/17/2000 in U.S. (in New York from 1/11/98 – 1/17/2000). Age: 57.98 (SD = 14.19) years N = 9,013 70.2% femaleWhite = 84.7%, Black = 11.2%, American Indian/Alaska native, Asian ≤1%, Hispanic = 2.4% 

Method of Measurement: MDSDefinition of Incontinence: MDS item for continence - bowel, MDS item for continence - bladder 

Bowel Incontinence Occasionally incontinent = 5.4% Frequently incontinent = 7.3% Incontinent = 38.8% Continent = 42.7% Usually continent = 5.8% Bladder Incontinence Occasionally incontinent = 5.6% Frequently incontinent = 9% Incontinent = 21.3% Continent = 58.9% Usually continent = 5.2% 

Ostlbye, 200428Cohort of Canadian community living elderly (>65 years) in 1991-92; (over sampled very old 75-84 years 1.5 times; > 85 years 2 times m = 8,949) Age: 77.3 years (mean for females) 75.3 years (mean for males) Total N (female) = 5,322 

Method of Measurement: Survey

Definition of Incontinence: Questions and answers from the survey, Urinary Incontinence = "Do you ever lose control of your bladder? "Fecal Incontinence = "Do you ever lose control of your bowels? "Double Incontinence = urinary incontinence and fecal incontinence, prevalence determined at survey wave 1, survey wave 2 was in 1996 and wave 3 was in 2001

Survey questions and answers risk factors or correlations Cognitive status by modified mini mental exam 3MS? Medical conditions- stroke or effects of stroke, arthritis or 

Prevalence of Fecal and Urinary Incontinence Overall urinary incontinence = 9% n = 314 Overall fecal incontinence = 3% N = 119 Prevalence by age and sex Urinary incontinence 65-69 years 14.2% - 167/1177 of females, 6.3% - 64/1070-74 years 15.9% - 156/982 of females, 7.2% - 54/752 75-79 years 19.7% - 285/1446 of females, 9% - 88/950 80-84 years 25% - 202/808 of females, 11.2% - 53/475 85-89 years 24.6% - 180/733 of females, 16.6% - 55/3390+ years 29% - 51/176 of females, 16.9% -11/65 of maFecal Incontinence in Females 65-69 years - 3.3% of females, 1.8% of males 70-74 years - 3.8% of females, 2.1% of males 75-79 years - 5.1% of females, 5.2% of males 80-84 years - 6.8% of females, 5.3% of males 85-89 years - 9.6% of females, 6.9% of males 90+ years - 8.5% of females, 10.8% of males Double Incontinence 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1e. Prevalence of combined urinary and fecal incontinence in adults (continued) 

F221 

Author, Year, Design, Adjustment 

for Confounding Factors 

Subject Selection, Data Source, 

Methods to Measure 

Incontinence (survey, screening, 

case finding), Definition of 

incontinence 

Prevalence (%) or Incidence of Combined Incontine

Severity, and Impact on Life 

rheumatism, kidney trouble, diabetes, trouble with feet or ankles Lifestyle- "Do you engage in regular exercise?" Have you been a regular coffee drinker (every day)? Have you smoked cigarettes regularly (nearly every day)? On average, how many packs per day?" Cognitive Status: normal, moderately, or severely impaired Lifestyle - yes/no Number of packs smoked- <1 per day, 1 per day, > 1 per day 

65-69 years - 1.0% of females, 0.6% of males 70-74 years - 1.1% of females, 0.5% of males 75-79 years - 2.4% of females, 1.3% of males 80-84 years - 2.2% of females, 1.7% of males 85-89 years - 4.2% of females, 3.6% of males 90+ years - 3.4% of females, 4.6 % of males Cumulative incidence was reported = persons continent incontinent both in wave 2 and 3 and in 1 follow up wavOverall cumulative incidence Wave 2- urinary incontinence = 33% n = 76/741, fecal in11/757 Wave 3- New urinary incontinence = 22% n = 16/1170, incontinence from wave 2 = 29% (n = 16), new fecal inc4/1189, remained fecal incontinence from wave 2 = 14% Wave 3- Urinary incontinence in wave 2 decreased in w27/1170, fecal incontinence in wave 2 decreased in wavUrinary Incontinence Female- 65-74 years = 14.3% (wave 2), 18.3% (wave 3(wave 2), 20% (wave 3); 85+ years = 24.3% (wave 2), 3Male- 65-74 years = 8.6% (wave 2), 13.3% (wave 3); 75(wave 2), 18.3% (wave 3); 85+ years = 23.2% (wave 2)Fecal Incontinence Female- 65-74 years = 5.3% (wave 2), 7% (wave 3); 75(wave 2), 11.1% (wave 3); 85+ years = 13% (wave 2), 1Male- 65-74 years = 4.1% (wave 2), 5.3% (wave 3); 75-2), 9.7% (wave 3); 85+ years = 13.2% (wave 2), 20% (wDouble Incontinence Female- 65-74 years = 4.2% (wave 2), 4.1% (wave 3); 7(wave 2), 8.6% (wave 3); 85+ years = 14.9% (wave 2), Male- 65-74 years = 2.8% (wave 2), 2.8% (wave 3); 75-2), 5.2% (wave 3), 85+ years = 11.8% (wave 2), 5.6% (wSignificant Correlates Female Urinary Incontinence 3 children or = 1.75, ci = 1.29, 2.38 2 children 1.52(1.13, 2.03) age 75-84 = 1.47(1.2, 1.79) 85+ years 1.78(1.35, 2.37) smoke > 1 pack per day 1.41 (1.06, 1.87) Coffee drinker 1.23(1.01, 1.51) 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1e. Prevalence of combined urinary and fecal incontinence in adults (continued) 

F222 

Author, Year, Design, Adjustment 

for Confounding Factors 

Subject Selection, Data Source, 

Methods to Measure 

Incontinence (survey, screening, 

case finding), Definition of 

incontinence 

Prevalence (%) or Incidence of Combined Incontine

Severity, and Impact on Life 

Medical Stroke 1.61(1.07, 2.43) Arthritis 1.32(1.08, 1.61) Kidney 3.36(2.69, 4.21) Correlates of Fecal Incontinence in Females 75-84 years 1.55(1.06, 2.26) 85+ years 1.91(1.14, 3.17) Foot and ankle trouble 2.01(1.18, 3.44) Correlates of Urinary Incontinence in Males 85+ years 2.46(1.5, 4.02) Diabetes 1.72(1.10, 2.66) Kidney problems 4.29(2.99, 6.16) Risks for Cumulative Incidence Reported For Urinary Incontinence in Women Stroke 1.58(1.13, 2.22) Kidney Problems 1.69(1.22, 2.33) Foot and ankle trouble 1.36(1.04, 1.78) Fecal Incontinence in Women-Risks for cumulative incidCognitive status 50 < 3MS < 78 1.80(1.02, 3.20) Stroke 2.07(1.44, 2.98) Cumulative Incidence Risks of Urinary Incontinence in M75-84 years 2.97(1.64, 5.39) 85+ years 3.41(1.44, 8.11) Smoke > 1 pack per day 2.03(1.05, 3.9) Diabetes 2.49(1.32, 4.69) Foot or ankle trouble 2.01(1.18, 3.44) Risks of Fecal Incontinence in Males 85+ years 2.51(1.26, 5.01) 

Chiang, 2000295Retrospective chart review, cross sectional design. Multivariate regression models controlled for patient characteristics of age, gender, Medicaid insurance status, and chronic disease conditions of CHF, emphysema, diabetes of stay in nursing home in U.S.Separate models compared double 

Method of Measurement: Chart abstractions and MDS data were used.Definition of Incontinence: Double incontinence included residents with indwelling urinary catheters; no other definitions of incontinence were given.Fecal incontinence only group was dropped from analysis due to small Number 

Prevalence Urinary incontinence only = 13% Fecal incontinence only = 6% Double incontinence = 54% Continent = 27% p < .05 on pair wise comparisons Cognitive impairment Double incontinence = 90%, C = 59%, urinary incontineAlzheimer's Disease Double incontinence = 25%, C = 13%, urinary incontineDementia diagnosis 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1e. Prevalence of combined urinary and fecal incontinence in adults (continued) 

F223 

Author, Year, Design, Adjustment 

for Confounding Factors 

Subject Selection, Data Source, 

Methods to Measure 

Incontinence (survey, screening, 

case finding), Definition of 

incontinence 

Prevalence (%) or Incidence of Combined Incontine

Severity, and Impact on Life 

incontinence residents with urinary incontinence only residents and continent (group C) residents. Average age: = 84 N = 413 

Double incontinence group: x = 84 years; 77% female Urinary Incontinence only group: x age = 83 years; 77% female C group: x age = 85 years; 72% female Urinary incontinence only = 53, Fecal incontinence only = 9, fecal incontinence and urinary incontinence = 237, no incontinence = 114 = C group, residents were in 20 nursing homes in 3 states who were in another study about primary care 

Double incontinence = 46%, C = 22%, urinary incontineImpairment in transfer Double incontinence = 94%, C = 54%, urinary incontineLocomotion impairment Double incontinence = 86%, C = 54%, urinary incontineBed Mobility impairment Double incontinence = 80%, C = 33%, urinary incontineStroke Double Incontinence = 33%, C = 18% Emphysema Double incontinence = 5%, C = 19%, urinary incontinenAdjusted regression values are reported here with popuSD Number of hospital stays per year: x(SD) = 1.11(4.4) Double incontinence = 2.92 Urinary incontinence = 9.74 C = 2.10 Number of emergency room visits per year: x(SD) = .26Double incontinence = .66, urinary incontinence = 1.34, Beta Values Number of hospital stays per year Double incontinence vs. C = .07 Double incontinence vs. urinary incontinence = -.19 Number of Emergency room visits per year Double incontinence vs. C = .04 Double incontinence vs. urinary incontinence = -.10 

Chiai, 1995296Cross section of consecutive patients with clinically significant MS attending national hospital in London, UK for management of bladder dysfunction. Age: 28-73 (average 47 years) N = 77 61% female (n = 47) 

Method of Measurement: data about fecal incontinence was obtained using a questionnaire.Definition of Incontinence: Current fecal incontinence as involuntary passage of stool at least once in preceding 3 months. Previous fecal incontinence as involuntary passage of stool at least once more than 3 months previously. 

Prevalence of fecal incontinence. Current fecal incontinence only; n = 12. Previous fecal incontinence only; n = 12. Constipation and current fecal incontinence; n = 4. Constipation and previous fecal incontinence; n = 11. Normal bowel function; n = 25. Constipation only; n = 13. Note: all have "bladder dysfunction" also but this wasn't 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F224 

F1f. Risk factors of fecal incontinence in adults 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

Abramowitz, 2000297

Prospective, descriptive, observational study in France. N = 259 100% female No age given 

Consecutive females 6 weeks before and 8 weeks after delivery. Exclusion criteria: No history of ano-rectal 

disease. Neurologic disease, or diabetesMethod of Measurement: Questionnaire

Definition of incontinence: fecal incontinence = incontinence of flatus and liquid or solid stools 

Sphincter defects by endoanal ultrasound 

Incidence of IncLiquid Stools AfPrimiparous = 0Secundiparous Multiparous = 2Total incontinenstools = 1.4% Sphincter defecultrasound Various conditiobut although risassessed, they incontinence" aleakage of stoo

Zetterstrom, 1999298

Cohort study in Sweden. 100% female. Age: X (SD) = 30 (4.1) years 

Of 345 primiparous women, 278 responded to questions about fecal incontinence, 38 had sphincter tears, 240 had non-sphincter tears. Questionnaires 1 day, 5 months, and 9 months after delivery. 

Maternal age. Continuous duration of labor >12 hours (yes/no), 2nd stage of labor >1 hour (yes/no), use of oxytocin (yes/no), fundal pressure to assist delivery (yes/no), instrumental vaginal delivery (yes/no), sphincter tear (yes/no), lithotomy position (yes/no) Fecal incontinence at 5 months risk factors per multivariate analysis. Maternal age 2.7(1.2, 6.0). 2nd stage of labor >1 hour 2.2(1.1, 4.2) Instrumental delivery 3.1(1.3, 7.4), Sphincter tear 3.0(1.3, 6.7) Factor in Univariate Analysis. Maternal age at 5 months 3.4(1.6, 7.1), at 9 months 3.1(1.5, 6.6). Labor > 12 hours at 5 months 2.6(1.4, 5.1). 2nd stage labor > 1hour at 5 months 2.7(1.4, 5.0) Use of oxytocin at 5 months 2.1(1.02, 4.2). Fundal pressure 2.3 at 5 months(1.3, 4.4) Instrumental delivery at 5 months 

Prevalence of FIncontinence BePregnancy Fecal incontinentotal 1(3%) those wittear 18(8%) those wtears No fecal incontifecal incontinenweek = 1%, fec> once per weePrevalence of FIncontinence at delivery Fecal incontinentotal 1(3%) in those w4(2%) in no sphNo fecal incontifecal incontinenweek = 1%, fec> once per weePrevalence of F
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F225 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

4.9(2.2, 10.8). Sphincter tear at 5 months 3.8(1.8, 8.1), at 9 months 2.4(1.1, 5.2). Lithotomy position at 5 months 3.2(1.2, 8.5). Fecal incontinence at 9 months risk factors per multivariate analysis. Maternal age 3.0(1.4, 6.4), Sphincter 2.4(1.04, 4.9). 

Incontinence at delivery Fecal incontinentotal 0 in sphincter te3(1%) in no sphNo fecal incontifecal incontinenweek = 1%, fec> once per wee

Galandiuk, 1991299Retrospective chart review of delayed IPAA group of patients at Mayo Clinic, MN. N = 43 females N = 52 males Age: 14-60 years 

(Average = 31 years) 

95 patients had a previous partial or subtotal colectomy (delayed IPAA group) Prior to a total chronic colectomy for ulcerative colitisstaged surgical procedure. Method of Measurement:, no definition of FI was reported. 776 patients had an ideal pouch anastomosis at the time of a total colectomy (IPAA concurrent group). Definition of Risk Factors: Delayed or concurrent IPAA. 

Level of risk appears dichotomous. Yes/no for delayed IPAA yes/no for IPAA concurrent 

3% of delayed Isevere incontineday and 8% had incontinence at 3% of those witconcurrent had incontinence duand 10% at nigh

Nelson, 2001300Cross Sectional, Survey, secondary data analysis from Wisconsin nursing homes.N = 18,170 (1992) N = 17,117 (1993) 71% female (1993) 72% female (1992) 

Data Source: Secondary analysis of data from 1992 (181 homes) and 1993 (177 homes)Wisconsin Center for Health Statistics Annual Nursing Home Survey

Definition of Incontinence: Urinary Incontinence; listed on MDS as being frequently or always incontinent. Fecal Incontinence; "defined in a manner similar to urinary incontinence”.Risk Factors were: age, gender, race, health indicators, body mass index in kg, history of heart disease, dementia, stroke, depression, vision impairment, arthritis, diabetes, constipation, diarrhea, fecal impaction, ulcers. Functional Status Indicators: ability to dress oneself, feed oneself, maintain personal hygiene, locomotion, mobility, use toilet transfer from bed to chair, tube feeding, trunk restraints. Age and BMI were continuous; all other risks 

Correlates of UI 1992: Odds Ratio (95%CI) Fecal Incontinence 20.5 (18.6-22.6) Trunk restraints: 2.5 (2.3-2.8) Dementia 1.5 (1.4-1.7) Impaired vision 1.4 (1.3-1.5) Stroke: 1.3 (1.2-1.4) Constipation (1.2-1.4) Age 0.99 (0.98-0.99) Diarrhea 0.7 (0.5-0.8) Male sex 0.8 (0.7-0.9) Correlates of Urinary Incontinence in 1993 Fecal incontinence 17.8 (16.1-19.7) Trunk restraints 2.4 (2.1-2.7) Dementia 1.5 (1.4-1.7) Impaired vision 1.4 (1.3-1.6) Stroke 1.4 (1.2-1.5) Constipation 1.3 (1.2-1.4) Age 0.98 (0.98-0.99) 

Urinary Incontin1992 = 53.9% 1993 = 61% Age of those wiincontinence: 1992 = 85.9 yea1993 = 85.2 yeaAge of continen1992 = 84.4 yea1993 = 85.2 yea

Prevalence by SUrinary Incontin1992: Occasionally = Frequently = 151993 Occasionally = Frequently = 161992: 93% Cau1993: 95% Cau
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F226 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

were dichotomous Diarrhea 0.7 (0.6-0.9) 

Male sex 0.8 (0.7-0.8) Tube feeding 0.7 (0.5-0.9) 

Borrie, 1992301Cross sectional study of long term care hospital in Canada. N = 447 Average age: Male = 73.6 Female = 73.8 27% female 

474 bed long term care hospital in 1986 N = 457 patients (the majority (240) were male veterans), 447 questionnaires were returned. Method of Measurement: nurse manager and primary nurse rated degree of patient's 

incontinence.Definition of Incontinence: a condition in which involuntary loss of urine or feces is a social or hygienic problem and is objectively demonstrableUrinary/Fecal incontinence = 1-2 incontinent events per week or 3-7 events per week. 

Hierarchic regression was used: Step 1 = 10 most common diagnoses entered as a set. Step 2 = meds as a set. Step 3 = mobility and mental function. Mobility (4 levels): 1) independent, 2) supervised, 3) assistance, 4) immobile. Mental impairment (4 levels): 1) none, 2) mild, 30 moderate, 4) severe. 

Overall UI prevaFecal incontinenDouble incontinUI in men = 61% UI in females = Urinary incontindiagnosis accouvariance. F = 5.72 p <.00F = 2.15 p <.05mental impairmF = 207.0 p <.0For Fecal Incondiagnosis = 11% F = 5.3 p <.001 meds = 5% F = 2.33 p <.01mental function F = 202.2 p <.0

Mecocci, 2005302

Longitudinal, cross sectional study from hospitals in Italy. N = 13,729 Age: >65 

Female = 73.3

81 community and university hospitals in Italy; data collected May-June and NovemberDecember for 5 years: N= 13,729 Methods of Measurement: Questionnaire completed by study MD daily and chart review.Definition of Incontinence: Incontinence had to be absent at admission and present at discharge; reported in patient's chart. 

Age = 3 categories Length of stay in weeks = 3 categories ADL = 3 categories Others yes/no 

Prevalence of InUrinary incontinMales = 19.9% Females = 24.5Cognitive impai5.3(2.3-12.0) CVA = 2.4(1.1-5Age > 85 years 3.2(1.1-9.8) Length of Stay >6.5(2.8-15.5) Totally depende2.9(1.1-7.6) 

Jackson, 1997303

Patients recruited from clinics of Cleveland Clinic Foundation. Average age: 53.3 (SD 

Patients recruited from urogynecology and gynecology clinics of Cleveland Clinic Foundation; N = 247 F Methods of Measurement: Questionnaire 

and MD interview,

All levels not reported but appear to be yes/no for UI and IBS Sphincter tone levels; normal, diminished, absent. Correlates of fecal incontinence: urinary 

Prevalence of InFecal incontinen(17%) Urinary incontinDouble incontin
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F227 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

= 15.2 years) N = 247 (91% white; 9% black) 100% female 

Definition of Incontinence: Involuntary loss of feces sufficient to be considered a problem by the patient. 91% white, (n = 225), 9% black, (n = 22) 

incontinence OR = 4.6 CI = 1.9, 11.2 IBS OR = 8.3 CI = 2.1-32.8 Abnormal sphincter tone; OR = 2.3; 1.1,5.1 

Endo, 2002304

Retrospective analysis of patient records in a U.S. geriatric clinic (1991-1999). Age: 78.6 (SD 6.5) 96.1% White 2.7% Black 1.2% Other N = 929 records 72.2% female 

N = 929 patients records source: clinic records 1991-1999. Definition of Incontinence: Urinary 

incontinence; involuntary loss of urine sufficient to be a problem.Fecal Incontinence; involuntary loss of stool 

sufficient to be a problem. Double Incontinence; urinary and fecal incontinence. Isolated fecal incontinence; without urinary incontinence. Isolated urinary incontinence; without fecal incontinence. Any urinary incontinence; (with or without fecal incontinence). 

IADSs MMSE CIRS: (cumulative illness rating scale and age were continuous variables Serum B12 1 ≥300 pg/ml 0 ≤300 pg/ml Medications = yes/no 

Prevalence: Any urinary inco38.6% total; mafemale = 41.7% Isolated urinary 34% total; male female = 37.1% Any fecal inconttotal; male = 11= 10.7% Isolated fecal in4.2% total, male female = 3.6% Double incontintotal; male = 10= 13.3% Any incontinenctotal; male = 34= 43.8% Correlates of InIsolated urinary Factor = anticonOR (CI) = 4.529 16.675) Factor = DiuretiOR (CI) = 1.481 Factor = antihisOR (CI) = 1.909 Factor = IADLS OR (CI) = 0.95Isolated Fecal inFactor = modifieOR (CI) = 1.204 Factor = Biz lev
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F228 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

OR (CI) = 2.225 Factor = IADLs OR (CI) = .821 Factor = CatharOR (CI) = 1.902 Factor = DiuretiOR (CI) = 2.226 

Chassagne, 1999305Cross sectional projective study in 13 French long term care facilities. Age: ≥60 years N = 1,186. % female unknown 

Methods of Measurement: Medical records 

and observation.Definition of Incontinence: "at least one involuntary loss of feces"."Long-lasting fecal incontinence was not defined". Exclusion criteria: Fecal incontinence at start of surveillance. 

Levels of risk were not reported Variables that were candidates for the multivariate regression analysis were not reported. 234 with fecal incontinence 83.5 years mean (SD).952 without fecal incontinence = 82.9 (8.7) years. 171 females in those with fecal incontinence = 73%. 669 females without fecal incontinence = 70%. 

Baseline prevalincontinence = 234 residents dincontinence ovCumulative incid5 risks were assfecal incontinenUrinary incontin(CI = 1.5, 2.6) Presence of neudisease RR = 1Poor Mobility R2.4) MMSE < 15 RR Age > 70 years 2.8) Risks for "long lincontinence history of urinarRR = 2.9 (1.8, 4Decreased mob(1.1, 3.0) MMSE score < 4.4) History of deme(1.2, 3.5) 68% of those wincontinence haincontinence 81% of those wincontinence haincontinence 
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F229 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

Nelson, 1998306

Cross sectional, Minimum Data Set (MDS) data of Wisconsin nursing home residents in 1992 and 1993; nursing homes. 1992, N = 18,224 1993, N = 17,127 % female not reported 

Methods of Measurement: MDS questions.

Definition of Incontinence: Fecal incontinence as; 1) usually continent, 2) occasionally incontinent, 3) frequently incontinent, or 4 )incontinent. Similar definition for urinary incontinence.Number of residents: 

All variables except age and body mass index (BMI) were dichotomous. Age and BMI were continuous. 1992: 71% = Fecal incontinence1993: 72% female Subject Race: 1992: 

Prevalence of FIncontinence 1992: 47% had incontinence. 1993: 46% had incontinence. Associations wiIncontinence in Nursing HomesData Set Repor1993 Urinary Incontin1992- 12.6; 11.51993- 11.3; 10.3Tube feeding 1992- 7.6; 5.6-11993- 8.8; 6.3-1Loss of ADL 1992- 6.0;4.7-71993- 7.3; 5.5-9Diarrhea 1992-3.3; 2.7-41993-2.4; 1.9-3Trunk restraints 1992- 3.2; 4.7-71993- 3.0; 2.7-9Pressure Ulcer 1992- 2.6; 2.2-31993- 2.3;2.0-2Dementia 1992- 1.5; 1.4-11993- 1.4; 1.3-1Impaired Vision 1992- 1.5; 1.4-11993- 1.4; 1.3-1Fecal impaction 1992- 1.5; 1.1-21993- 2.1; 1.3-3Constipation 1992- 1.4; 1.3-1
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F230 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

1993- 1.3; 1.2-1Stroke 1992- 1.3; 1.2-11993- 1.2; 1.1-1Male Gender 1992- 1.2; 1.1-11993- 1.3; 1.1-1Non-Caucasian 1992- NS 1993- 1.3; 1.0-1Age 1992; 1.1-1.01 1993; 1.0; 1.0-1Body mass inde1992- 1.0; 1.0-11993- 1.0; 1.0-1Diabetes 1992- NS 1993- NS Heart disease 1992- 0.9; 0.8-11993- NS Arthritis 1992- 0.9; 0.8-11993- 0.8; 0.7-0Depression 1992- NS 1993- 0.9; 0.8-1NS = not statist

Eason, 2002283

Cross sectional study in Quebec hospitals N = 949 100% female 

Target population of pregnant women who gave birth in 5 Quebec hospitals in 1995-1996 and had previously participated in a study of perineal massage. Method of Measurement: 1,198 received a mailed questionnaire 3 months after delivery.. 

DeLeeuw, 2001307

Retrospective cohort, comparative study of women in a Netherlands Hospital. 

171 women who underwent primary repair of a 3rd and 4th degree perineal rupture between Jan 1971 and Dec 1990 were eligible as cases; controls were women matched for parity to cases who had a vaginal 

Candidate variables: Extent of anal sphincter damage 3 levels: 1) partial rupture, 2) complete rupture with intact mucosa, and 3) complete rupture of sphincters mucosa. 

Prevalence of cAnorectal compCases (n = 125Controls (n = 12Mantel-Haenze
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F231 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

Median age at delivery: Cases; 26 (18-41) Control: 28 (19-38) N = 125 pairs 100% female 

delivery without anal sphincter damage in the same hospital. Sample of 125 case and control pairs. Method of Measurement: Postal questionnaire and surgical recordsDefinition of Incontinence: Parks 

classification of fecal incontinence 

Presence of medio-lateral episiotomy, (yes/no). Subsequent vaginal delivery, (yes/no). 

Odds-Ratio [95%[1.87-7.09] Fecal IncontineCases (n = 125Controls (n = 12Mantel-HaenzeOdds-Ratio [95%[1.57-6.10] Grade-II Cases (n = 125Controls (n = 12Grade-III Cases (n = 125Controls (n = 12Grade-IV Cases (n = 125Controls (n = 12Fecal urgency Cases (n = 125Controls (n = 12Mantel-HaenzeOdds-Ratio [95%[2.55-20.62] Fecal soiling Cases (n = 125Controls (n = 12Mantel-HaenzeOdds-Ratio [95%[1.56-92.29] Urinary incontinCases (n = 125Controls (n = 12Mantel-HaenzeOdds-Ratio [95%[0.91-2.37] Stress-incontineCases (n = 125Controls (n = 12Mantel-HaenzeOdds-Ratio [95%
Table F1. Incidence, risk factors, and prevalence for urinary and fecal incontinence in adults in long term care setting and in th

F1f. Risk factors of fecal incontinence in adults (continued) 

F232 

Author Sample 

Subject Selection, Data Source, Methods 

to Measure Incontinence (survey, 

screening, case finding), Definition of 

Incontinence. Definition of Risk Factors. 

Level of Risk Factors 

Prevalence (%

of Fecal Inc

Overall: by Ty

and Impa

[0.91-2.37] Urge-incontinenCases (n = 125Controls (n = 12Mantel-HaenzeOdds-Ratio [95%[0.68-1.98] Results are oddconfidence intermultivariate anaperineal damag4.45) Mediolateral epprimiparous wo.61) 
F233 

F1g.Evidence tables of the association between risk factors and prevalence of fecal incontinence in adults in the community an

settings 

Author, Study 

Design 

Adjustment for 

Confounding 

Factors 

Subject election, 

Data Source, 

Measurement 

Methods, 

Definitions 

Subject 

Age, 

Gender 

Levels of Risk Factors Preval

and UI 

Bliss,2004308Design Cross sectional Adjustment for confounding factors: Numerous; age, sex etc. 

1,352 elderly subjects selection: Elderly visiting HMO Clinics 

Methods to measure incontinence: survey distributed at clinics Definition of FI: accidental stool leakage during past 12 mos. Severity/type: amount of leakage Type of leakage Frequency of leakage 

Mean age (SD) = 75(6) 

60% female 

Amount of leakage: Soils underwear, outerwear or shoes/floor FI frequency: ≥1/day Several times per week Several times per month One or more times per year Type: loose/liquid, formed, mucus 

Freq, Type, Amount Risk Factors with Cut Offs 

Solid urgency always 

urgency most times hemorrhoid surgery urgency most times urgency sometimes 

Loose liquid 

loose liquid stool Ref is no FI loose or liquid stool bowel resection 

Severity, frequency ≥1/day 

hemorrhoids stool softener for constipation Urinary incontinence self rate health as poor urgency always urgency most times 

Frequency ≥1/day 

urgency sometime Ref is no FI loose liquid stool bowel resection mild memory problems Moderate/severe memory problems low back pain or sciatica hemorrhoids overweight urgency sometime urgency most times 

Severity amount 

urgency always 

Overall 19% ha1.5% haPrevale= 1.7% 
F234 

Table F2. Prevalence of UI in community dwelling males by country, type, and definition of UI (the results from individual studie

Author Location Age N Prevalence 

Total Van Oyen, 2002157 Belgium 15-24 443 0.1 (0.1Temml, 1999170 Austria 20-29 59 1.7 (1.6Diokno, 200789 USA 18-34 3,177 7.25 (7.Andersson, 200410 Sweden 18-34 9,836 3 (3.0Van Oyen, 2002157 Belgium 25-34 680 0 (0.0Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK <39 2,792 2.4 (2.3Schulman, 1997192 Belgium 30-34 2,499 0.8 (0.8Smoger, 2000169 USA <40 67 25.4 (25.Temml, 2000170 Austria 30-39 184 2.7 (2.6Schulman, 1997192 Belgium 35-39 2,499 2.6 (2.5Brocklehurst, 1993199 Great Britain 30-49 867 2 (1.9Diokno, 200789 USA 35-44 4,295 7.17 (7.O'Brien, 1991309 UK 35-44 576 2.4 (2.3Van Oyen, 2002157 Belgium 35-44 705 0.6 (0.5Lagace, 1993200 USA >20 922 11.3 (11.Schulman, 1997192 Belgium 40-44 2,499 2 (1.9Andersson, 200410 Sweden 35-49 9,836 6 (6.0MacLennan, 200084 Australia 15-97 1,464 4.4 (4.3Temml, 2000170 Austria 40-49 458 3.9 (3.8Ueda, 2000172 Japan 40-49 180 5 (4.9Malmsten, 1997188 Sweden 45 1,151 3.6 (3.5Smoger, 2000169 USA 41-50 165 30.9 (30.Schulman, 1997192 Belgium 45-49 2,499 2.3 (2.2Roe, 2000168 UK 18-98 2,660 5.3 (5.2Temml, 2005310 USA 20-91 1,199 1.8 (1.7Andersson, 200410 Sweden 18-79 9,836 10 (9.99Temml, 2000170 Austria 20-96 1,236 5 (4.9Schmidbauer, 200162 Austria 20-91 1,236 5 (4.9Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >18 8,130 5.4 (5.4Diokno, 200789 USA 45-54 4,510 10.98 (10O'Brien, 1991309 UK 45-54 511 5.5 (5.4Van Oyen, 2002157 Belgium 45-54 599 0.9 (0.8Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK 40-59 3,096 5.2 (5.1Malmsten, 1997188 Sweden 50 945 4.1 (4.0Schulman, 1997192 Belgium 50-54 2,499 4.9 (4.8Brocklehurst, 1993199 Great Britain >30 1,883 6.6 (6.5Schulman, 1997192 Belgium >30 2,499 5.2 (5.1Temml, 2000170 Austria 50-59 294 3.7 (3.6Brocklehurst, 1993199 Great Britain 50-59 315 5.4 (5.3
Table F2. Prevalence of UI in American males by type and time period (continued) 

F235 

Author Location Age N Prevalence 

Ueda, 2000172 Japan 50-59 197 6.6 (6.5Roberts, 1998311 USA 50-59 225 16.9 (16.O’Brien, 1991309 UK >35 2,496 7.4 (7.3Malmsten, 1997188 Sweden 55 779 3.3 (3.2Bortolotti, 2000165 Italy 51-60 1,222 2 (1.9Smoger, 2000169 USA 51-60 137 31.4 (31.Schulman, 1997192 Belgium 55-59 2,499 4.9 (4.8Andersson, 200410 Sweden 50-64 9,836 13 (12.9Umlauf, 1996195 USA 52-64 223 20 (19.9Ueda, 2000172 Japan 40-80 818 10.5 (10.Diokno, 200789 USA 55-64 3,113 15.58 (15O’Brien, 1991309 UK 55-64 584 5.7 (5.6Van Oyen, 2002157 Belgium 55-64 428 2.7 (2.6Roberts, 1998311 USA 40-79 2,150 17.3 (17.

France 40-79 1,217 7.8 (7.7Netherlands 40-79 1,233 16.2 (16.UK 40-79 990 14 (13.9

Boyle, 2003121

South Korea 40-79 1,360 10 (9.98

25-93 809 32.3 (32.25-93 660 32 (31.925-93 133 33.1 (33.

Smoger, 2000169 USA 

25-93 11 36.4 (36.

Aggazzotti, 2000163 Italy <65 217 19.1 (19.Perry, 2000312 UK >40 6,941 8.9 (8.8Malmsten, 1997188 Sweden 60 775 5.1 (5.0McGrother, 200326 UK >40 42,939 14.2 (14.Teunissen, 2004119 Netherlands 60-64 2,137 5 (4.9Schulman, 1997192 Belgium 60-64 2,499 5.5 (5.Stothers, 2005116 USA 60-64 5,037,678 11 (11.0Roberts, 1998311 USA >50 766 26.4 (26.Goluboff, 1998313 Columbia 480 13.1 (13.Malmsten, 1997188 Sweden 45-99 7,763 9.2 (9.1Temml, 1999170 Austria 60-69 132 7.6 (7.5Ueda, 2000172 Japan 60-69 281 11.4 (11.Roberts, 1998311 USA 60-69 270 23.7 (23.Diokno, 1990314 USA 60-69 489 18.2 (18.Koyama, 1998177 Japan 60-69 308 1.3 (1.2Bortolotti, 2000165 Italy >50 2,721 3.4 (3.3Jorgensen, 2005114 Norway 31-93 136 4 (3.9Malmsten, 1997188 Sweden 65 739 6.1 (6.0Bogren, 19979464154 Sweden 65 233 9 (8.9
Table F2. Prevalence of UI in American males by type and time period (continued) 

F236 

Author Location Age N Prevalence 

Bortolotti, 2000165 Italy 61-70 768 2.6 (2.5Smoger, 2000169 USA 61-70 237 36.3 (36.Teunissen, 2004119 Netherlands 65-69 2,137 6 (5.9Stoddart, 2001162 Great Britain 65-69 167 12 (11.9Schulman, 1997192 Belgium 65-69 2,499 8.5 (8.Maggi, 2001158 Italy 65-69 867 4.6 (4.5Stothers, 2005116 USA 65-69 4,731,187 11 (11.0Haltbakk, 2005315 Norway 39-91 480 36.7 (36.Brocklehurst, 1993199 Great Britain 60+ 701 13.3 (13.Teunissen, 2004119 Netherlands >60 2,137 9 (8.9Tseng, 2000 <70 65 13.8 (13.

171 Taiwan 

>70 181 15.5 (15.

Adolfsson, 1998252 Sweden 50-80 656 20.6 (20.Joly, 1998316 Netherlands 51-82 65 9 (8.9Jitapunkul, 1998182 Thailand >60 232 16.81 (16Diokno, 200789 USA 65-74 2,260 23.82 (23Aggazzotti, 2000163 Italy 65-74 217 22.7 (22.O’Brien, 1991309 UK 65-74 506 12.1 (12.Umlauf, 1996195 USA 65-74 724 26 (25.9Van Oyen, 2002157 Belgium 65-74 384 5.2 (5.1Herzog, 199041 USA >60 802 18.8 (18.Diokno, 1990314 USA >60 802 18.8 (18.Diokno, 1991317 USA >60 655 20.2(20.

Denmark >60 1,799 51.2 (51.France >60 167 46 (45.9Iceland >60 377 64.4 (64.Italy >60 586 36 (35.9Japan >60 539 51.6 (51.Sweden >60 436 61.4 (61.

Sgadari, 199740

USA >60 12,6070 44.5 (44.

Van Oyen, 2002157 Belgium >15 3,462 1.4 (1.4Malmsten, 1997188 Sweden 70 776 7.3 (7.2Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >60 2,029 10.4 (10.Ouslander, 1990318 USA 60 37 (36.8Umlauf1996195 USA 52-99 1,490 29 (28.9Teunissen, 2004119 Netherlands 70-74 2,137 8 (7.9Stoddart, 2001162 Great Britain 70-74 194 21.1 (21.Maggi, 2001158 Italy 70-74 867 12.6 (12.Stothers, 2005116 USA 70-74 3,320,840 19 (19.0Andersson, 200410 Sweden 65-79 9,836 21 (20.9Schulman, 1997192 Belgium 70+ 2,499 13.8 (13.
Table F2. Prevalence of UI in American males by type and time period (continued) 

F237 

Author Location Age N Prevalence 

Tseng, 2000171 Taiwan >65 248 15 (14.9Damian, 1998176 Spain >65 589 14.5 (14.Stothers, 2005116 USA >65 1,8231,934 17 (17.0Nakanishi, 1997190 Japan >65 1,405 8.7 (8.6Ju, 1991205 Singapore >65 435 4.4 (4.3Borrie, 1992301 Canada 326 61 (60.9Roberts, 1998311 USA 70-79 217 35.9 (35.Diokno, 1990319 USA 70-79 229 18.8 (18.Koyama, 1998177 Japan 70-79 378 8 (7.9Bortolotti, 2000165 Italy >70 731 6.6 (6.5Ueda, 2000172 Japan >70 160 20 (19.9Stoddart, 2001162 Great Britain >65 781 23.4 (23.Malmsten, 1997188 Sweden 75 583 9.6 (9.5Maggi, 2001158 Italy >65 867 11.5 (11.Smoger, 2000169 USA 71-80 178 33.2 (33.Koyama, 1998177 Japan >60 856 6.1 (6.0Nuotio, 2003, 136 Finland >70 171 25 (24.9Iglesias, 2000167 Spain >65 341 32.3 (32.Teunissen, 2004119 Netherlands 75-79 2,137 14 (13.9Stoddart, 2001162 Great Britain 75-79 198 22.2 (22.Maggi, 2001158 Italy 75-79 867 12.3 (12.Stothers, 2005116 USA 75-79 2,748,396 27 (27.0Kutner, 1994197 USA >65 113 4.5 (4.4Stenzelius, 200454 Sweden 75-79 655 31.2 (31.O’Brien, 1991309 UK >75 319 15.4 (15.Van Oyen, 2002157 Belgium >75 223 13.3 (13.

>65 163 25.8 (25.>65 22 13.6 (13.

Adelmann, 200450 USA 

>65 100 72 (71.9

Langa, 200282 USA >70 2,812 13 (12.9Aggazzotti, 2000163 Italy 75-84 217 51.8 (51.Umlauf, 1996195 USA 75-84 452 38 (37.9Malmsten, 1997188 Sweden 80 360 19.7 (19.Temml, 2005310 USA >70 106 5.7 (5.6Maggi, 2001158 Italy 80-84 867 22.2 (22.Aggazzotti, 2000, 163 Italy 33-102 217 39.2 (39.Stothers, 2005116 USA 80-84 1,478,414 27 (27.0Stenzelius, 200454 Sweden 80-84 554 32.5 (32.Stoddart, 2001162 Great Britain >80 222 34.2 (34.Roberts, 1998, 311 USA >80 54 40.7 (40.Boyington, 200743 Southeastern USA >65 22,539 72.2 (72.
Table F2. Prevalence of UI in American males by type and time period (continued) 

F238 

Author Location Age N Prevalence 

Temml, 1999170 Austria >70 109 15.6 (15.Stenzelius200454 Sweden >75 1,642 34.8 (34.Brandeis, 1997186 USA 60-105 474 24.1 (24.Teunissen, 2004119 Netherlands >80 2,137 21 (20.9Diokno, 1990319 USA >80 85 22.4 (22.Koyama, 1998177 Japan >80 170 10.6 (10.Diokno, 200789 USA 75-97 1,386 30.19 (30Smoger, 2000169 USA 80-93 25 20 (19.8Malmsten, 1997188 Sweden 85-89 1,279 21.8 (21.Stenzelius, 200454 Sweden 85-89 300 43.6 (43.Stothers, 2005116 USA >85 915,419 31 (31.0Aggazzotti, 2000163 Italy 85-94 217 52.4 (52.Umlauf, 1996195 USA 85-94 51 31 (30.8Maggi, 2001158 Italy >85 867 23.6 (23.Stenzelius, 200454 Sweden >90 133 41.9 (41.Malmsten, 1997188 Sweden 90-99 376 28.2 (28.Aggazzotti, 2000163 Italy 95+ 217 57.1 (57.Umlauf, 1996195 USA 95-99 3 66 (65.6MixedIrwin, 200696 Canada, Germany, Italy, Sweden, and the UK <39 2,500 0.4 (0.4MacLennan, 200084 Australia 15-97 1,464 1 (0.9Ueda, 2000172 Japan 40-49 180 0 (0.0Irwin, 2006 >18 8,167 0.6 (0.6

96 Canada, Germany, Italy, Sweden, and the UK 

40-59 3,000 0.4 (0.4

Diokno, 200789 USA 18-97 21,590 1.8 (1.8

50-59 197 0.4 (0.340-80 818 1.5 (1.4

Ueda, 2000172 Japan 

60-69 281 0.7 (0.6

Diokno, 1990319 USA 60-69 489 5.3 (5.2Bortolotti, 2000165 Italy >50 2,721 20 (19.9Roberts, 1998311 USA >50 775 6.7 (6.6Jitapunkul, 1998182 Thailand >60 232 1.72 (1.Diokno, 1990319 USA >60 802 5.5 (5.4Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >60 2,250 1.2 (1.2Umlauf, 1996195 USA 52-99 1,490 13.1 (13.Damian, 1998176 Spain >65 589 2.3 (2.2Ju, 1991205 Singapore >65 435 0 (0.0Diokno, 1990319 USA 70-79 229 4.4 (4.3Ueda, 2000172 Japan >70 160 0.4 (0.3Nuotio, 2003136 Finland >70 171 6 (5.9Diokno, 1990319 USA >80 85 9.4 (9.3
Table F2. Prevalence of UI in American males by type and time period (continued) 

F239 

Author Location Age N Prevalence 

Stress Maral, 2001 Turkey 15-24 273 0 (0.0

159

Turkey 25-34 182 0 (0.0

Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK <39 3,000 0.1 (0.1Maral, 2001159 Turkey 35-44 235 0.9 (0.8MacLennan, 200084 Australia 15-97 1,464 1.5 (1.4Ueda, 2000172 Japan 40-49 180 0.2 (0.1Engstrom, 2003125 UK 40-49 687 1 (0.9Muscatello, 2001160 Australia 41-49 232 7 (6.9Maral, 2001159 Turkey >15 1,000 1 (0.9Temml, 1999170 Austria 20-96 1,236 1.5 (1.4Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >18 8,167 0.6 (0.6Mozes, 1997189 Israel 45-54 363 0.3 (0.2Maral, 2001159 Turkey 45-54 169 1.2 (1.1Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK 40-59 2,833 0.6 (0.6Diokno, 200789 USA 18-97 21,590 2.4 (2.4Muller, 2005320 USA 30-70 1,001 2 (1.9Corcos, 20012 Canada >35 1,566 0.8 (0.8Ueda, 2000172 Japan 50-59 197 0.5 (0.4Muscatello, 2001160 Australia 50-59 232 2 (1.9Engstrom, 2003 UK 50-59 717 2 (1.9

125

UK 40-80 2,217 2 (1.9

Mozes, 1997189 Israel 45-75 896 2.1 (2.0Ueda, 2000172 Japan 40-80 818 1.3 (1.2Mozes, 1997189 Israel 55-64 241 2.9 (2.8Maral, 2001159 Turkey 55-64 80 3.8 (3.7Muscatello, 2001160 Australia >40 232 9 (8.96Koskimaki, 1998178 Finland 50-70 2,128 9 (8.9Goepel, 2001321 Germany >40 211,648 11.6 (11.Ueda, 2000172 Japan 60-69 281 0.5 (0.4Muscatello, 2001160 Australia 60-69 232 25 (24.9Diokno, 1990319 USA 60-69 489 1.4 (1.3Engstrom, 2003125 UK 60-69 465 4 (3.9Bortolotti, 2000165 Italy >50 2,721 6 (5.9Roberts, 1998183 USA >50 775 0.9 (0.8Jitapunkul, 1998182 Thailand >60 232 0.43 (0.Mozes, 1997189 Israel 65-75 293 3.8 (3.7Diokno, 1990319 USA >60 802 1.4 (1.3Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >60 1,813 1.6 (1.5Umlauf, 1996195 USA 52-99 1,490 0.5 (0.5Tseng, 2000171 Taiwan >65 248 1.2 (1.1
Table F2. Prevalence of UI in American males by type and time period (continued) 

F240 

Author Location Age N Prevalence 

Damian, 1998176 Spain >65 589 1.5 (1.4Maral, 2001159 Turkey >65 61 4.9 (4.8Diokno, 1990319 USA 70-79 229 1.7 (1.6Ueda, 2000172 Japan >70 160 0.1 (0.1Muscatello, 2001160 Australia >70 232 11 (10.9Engstrom, 2003125 UK 70-80 348 5 (4.9Koyama, 1998177 Japan >60 856 0.7 (0.6Nuotio, 2003136 Finland >70 171 2 (1.9Diokno, 1990319 USA >80 85 0 (0.0Urge Maral, 2001 Turkey 15-24 273 1.1 (1.0

159

Turkey 25-34 182 0 (0.00

Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK <39 2,500 0.4 (0.4Corcos, 200412 Canada 35-44 591 11.1 (11.Maral, 2001159 Turkey 35-44 235 1.3 (1.2MacLennan, 200084 Australia 15-97 1,464 1.9 (1.8Ueda, 2000172 Japan 40-49 180 0.9 (0.8Engstrom, 2003125 UK 40-49 687 1 (0.9Muscatello, 2001160 Australia 41-49 232 7 (6.9Maral, 2001159 Turkey >15 1,000 2.7 (2.6Temml, 1999170 Austria 20-96 1,236 2.7 (2.6Moorthy, 2003118 Asia (China, Hong Kong, India, Indonesia, 

Malaysia, Pakistan, Philippines, Singapore, South 

Korea, Taiwan, and Thailand) 

>18 2,369 13 (12.9

Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >18 8583 1.2 (1.2Corcos, 200412 Canada 45-54 4,63 14.3 (14.Maral, 2001159 Turkey 45-54 169 3.6 (3.5Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK 40-59 3,154 1.3 (1.3Diokno, 200789 USA 18-97 21,590 4.3 (4.3Stewart, 2002141 USA >18 2,469 2.6 (2.5Ueda, 2000172 Japan 50-59 197 0.7 (0.6Muscatello, 2001160 Australia 50-59 232 2 (1.9Engstrom, 2003125 UK 50-59 717 5 (4.9Lee, 1998322 Korea 50-59 232 9.9 (9.8Engstrom, 2003125 UK 40-80 2,217 6 (5.9Ueda, 2000172 Japan 40-80 818 7.7 (7.6Corcos, 200412 Canada 55-64 265 17.5 (17.Maral, 2001159 Turkey 55-64 80 11.3 (11.Muscatello, 2001160 Australia >40 232 9 (8.96Koskimaki, 1998178 Finland 50-70 2,128 17 (16.9Sladden, 1999323 Australia 40-80 330 4 (3.9Goepel, 2001321 Germany >40 211,648 14.3 (14.
Table F2. Prevalence of UI in American males by type and time period (continued) 

F241 

Author Location Age N Prevalence 

Ueda, 2000172 Japan 60-69 281 2.7 (2.6Muscatello, 2001160 Australia 60-69 232 18 (17.9Diokno, 1990319 USA 60-69 489 6.7 (6.6Engstrom, 2003125 UK 60-69 465 9 (8.9Lee, 1998322 Korea 60-69 181 14.9 (14.Bortolotti, 2000165 Italy >50 2,721 20 (19.9Roberts, 1998311 USA >50 775 10.8 (10.Lee, 1998322 Korea >50 519 14.2 (14.Jitapunkul, 1998182 Thailand >60 232 7.33 (7.Stewart, 2002141 USA 65-74 232 8.2 (8.1Corcos, 200412 Canada 65-74 151 21.5 (21.Diokno, 1990319 USA >60 802 6.6 (6.5Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >60 2,080 2.5 (2.4Umlauf, 1996195 USA 52-99 1,490 10.6 (10.Tseng, 2000171 Taiwan >65 248 5.6 (5.5Damian, 1998176 Spain >65 589 7.6 (7.5Ju, 1991205 Singapore >65 435 0.5 (0.4Maral, 2001159 Turkey >65 61 9.7 (9.6Nuotio, 2002148 Finland 60-89 524 5.3 (5.2Diokno, 1990319 USA 70-79 229 7.4 (7.3Nuotio, 2002148 Finland 70-79 171 21.1 (21.Ueda, 2000172 Japan >70 160 3.4 (3.3Muscatello, 2001160 Australia >70 232 17 (16.9Engstrom, 2003125 UK 70-80 348 15 (14.9Koyama, 1998177 Japan >60 856 3.7 (3.6Lee, 1998322 Korea >70 106 23.5 (23.Nuotio, 2003136 Finland >70 171 17 (16.9Stewart, 2002141 USA >75 128 12.8 (12.Corcos, 200412 Canada >75 90 29.5 (29.Nuotio, 2002148 Finland 70-98 171 28.9 (28.Diokno, 1990319 USA >80 85 3.5 (3.4Nuotio, 2002148 Finland 80-98 171 34.3 (34.Homma, 2005113 Japan 40-100 2,100 6 (5.9Other type of UI 

Canada, Germany, Italy, Sweden, and the UK <39 2,933 1.5 (1.5Canada, Germany, Italy, Sweden, and the UK >18 8,207 2.9 (2.9

Irwin, 200696

Canada, Germany, Italy, Sweden, and the UK 40-59 3,033 3 (2.9

Diokno, 200789 USA 18-97 21,590 1.2 (1.2Koskimaki, 1998178 Finland 50-70 2,128 10 (9.99Diokno, 1990319 USA 60-69 489 4.7 (4.6Roberts, 1998311 USA >50 775 8.3 (8.2
Table F2. Prevalence of UI in American males by type and time period (continued) 

F242 

Author Location Age N Prevalence 

Diokno, 1990319 USA >60 802 5.4 (5.3Irwin, 200696 Canada, Germany, Italy, Sweden, and the UK >60 1,981 5.2 (5.1Damian, 1998176 Spain >65 589 3.1 (3.0Diokno, 1990319 USA 70-79 229 5.2 (5.1Koyama, 1998177 Japan >60 856 1.6 (1.5Diokno, 1990319 USA >80 85 9.4 (9.3
F243 

Table F3. Prevalence of UI in American males by type and time period of involuntary loss of urine (the results from 

individual studies) 

Author 

Time Involuntary 

Leakage of Urine 

Reported (months) 

Sample Size Prevalence (%) 95%CI 

Total UI 

Median age of sample: 19-44 years 

Diokno, 2007 1 3,177 7.25 (7.24; 7.26) 89

1 4,295 7.17 (7.16; 7.18) 

Smoger, 2000169 12 67 25.40 (25.30; 25.50) 

Lagace, 1993200 12 922 11.30 (11.28; 11.32) 

Median age of sample: 45-64 years 

Diokno, 200789 1 4,510 10.98 (10.97; 10.99) 

Umlauf, 1996195 1 223 20.00 (19.95; 20.05) 

Diokno, 200789 1 3,113 15.58 (15.57; 15.59) 

Smoger, 2000169 12 165 30.90 (30.83; 30.97) 

Roberts, 1998311 12 225 16.90 (16.85; 16.95) 

Smoger, 2000169 12 137 31.40 (31.32; 31.48) 

Roberts, 1998183 12 2,150 17.30 (17.28; 17.32) 

Smoger, 2000169 12 809 32.30 (32.27; 32.33) 

Roberts, 1998 12 766 26.40 (26.37; 26.43) 311

12 270 23.70 (23.65; 23.75) 

Diokno, 1990314 6 days/12 489 18.20 (18.17; 18.23) 

Stothers, 2005116 ever 5,037,678 11.00 (11.00; 11.00) 

Temml, 2005310 ND 1199 1.80 (1.79; 1.81) 

Median age of sample: ≥65 years 

Diokno, 200789 1 2,260 23.82 (23.80; 23.84) 

Umlauf, 1996195 1 724 26.00 (25.97; 26.03) 

Umlauf, 1996 1 1,490 29.00 (28.98; 29.02) 195

1 452 38.00 (37.96; 38.04) 

Smoger, 2000169 12 237 36.30 (36.24; 36.36) 

Herzog, 199041 12 802 18.80 (18.77; 18.83) 

Roberts, 1998311 12 217 35.90 (35.84; 35.96) 

Smoger, 2000169 12 178 33.20 (33.13; 33.27) 

Langa, 200282 12 2,812 13.00 (12.99; 13.01) 

Diokno, 1990314 6 days/12 802 18.80 (18.77; 18.83) 

Diokno, 1991317 6 days/12 655 20.20 (20.17; 20.23) 

Diokno, 1990314 6 days/12 229 18.80 (18.75; 18.85) 

ever 4,731,187 11.00 (11.00; 11.00) 

 3,320,840 19.00 (19.00; 19.00) 

 18,231,934 17.00 (17.00; 17.00) 

Stothers, 2005116

 2,748,396 27.00 (27.00; 27.00) 

Kutner, 1994197 ND 113 4.50 (4.46; 4.54) 

Adelmann, 2004 ND 163 25.80 (25.730; 25.87) 50

 22 13.60 (13.47; 13.73) 

Median age of sample: ≥80 years 

Diokno, 200789 1 1,386 30.19 (30.17; 30.21) 

Umlauf, 1996 1 51 31.00 (30.88; 31.12) 195

1 3 66.00 (65.65; 66.35) 

Roberts, 1998311 12 54 40.70 (40.57; 40.83) 

Diokno, 1990314 12 85 22.40 (22.31; 22.49) 

Smoger, 2000169 12 25 20.00 (19.85; 20.15) 

Brandeis, 1997186 2 episodes/week 474 24.10 (24.06; 24.14) 

Stothers, 2005 ever 1,478,414 27.00 (27.00; 27.00) 116

 915,419 31.00 (31.00; 31.00) 

Boyington, 200743 ever 22,539 72.20 (72.19; 72.21) 

Temml, 2005310 ND 106 5.70 (5.66; 5.74) 

Mixed UI 

Median age of sample: 45-64 years 

Diokno, 200789 1 21,590 1.80 (1.80; 1.80) 

Diokno, 1990314 6 days/12 489 5.30 (5.28; 5.32) 
Table F3. Prevalence of UI in American males by type and time period of involuntary loss of urine (the results from 

individual studies) (continued) 

F244 

Author 

Time Involuntary 

Leakage of Urine 

Reported (months) 

Sample Size Prevalence (%) 95%CI 

Median age of sample: ≥65 years 

Diokno, 1990 6 days/12 802 5.50 (5.48; 5.52) 314

6 days/12 229 4.40 (4.37; 4.43) 

Umlauf, 1996195 1 1,490 13.10 (13.08; 13.12) 

Roberts, 1998183 12 775 6.70 (6.68; 6.72) 

Median age of sample: ≥80 years 

Diokno, 1990314 6 days/12 85 9.40 (9.34; 9.46) 

Stress UI 

Median age of sample: 45-64 years 

Diokno, 200789 1 21,590 2.40 (2.40; 2.40) 

Diokno, 1990314 12 489 1.40 (1.39; 1.41) 

Muller, 2005320 ND 1,001 2.00 (1.99; 2.01) 

Median age of sample: ≥65 years 

Diokno, 1990 6 days/12 802 1.40 (1.39; 1.41) 314

6 days/12 229 1.70 (1.68; 1.72) 

Umlauf, 1996195 1 1,490 0.50 (0.50; 0.50) 

Roberts, 1998183 12 775 0.90 (0.89; 0.91) 

Median age of sample: ≥80 years 

Diokno, 1990314 6 days/12 85 0.00 (0.00; 0.00) 

Urge UI 

Median age of sample: 45-64 years 

Diokno, 1990314 6 days/12 489 6.70 (6.68; 6.72) 

Diokno, 200789 1 21,590 4.30 (4.30; 4.30) 

Stewart, 2003141 ND 2,469 2.60 (2.59; 2.61) 

Median age of sample: ≥65 years 

Diokno, 1990 6 days/12 802 6.60 (6.58; 6.62) 314

6 days/12 229 7.40 (7.37; 7.43) 

Umlauf, 1996195 1 1,490 10.60 (10.58; 10.62) 

Roberts, 1998183 12 775 10.80 (10.78; 10.82) 

Stewart, 2003 ND 232 8.20 (8.16; 8.24) 141

ND 128 12.80 (12.74; 12.86) 

Median age of sample: ≥80 years 

Diokno, 1990314 6 days/12 85 3.50 (3.46; 3.54) 
F245 

Table F4. Prevalence of UI by severity in age groups of the American men (the results from individual studies) 

Author 

Time Involuntary 

Leakage of 

Urine Reported 

(months) 

Frequency Amount Age Sample Size Prevalen

Median age: 19-44 yearsSmoger, 2000169 12 <1/month <40 67 11.90 (

<Once/month Loss of a few drops >20 922 2.30 <Once/month Wet outerwear >20 922 0.30 

Lagace, 1993200 12 

<Once/month Wet underwear >20 922 1.00 

Smoger, 2000169 12 About 1/month <40 67 1.50 

Monthly Loss of a few drops >20 922 2.10 Monthly Wet outerwear >20 922 0.20 Monthly Wet underwear >20 922 5.00 

Lagace, 1993200 12 

Monthly Wet underwear >20 922 0.50 

Smoger, 2000 <1/week <40 67 1.50 (

169 12 

About 1/week <40 67 1.50 

Weekly Loss of a few drops >20 922 0.90 Weekly Wet outerwear >20 922 0.20 

Lagace, 1993200 12 

Weekly Wet underwear >20 922 0.80 

Smoger, 2000169 12 Almost every day <40 67 9.00 

Daily Loss of a few drops >20 922 0.80 Daily Wet outerwear >20 922 0.80 

Lagace, 1993200 12 

Daily Wet underwear >20 922 1.50 

Smoger, 2000 Wet my underwear <40 67 9.00 

169 12 

 Wet outer clothing <40 67 3.00 

Roberts, 1998183 12 Wet underclothing 40-79 2,150 10.80 (Median age: 45-64 years 

<1/month 41-50 165 6.10 <1/month 51-60 137 6.60 <1/month 25-93 809 6.60 About 1/month 41-50 165 4.80 About 1/month 51-60 137 5.10 

Smoger, 2000169 12 

About 1/month 25-93 809 4.70 

Stothers, 2005 Few times/month 60-64 5,037,678 1.00 

116 Ever 

Few times/year 60-64 5,037,678 2.00 

<1/week 41-50 165 4.20 <1/week 51-60 137 2.90 <1/week 25-93 809 3.30 About 1/week 41-50 165 7.30 About 1/week 51-60 137 8.00 

Smoger, 2000169 12 

About 1/week 25-93 809 6.80 
Table F4. Prevalence of UI by severity in age groups of the American men (the results from individual studies). 

F246 

Author 

Time Involuntary 

Leakage of 

Urine Reported 

(months) 

Frequency Amount Age Sample Size Prevalen

Stothers, 2005116 Ever Few times/week 60-64 5,037,678 4.00 

Almost every day 41-50 165 4.80 Almost every day 51-60 137 4.40 

Smoger, 2000169 12 

Almost every day 25-93 809 7.00 

Stothers, 2005 Daily 60-64 50,37,678 4.00 

116 Ever 

Do not know 60-64 50,37,678 0.00 

Roberts, 1998183 12 A few drops 40-79 2,150 4.20 

 Few Drops <40 67 13.40 ( Few Drops 41-50 165 13.90 ( Few Drops 51-60 137 21.20 ( Few Drops 25-93 809 19.50 ( Wet my underwear 41-50 165 10.90 ( Wet my underwear 51-60 137 8.00 

Smoger, 2000169 12 

 Wet my underwear 25-93 809 7.80 

Roberts, 1998183 12 Wet outer 

clothes/floor 

40-79 2,150 2.20 

 Wet outer clothing 41-50 165 4.20  Wet outer clothing 51-60 137 0.70  Wet outer clothing 25-93 809 2.20  Wet the floor <40 67 0.00  Wet the floor 41-50 165 0.00  Wet the floor 51-60 137 0.00 

Smoger, 2000169 12 

 Wet the floor 25-93 809 0.70 

Median age: ≥65 years 

<1/month 61-70 237 7.60 <1/month 71-80 178 4.50 About 1/month 61-70 237 5.90 

Smoger, 2000169 12 

About 1/month 71-80 178 3.40 

Few times/month 65-69 4,731,187 2.00 Few times/month 70-74 3,320,840 4.00 Few times/month 75-79 2,748,396 6.00 Few times/month >65 18,231,934 3.00 Few times/month >65 14,790,935 3.00 Few times/month >65 1,436,582 2.00 Few times/month >65 559,680 1.00 Few times/month >65 429,299 10.00 (Few times/month >65 1,015,438 8.00 Few times/year 65-69 4,731,187 2.00 

Stothers, 2005116 Ever 

Few times/year 70-74 3,320,840 3.00 
Table F4. Prevalence of UI by severity in age groups of the American men (the results from individual studies). 

F247 

Author 

Time Involuntary 

Leakage of 

Urine Reported 

(months) 

Frequency Amount Age Sample Size Prevalen

Few times/year 75-79 2,748,396 3.00 Few times/year >65 18,231,934 3.00 Few times/year >65 14,790,935 3.00 Few times/year >65 1,436,582 2.00 Few times/year >65 559,680 1.00 Few times/year >65 429,299 0.00 Few times/year >65 1,015,438 1.00 <1/week 61-70 237 3.80 <1/week 71-80 178 2.80 About 1/week 61-70 237 5.50 

Smoger, 2000169 12 

About 1/week 71-80 178 9.60 

Few times/week 65-69 4,731,187 3.00 Few times/week 70-74 3,320,840 3.00 Few times/week 75-79 2,748,396 4.00 Few times/week >65 18,231,934 4.00 Few times/week >65 14,790,935 3.00 Few times/week >65 1,436,582 7.00 Few times/week >65 559,680 3.00 Few times/week >65 429,299 15.00 (

Stothers, 2005116 Ever 

Few times/week >65 1,015,438 6.00 

Smoger, 2000 Almost every day 61-70 237 8.90 

169 12 

Almost every day 71-80 178 8.40 

Daily 65-69 4,731,187 4.00 Daily 70-74 3,320,840 9.00 Daily 75-79 2,748,396 14.00 (Daily >65 18,231,934 7.00 Daily >65 14,790,935 7.00 Daily >65 1,436,582 8.00 Daily >65 559,680 9.00 Daily >65 429,299 9.00 Daily >65 1,015,438 7.00 Do not know 65-69 4,731,187 0.00 Do not know 70-74 3,320,840 0.10 Do not know 75-79 2,748,396 0.30 Do not know >65 18,231,934 0.20 Do not know >65 14,790,935 0.20 Do not know >65 1,436,582 0.60 Do not know >65 559,680 0.30 

Stothers, 2005116 Ever 

Do not know >65 429,299 0.00 
Table F4. Prevalence of UI by severity in age groups of the American men (the results from individual studies). 

F248 

Author 

Time Involuntary 

Leakage of 

Urine Reported 

(months) 

Frequency Amount Age Sample Size Prevalen

Do not know >65 1,015,438 0.00 

Smoger, 2000 Few Drops 61-70 237 24.50 (

169 12 

 Few Drops 71-80 178 21.30 (

Roberts, 1998183 12 Mild >50 775 20.10 (

 Wet my underwear 61-70 237 6.30  Wet my underwear 71-80 178 5.60  Wet outer clothing 61-70 237 2.10  Wet outer clothing 71-80 178 1.70  Wet the floor 61-70 237 1.30 

Smoger, 2000169 12 

 Wet the floor 71-80 178 1.10 

Median age: ≥80 years Smoger, 2000 <1/month 80-93 25 0.00 

169 12 

About 1/month 80-93 25 8.00 

Ever Few times/month 80-84 1,478,414 4.00 

Few times/month >85 915,419 8.00 Few times/year 80-84 1,478,414 4.00 

Stothers, 2005 116

Ever 

Few times/year >85 915,419 3.00 

Smoger, 2000 <1/week 80-93 25 4.00 

169 12 

About 1/week 80-93 25 4.00 

Ever Few times/week 80-84 1,478,414 9.00 

Few times/week >85 915,419 5.00 

12 Almost every day 80-93 25 4.00 

Daily 80-84 1,478,414 9.00 Daily >85 915,419 15.00 (Do not know 80-84 1,478,414 1.00 

Stothers, 2005116

Ever 

Do not know >85 915,419 2.00 

 Few Drops 80-93 25 4.00  Wet my underwear 80-93 25 12.00 ( Wet outer clothing 80-93 25 0.00 

Smoger, 2000169 12 

 Wet the floor 80-93 25 4.00 
F249 

Table F5. Severity of FI in LTC facilities 

Author 

Sample Population Subgroup Severity of Fecal incontinence Prevalence 

(%) 

Nursing homes Fecal incontinence, <1/week 23.0 

Nursing homes, residents with 

arthritis/fracture femur 

Fecal incontinence, >1/week 16.0 

Nursing homes, residents with congestive 

heart failure/Ischemic heart disease 

Fecal incontinence, >1/week 5.0 

Nursing homes, residents with dementia Fecal incontinence, >1/week 45.0 

Nursing homes, frail Fecal incontinence, >1/week 16.0 

Nursing homes, residents with stroke Fecal incontinence, >1/week 25.0 

Nursing homes Fecal incontinence, 1-3 days/week 13.0 

Brocklehurst, 

1998324

N = 497 

Nursing homes Fecal incontinence, 4-7 days/week 16.0 

Bharucha, 2005241

N = 2,800 

Nursing homes, women Moderate fecal incontinence 8.1 

Haas, 2005325

N = 837 

Residents with spinal cord injury Spontaneous bowel evacuation 12.4 
F250 

Table F6. Prevalence of FI in community dwelling women by type of incontinence 

Author Prevalence 

(%) 95% CI 

Flatus

Chaliha, 1999326

N = 549 

0.5 0.19; 1.59 

Alnaif, 2001327

N = 229 

34.9 29.05; 41.31 

N = 298, <60 years old 5.3 3.33; 8.54 

Faltin 2001328 

N = 984, total 

4.4 3.26; 5.83 

Hojberg, 2003329

N = 7,557 

7.1 6.5; 7.65 

Walter, 2002330

N = 577 

9.9 7.70; 12.59 

Eva, 2003127

N = 529 

42.0 37.83; 46.21 

Boreham, 2005331

N = 457 

25.6 

Ballester, 2005332

N = 115 

7.0 

Bradley, 200664

N = 297 

33.0 

Gordon, 1999333

N = 283 

14.0 

Roche, 2002334

N = 418 

6.7 4.67; 9.51 

MacLennan, 200084

N = 1,546 

10.9 9.41; 12.52 

Lam, 1999335

N = 359 

7.5 5.22; 10.72 

Kjolhede, 1997336excluded in endnote 

N = 44 

0.0 0; 8.03 

Lopes, 1997337

N = 103 

8.7 4.67; 15.78 

Combined urge and passive fecal incontinence

Bharucha, 2005241 (N = 2,800) 1.0 

Liquid feces

Boreham, 2005331

N = 457 

12.9 

Ballester, 2005332

N = 115 

5.2 

Bharucha, 2005241

N = 2,800 

5.3 

Bradley, 200664

N = 297 

11.1 

Gordon, 1999333

N = 283 

6.0 

Melville, 2005338

N = 3,444 

3.4 

Alnaif, 2001327

N = 229 

2.6 1.21; 5.6 

Chaliha, 1999326

N = 549 

0.2 0.03; 1.02 

Hojberg, 2003329

N = 7,557 

2.5 2.14; 2.85 

Eva, 2003127

N = 639 

29.0 25.57; 32.59 
Table F6. Prevalence of FI in community dwelling women by type of incontinence (continued 

F251 

Author Prevalence 

(%) 95% CI 

Walter, 2002330

N = 577 

1.0 0.48; 2.25 

Kalantar, 2002339

N = 353 

8.8 6.26; 12.2 

Roche, 2002334

N = 418 

4.8 3.12; 7.27 

Kjølhede, 1997336

N = 44 

0.0 0; 8.03 

Passive fecal incontinence

Bharucha, 2005241

N = 2,800 

0.8 

Solid and liquid feces

Melville, 2005338

N = 3,444 

2.2 

Roberts, 1999340

N = 762 

15.2 12.85; 21.87 

Eva, 2003127

N = 670 

9.0 7.02; 11.36 

Lopes, 1997337

N = 103 

7.8 3.9; 14.58 

Kok, 1992202

N = 625 

7.2 5.42; 9.50 

Diokno, 1990314

N = 969 

8.3 7.62; 11.28 

Walter, 2002330

N = 274 

0.7 0.20; 2.62 

Thomas, 1984341

N = 1,562 

2.9 2.16; 3.83 

Verhagen, 2001342

N = 3,345 

8.0 7.11; 8.95 

Edwards, 2001277

N = 1,695 

4.0 2.92; 4.73 

Wetle, 1995343

N = 2,360 

7.8 6.78; 8.95 

O’Keefe, 1995212

N = 260 

8.1 5.34; 12.03 

Solid feces

Boreham, 2005331

N = 457 

13.1 

Bharucha, 2005241

N = 2,800 

5.6 

Bradley, 200664

N = 297 

1.7 

Gordon, 1999333

N = 283 

9.0 

Melville, 2005338

N = 3,444 

1.7 

Alnaif, 2001327

N = 229 

0.0 0; 2 

Chaliha, 1999326

N = 549 

0.7 0.03; 1.02 

Hojberg, 2003329

N = 7,557 

1.4 1.13; 1.65 

Eva, 2003127

N = 639 

9.0 5.39; 9.29 

Walter, 2002330

N = 577 

0.0 0; 0.66 
Table F6. Prevalence of FI in community dwelling women by type of incontinence (continued 

F252 

Author Prevalence 

(%) 95% CI 

Kalantar, 2002339

N = 353 

1.1 0.4; 2.9 

Okonkwo, 2002280

N = 3,963 

2.2 1.76; 2.67 

Roche, 2002334

N = 418 

1.7 0.81; 3.42 

Rizk, 2001344

N = 450 

5.6 3.79; 8.07 

Kjolhede, 1997336

N = 44 

0.0 0; 8.03 

Solid or liquid feces

Alnaif, 2001327

N = 229 

2.6 1.21; 5.6 

Faltin, 2001328

N = 298 

1.4 0.52; 3.40 

Hojberg, 2003329

N = 7,557 

2.7 2.36; 3.09 

Enck, 1991219

N = 73 

1.4 0.24; 7.36 

Thomas, 1984341

N = 6,205 

1.0 0.79; 1.30 

Kalantar, 2002339

N = 353 

11.6 8.68; 15.38 

Okonkwo, 2002280

N = 3,963 

4.8 4.22; 5.56 

Perry, 2002279

N = 5,483 

2.7 2.3; 3.16 

Roche, 2002334

N = 418 

6.5 4.48; 9.23 

Manning, 2001345

N = 148 

9.1 5.72; 15.25 

Rizk, 2001344

N = 450 

11.3 8.73; 14.60 

MacLennan, 200084

N = 1,546 

3.5 2.69; 4.54 

Mann, 2000 346

N = 130 

8.5 4.79; 14.52 

Soligo, 2000347

N = 101 

4.9 2.13; 11.07 

Lam, 1999335

N = 359 

5.6 3.64; 8.45 

Kjolhede, 1997336

N = 44 

0.0 0; 8.03 

Drossman, 1993257

N = 2,791 

0.9 0.61; 1.32 

Bharucha, 2005241

N = 2,800 

7.1 

Bradley, 200564

N = 297 

20.3 

Urge fecal incontinence

Bharucha, 2005241 ( N = 2,800) 6.2 

Vaginal or perineal splinting to defecate by age categories

<64 years = 4.0 

>72 years = 8.1 

64-67 years = 3.0 

Bradley, 200564

N = 297 

68-72 years = 5.1 
F253 

Table F7. Prevalence of FI in community dwelling women by severity of incontinence 

Author 

Sample Severity Prevalence 

(%) 95% CI 

Ballester, 2005 Fecal incontinence, <1 episode/month 6.1 332

N = 115 Fecal incontinence, >1/month 0.9 0.39; 5.9 

Talley, 1992 Fecal incontinence more than once a week 3.1 2.9; 10.6 214

N = 328 Wear a pad for fecal incontinence 6.7 

Bharucha, 2005241

N = 2,800 

Fecal incontinence, <1/month 9.6 

Melville, 2005 Fecal incontinence, >1/month 4.6 338

N = 3,444 Fecal incontinence, >1/week 2.7 

Fecal incontinence, >1/week 1.6 

Fecal incontinence, 1/month 4.3 

Bharucha, 2005241

N = 2,800 

Fecal incontinence, 1/week 2.2 

Fecal incontinence, 1-3 times monthly 4.0 

Fecal incontinence, 1-6 times weekly 3.4 

Bradley, 200564

N = 297 

Fecal incontinence, daily 1.4 

Bharucha, 2005241

N = 2,800 

Fecal incontinence, daily 0.4 

Bradley, 200564

N = 297 

Fecal incontinence, ever 34.0 

Bharucha, 2005241

N = 2,800 

Fecal incontinence, large to change clothes 1.3 

Bradley, 200564

N = 297 

Fecal incontinence, less than once a month 25.3 

Bharucha, 2005 Fecal incontinence, moderate 5.9 241

N = 2,800 Fecal incontinence, underwear stains only 10.7 

Ballester, 2005 Liquid feces, <1 episode/month, age 20-64 3.5 332

N = 115 Liquid feces, >1 episode/month, age 20-64 1.7 

Moderate fecal incontinence, age 20-29 0.3 

Moderate fecal incontinence, age 30-39 0.7 

Moderate fecal incontinence, age 40-49 1.3 

Moderate fecal incontinence, age 50-59 1.8 

Moderate fecal incontinence, age 60-69 2.0 

Bharucha, 2005241

N = 2,800 

Moderate fecal incontinence, age 70-79 1.9 31.95; 44.43 

Alnaif 2001327

N = 229 

Underwear staining 38.0 0.24; 7.36 

Enck 1991219

N = 73 

Underwear staining 1.4 12.35; 17.08 

Walter 2002330

N = 852 

Underwear staining 14.5 0.10; 1.32 

Chaliha, 1999326

N = 549 

Underwear staining 0.4 6.83; 8.22 

Perry, 2002279

N = 5,483 

Underwear staining 7.5 

Ballester, 2005332

N = 115 

Wear pad 1.7 
F254 

Table F8. Prevalence of FI in community dwelling adults (men and women) 

Author 

Sample 

Age Categories Prevalence 

(%) 

95% CI 

Combined urinary and fecal incontinence 

60–64 2.0 1.4; 2.8 

65–69 3.0 2.1; 4.3 

70–74 4.0 2.8; 5.6 

Teunissen, 2004119

N = 4,650 

75–79 6.0 4.2; 8.4 

Brittain, 2006348

N = 39,519 

 0.9 

Anal incontinence

<65 1.6 

>65 0.7 

Nelson, 1995272

N = 6,959 

 2.2 

Damon, 2006349

N = 706 

 5.1 3.6; 7.0 

Brittain, 2006348

N = 39,519 

 2.9 

<30 12.3 

>18 18.4 

Johanson, 1996350

N = 881 

>70 19.4 

60–64 5.0 4.0; 6.3 

65–69 5.0 3.9; 6.4 

Teunissen, 2004119

N = 4,650 

70–74 8.0 6.3; 10.1 

Teunissen, 2004119

N = 4,650 

75–79 8.0 6.1; 10.5 

Liquid feces

Giebel, 1998273

N = 500 

>18 years 6.7 

Soiling underwear

Giebel, 1998273

N = 500 

>18 years 3.1 

Solid feces 

Giebel, 1998273

N = 500 

>18 years 4.8 

Bytzer, 2001351

N = 8,185 

18-101 0.8 

Solid or liquid feces

Campbell, 1985352

N = 559 

>65 3.1 

Bytzer, 2001351

N = 8185 

18-101 3.8 

Giebel, 1998 273

N = 500 

>18 years 6.7 

Flatus

Giebel, 1998273

N = 500 

>18 years 5.5 
F255 

Table F9. Prevalence of FI in community dwelling adults (men and women) by severity 

Author 

Sample Definition Age Categories Prevalence 

(%) 

Fecal incontinence, <1/month 7.1 

Fecal incontinence, daily 2.7 

Fecal incontinence, weekly 4.5 

Johanson, 1996350

N = 881 

Wear pad 22.7 

Talley, 1992 Fecal incontinence, >1/week >65 3.7 214

N = 328 Wear pad >65 7.0 

Fecal incontinence, furnishing or bedding 1,483 after stroke 11.0 

Fecal incontinence, outer clothing 1,483 after stroke 6.0 

Brittain, 2006348

N = 39,519 

Major fecal incontinence 1.5 

Flatus, <1/day <60 6.1 

Flatus, <1/month <60 28.7 

Flatus, <1/week <60 27.8 

Flatus, >1/day <60 1.4 

Lifestyle alteration, <1/day <60 1.4 

Lifestyle alteration, <1/month <60 4.6 

Lifestyle alteration, <1/week <60 2.1 

Liquid, <1/day <60 0.7 

Liquid, <1/month <60 7.4 

Liquid, <1/week <60 4.2 

Liquid, >1/day <60 0.4 

Wear pad, <1/month <60 1.3 

Wear pad, <1/week <60 0.3 

Wear pad, <1/day <60 0.1 

Solid, <1/day <60 1.1 

Solid, <1/month <60 5.4 

Solid, <1/week <60 2.8 

Lynch, 2001278

N = 717 

Solid, >1/day <60 0.4 

Flatus, <1/month 13.2 

Flatus, <1/week 7.9 

Flatus, <1/week 6.6 

Liquid feces, <1/month 8.3 

Liquid feces, <1/week 0.5 

Liquid feces, <1/week 0.6 

Sold feces, <1/month 0.9 

Sold feces, <1/week 0.4 

Sold feces, <1/week 0.1 

Wear pad, <1 month 1.3 

Wear pad, <1 week 0.8 

Damon, 2006349

N = 706 

Wear pad, <1 week 0.2 

Frequent stools after meal >18 years 20.1 

Frequent stools due to stress >18 years 44.8 

Giebel, 1998273

N = 500 

Frequent flatus during micturition >18 years 56.5 
F256 

Table F10. Prevalence of FI in community dwelling adults by race 

Author 

Sample Race Definition Prevalence 

(%) 

Men and women

Nelson, 1995272

N = 6,959 

White Anal incontinence 2.1 

Men

Goode, 2005 African-American Fecal incontinence 13.5 248

N = 1,000 White Fecal incontinence 11.2 

Women

Goode, 2005 African-American Fecal incontinence 9.2 248

N = 1,000 White Fecal incontinence 14 

Asians Anal incontinence 21.2 

Asians Combined urinary and anal incontinence 10.7 

Asians Fecal incontinence 4.1 

Huang, 200670

N = 345 

Asians Flatus 19.4 

White Anal incontinence 28.6 

White Combined urinary and anal incontinence 19.9 

White Fecal incontinence 6.8 

Huang, 200670

N = 1,003 

White Flatus 25.5 

Jackson, 1997303

N = 16 

African-American Fecal incontinence 18.8 

Jackson, 1997303

N = 184 

White Fecal incontinence 21.2 

Melville, 2005338

N = 3,444 

Non-white race Fecal incontinence 0.8 
F257 

Table F11. Association between age and UI in women 

Author, Sample Age Definition of Severity Age 

Incident UI , TotalJackson, 200422

N = 1,584 

70-79 At least weekly 75-79 vs. 70-74 

Ostbye, 2004 In the last 12 months 75-84 vs. <75 

28

N = 5,322 

>65 

In the last 12 months 85+ vs. <75 

Prevalent UIBrown, 1999353

N = 2,763 

Mean: 67 

(SD: 7) 

Within the past week Age (per 5 y) 

Prevalent UI, StressBrown, 1999353

N = 2,763 

Mean: 67 

(SD: 7) 

Within the past week Age (per 5 y) 

McGrother, 20066

N = 12,570 

>40 Monthly or more Age (10-year 

increase) 

45 vs. <45 50s. <45 55s. <45 

Moller, 2000, 354

N = 3,208 

40-60 Sometime or more often 

60s. <45 

Chen, 2003123

N = 1,247 

>20 Within the past 2 weeks > 65 vs. <65 

Rohr, 2005 Within the past month 60-80 vs. <60 

107

N = 5,795 

>45 

Within the past month >80 vs. <60 

Prevalent UI, Total

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Age (per year 

increase) 

Holtedahl, 1998 

355

N = 507 

50-74 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Age (per year 

increase) 

Mild-moderate incontinence - Incontinence on 15 or fewer days in the last month In the last 12 months, have you lost any amount of urine beyond your control 

Age(per year increase) 

Nygaard, 2003 

79

N = 5,701 

50-69 

Severe incontinence-incontinence on more than 15 days in the last month 

Age(per year increase) 

Frequency: at least monthly Age(per year 

increase) 

Waetjen, 2007 

49

N = 3,302 

42-52 

Frequency: >weekly/daily Age(per year 

increase) 

Hvidman, 2003356 20-59 Within the past seven days Age per year Brown, 200695

N = 7,949 

69-101 Daily UI Per 5 year 

Brown, 2006 >20 Weekly urinary incontinence Age (per 5 years)in 
Table F11. Association between age and UI in women (continued) 

F258 

Author, Sample Age Definition of Severity Age 

95

N = 1,461 

diabetics 

Melville, 2005 Age, per decade 

112

N = 3,596 

30-90 Frequency: at least monthly. Severe: Sandvik severity index score of 

6-8 Age, per decade 

Van Oyen, 2002 25-34 vs. 15-24 

157

N = 3,804 

≥15 At least once a week, at least once a month, less than once a month 

35-44 vs. 15-24 

Occasional: 1-3 times a month. 40-44 vs. <40  Frequent: At least weekly. 40-44 vs. <40 

Danforth, 200668N = 83,355 

25-54 

Severe: Wet underwear. 40-44 vs. <40 

Maclennan, 200084

N = 3,010 

15-97 Within the past year 35-54 vs. 15-34 

Occasional: 1-3 times a month. 45-49 vs. <40  Frequent: At least weekly. 45-49 vs. <40 

Danforth, 200668N = 83,355 

25-54 

Severe: Wet underwear. 45-49 vs. <40 

Van Oyen, 2002157

N = 3,804 

≥15 At least once a week, at least once a month, less than once a month 45-54 vs. 15-24 

Fitzgerald, 200281

N = 265 

40 Leaked urine at least monthly >50 years 

Sampselle, 2002151N = 3,302 

42-52 Frequency and volume: 

frequency score is multiplied by volume score 

48-52 y vs. 42-47 y 

Occasional leaking - leaking one to three times per month 50-55 vs. < 50 

years 

Occasional leaking - leaking one to three times per month at least enough to wet underwear 

50-55 vs. < 50 years 

Grodstein, 2003129

N = 27,936 

≥20 years 

Frequent leaking is defined as at least once per week 50-55 vs. < 50 

years 

Occasional: 1-3 times a month. 50-54 vs. <40  Frequent: At least weekly. 50-54 vs. <40 

Danforth, 200668N = 83,355 

25-54 

Severe: Wet underwear. 50-54 vs. <40 

Grodstein, 2003129

N = 27,936 

≥20 years Frequent leaking - at least once per week at least enough to wet 

underwear 

50-55 vs. < 50 

Maclennan, 200084

N = 3,010 

15-97 Within the past year ≥ 55 vs. 15-34 

Muscatello, 2001160

N = 262 

>16 >1 symptom: nocturia, urgency, stress UI, urge UI 50-59 vs. 41-49 

years 

Occasional leaking -leaking one to three times per month 56-60 vs. < 50 Frequent leaking - at least once per week at least enough to wet underwear 

56-60 vs. < 50 

Occasional leaking - leaking one to three times per month at least enough to wet underwear 

56-60 vs. < 50 

Grodstein, 2003129

N = 27,936 

≥20 years 

Frequent leaking - at least once per week 56-60 vs. < 50 

Van Oyen, 2002157 ≥15 At least once a week, at least once a month, less than once a month 55-64 vs. 15-24 
Table F11. Association between age and UI in women (continued) 

F259 

Author, Sample Age Definition of Severity Age 

N = 3,804 Fornel, 2004208

N = 1,336 

40 yr and 

60 yr 

Leakage weekly or more often 60 cohort vs. 40 

cohort 

Jackson, 2006, 100

N = 1,017 

55-75 Severe: Sandvik score of 6-8 over the past year 60-64 vs. 55-59 

Occasional leaking - leaking one to three times per month 61-65 vs. <50 Occasional leaking - leaking one to three times per month at least enough to wet underwear 

61-65 vs. <50 years 

Frequent leaking - at least once per week 61-65 vs. <50 years 

Grodstein, 2003129

N = 27,936 

≥20 years 

Frequent leaking -at least once per week at least enough to wet underwear 

61-65 vs. <50 years 

Jackson, 2006100

N = 1,017 

55-75 Any leakage in the past year 60-64 vs. 55-59 

Muscatello, 2001160

N = 262 

>16 >1 symptom: nocturia, urgency, Stress UI, urge UI 60-69 vs. 41-49 

Frequent leaking is defined as at least once per week at least enough to wet underwear 

Grodstein, 2003 66-70 vs. <50 years 

129

N = 27,936 

≥20 years 

Frequent leaking is defined as at least once per week 66-70 vs. < 50 

years 

Jackson, 2006 Any leakage in the past year 65-69 vs.55-59 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year 65-69 vs. 55-59 

Occasional leaking is defined as leaking one to three times per month 66-70 vs. < 50 

years 

Grodstein, 2003 

129

N = 27,936 

≥20 years 

Occasional leaking is defined as leaking one to three times per month at least enough to wet underwear 

66-70 vs. < 0 years 

Van Oyen, 2002157

N = 3,804 

≥15 At least once a week, at least once a month, less than once a month 65-74 vs. 15-24 

Maggi, 2001158

N = 1,531 

>65 Rarely, 1 to 2 times per month, ≥1/week, or every day >70 years 

Muscatello, 2001160

N = 262 

>16 >1 symptom: nocturia, urgency, stress UI, urge UI >70 vs. 41-49 

years 

Occasional leaking is defined as leaking one to three times per month >70 vs. < 50 years Occasional leaking is defined as leaking one to three times per month at least enough to wet underwear 

>70 vs. < 50 years 

Frequent leaking is defined as at least once per week >70 vs. < 50 years 

Grodstein, 2003129

N = 27,936 

≥20 years 

Ft least once per week at least enough to wet underwear >70 vs. < 50 years 

Rohr, 2005107N = 5,795 

>45 Within the past month 60-80 vs. <60 

Jackson, 2006 Any leakage in the past year 70-76 vs. 55-59 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year 70-76 vs. 55-59 

Van Oyen, 2002157

N = 3,804 

≥15 At least once a week, at least once a month, less than once a month 75+ vs. 15-24 
Table F11. Association between age and UI in women (continued) 

F260 

Author, Sample Age Definition of Severity Age 

Ostbye, 200428

N = 5,322 

>65 In the last 12 months, have you lost any amount of urine beyond your 

control 

75-84 vs. <75 

Landi, 2003131

N = 3,194 

79.5+-9.5 0 (complete control)-4 (inadequate control with multiple daily episodes) 75-84 vs. 65-74 

Mild=0-6 days/month Have you ever lost urine when you were not able to get to the toilet on time?, have you ever lost urine when you are asleep?, have you ever lost urine when you laugh, cough or sneeze?, and if they stated they leaked urine at least monthly 

>80 years 

Moderate=7-20days/month Have you ever lost urine when you were not able to get to the toilet on time?, have you ever lost urine when you are asleep?, have you ever lost urine when you laugh, cough or sneeze?, and if they stated they leaked urine at least monthly 

>80 years 

Fultz, 1999357N = 3,991 

>70 

Severe ≥21 days/month Have you ever lost urine when you were not 

able to get to the toilet on time?, have you ever lost urine when you are asleep?, have you ever lost urine when you laugh, cough or sneeze?, and if they stated they leaked urine ≥1/month 

>80 years 

Rohr, 2005107N = 5,795 

>45 Within the past month >80 vs. <60 

Ostbye, 200428

N = 5,322 

>65 In the last 12 months, have you lost any amount of urine beyond your 

control 

85+ vs. <75 

Landi, 2003131

N = 3,194 

79.5+-9.5 0 (complete control)-4 (inadequate control with multiple daily episodes) >85 vs. 65-74 

Prevalent UI, Urge Brown, 1999353

N = 2,763 

Mean: 67 

(SD: 7) 

Within the past week Age (per 5 y) 

Huang, 200670

N = 345 Asian women 

40-69 At least weekly incontinence to recall the number of episodes in the 

past 7 days 

Age (per 10 y) 

Moller, 2000 Sometime or more often 45s. <45 

354

N = 3,208 

40-60 

Sometime or more often 50s. <45 

Ueda, 2000172

N = 968 

40-75 1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Very Often 50-59 vs. 40-49 

Moller, 2000 Sometime or more often 55s. <45 

354

N = 3,208 

40-60 

Sometime or more often 60s. <45 

Ueda, 2000 1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Very Often 60-69 vs. 40-49 

172

N = 968 

40-75 

1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Very Often 70+ vs. 40-49 

Rohr, 2005107N = 5,795 

>45 Within the past month 60-80 vs. <60 

Jackson, 200421

N = 1,584 

70-79 Within the past week 75-79 (y) vs. 70-74 

Rohr, 2005107N = 5,795 

>45 Within the past month >80 vs. <60 

Bold- significant results at 95%confidence level
F261 

Table F12 Association between race and prevalent UI in women 

Author, Sample Age Definition of UI Race vs. Caucasian Odds 

Mixed UI Brown, 1999353

N – 2,763 

Mean: 67 ±7 UI within the past week White vs. other 2.1

African American 0.3Chinese 0.Japanese 3.1

Waetjen, 200749

N = 3,302 

42-52 UI at least monthly 

Hispanic 0.1

African American 0.8Chinese 0Hispanic 0.6

Sampselle, 2002151

N = 3,302 

42-52 Frequency score is multiplied 

by volume score 

Japanese 1.1

Stress UIBrown, 1999353

N – 2,763 

Mean: 67 ±7 UI within the past week White vs. other 2.

Jackson, 200421

N = 1,584 

70-79 UI within the past week White vs. other 4.1

Hispanic 1.4African American 0.3

Thom, 200699

N = 2,109 

40-69 UI at least weekly 

Asian-American 0.5

African American 0.2Chinese 0.Japanese 0.7

Waetjen, 200749

N = 3,302 

42-52 UI at least monthly 

Hispanic 0.2

Urge UIBrown, 1999353

N – 2,763 

Mean: 67 (SD: 7) UI within the past week White vs. other 1.2

Jackson, 200421

N = 1,584 

70-79 UI within the past week White vs. other 3.0

Hispanic 1.3African American 1.1

Thom, 200699

N = 2,109 

40-69 UI at least weekly 

Asian-American 0.8

African American 0.9Chinese 0.4Japanese 0.3

Waetjen, 200749

N = 3,302 

42-52 UI at least monthly 

Hispanic 0.
F262 

Figure F1. Prevalent UI in Asian women compared to Caucasian women 

 Odds Ratio

 .5 1

 Study

 Odds Ratio

 (95% CI)

 Mild

 Grodstein (27936) 0.83 ( 0.65, 1.06)

 Danforth (83355) 0.80 ( 0.70, 0.90)

 Moderate

 Grodstein (27936) 0.79 ( 0.61, 1.02)

 Danforth (83355) 0.70 ( 0.60, 0.80)

 Severe

 Danforth (83355) 0.60 ( 0.50, 0.70)
F263 

Table F13. Association between body mass index and UI in females 

Author, Sample Age Definition of Severity Strata of Risk Factors with Cut Offs 

Incident UI Waetjen, 200749

N = 3,302 

42-52 UI at least monthly BMI per 1 unit increase 

Underweight vs. normal weight Overweight vs. normal weight 

UI at least several times a month 

Obese vs. normal weight 

UI at least monthly BMI per 1 unit increase 

Dallosso, 200314N = 6,424 

>40 

UI >weekly/daily BMI per 1 unit increase 

Prevalent Urge UIMommsen, 1994198

N = 2,589 

30-59 UI in the past year BMI per 1 unit increase 

Waetjen, 200749

N = 3,302 

42-52 UI at least monthly BMI per 1 unit increase 

Brown, 1999353

N = 2,763 

Mean: 67 (SD: 7) 

UI within the past week BMI per 5 unit increase 

Kuh, 1999Kuh, 1999179

N = 1,333 

48 UI at least two hourly during the 

day and at least twice a night 

BMI per 5 unit increase 

Huang, 200670

N = 345 

40-69 UI at least weekly BMI 25 kg/m2 in Asian women 

Rohr, 2005107

N = 5,795 

>45 UI in the past month BMI 25-30 vs. <25 

Huang, 200670

N = 345 Asian women 

40-69 UI at least weekly BMI >25 

Rohr, 2005 107N = 5,795 

>45 UI in the past month BMI>30 vs. <25 

Stress UI

Ever had incontinence surgery BMI <19.8  BMI <19.8  BMI 19.8-26  BMI 19.8-26  BMI >26 

Persson, 2000358

N = 1,492 

 BMI >26 

Chen, 2003123

N = 1,247 

>20 UI in the past week BMI ≥75th percentile with symptoms of 

uterovaginal prolapse vs. <75th percentile and no prolapse 

Total UIBrown, 200695

N = 1,461 

>20 UI at least weekly BMI (kg/m2)in diabetics 
Table F13. Association between body mass index and UI in females (continued) 

F264 

Author, Sample Age Definition of Severity Strata of Risk Factors with Cut Offs 

Moghaddas, 2005 Ever UI BMI <20 vs. 20-25;Women with depression 

359

N = 6,642 

50-64 

Ever UI BMI >25 vs. 20-25;Women with depression 

>1 symptom: nocturia, urgency, stress UI, urge UI 

BMI >30 vs. 25 

>1 symptom: nocturia, urgency, stress UI, urge UI 

BMI 25 vs. <19 

Muscatello, 2001160

N = 262 

>16 

>1 symptom: nocturia, urgency, stress UI, urge UI 

BMI> 29 vs. 25-29 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe 

Holtedahl, 1998 BMI per 1 unit increase 

355

N = 507 

50-74 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe 

BMI per 1 unit increase 

Van Oyen, 2002157

N = 3,804 

≥15 At least once a week, at least 

once a month, less than once a month 

BMI > 30 vs. 20-25 

Sampselle, 2002 BMI per 1 unit increase 

151

N = 3,302 

42-52 Frequency score is multiplied by 

volume score BMI per 1 unit increase 

Fultz, 1999357

N = 3,991 

>70 Moderate=7-20 days/month BMI >28.1 vs. <22.1 

Severe: Wet underwear. BMI < 22 vs. 22-24 Severe: Wet underwear. BMI ≥ 30 vs. 22-24 

Danforth, 200668N = 83,355 

25-54 

Severe: Wet underwear. BMI 25-29 vs. 22-24 

Severe: Sandvik score of 6-8 over the past year 

Jackson, 2006 BMI > 29 vs. <25 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year 

BMI 25-29 vs. <25 

Fultz, 1999357

N = 3,991 

>70 Severe ≥21 days/month BMI >28.1 vs. <22.1 

Fitzgerald, 200281

N = 265 

40 UI at least monthly BMI ≥ 25 vs. <25 

 Bold- significant results at 95%confidence level
F265 

Table14. Association between behavioral and environmental factors and UI in women 

Author, Sample Age Definition UI Risk Factors 

Incident UI, Physical activity, Total UIOstbye, 200428

N = 5,322 

>65 UI in the last 12 months Exercise 

Physical activity (MET-h/wk) 2 vs.1 quantile Physical activity (MET-h/wk) 3 vs.1 quantile Physical activity (MET-h/wk) 4 vs.1 quantile Physical activity (MET-h/wk) 5 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile 

Danforth, 200744N = 1,566 

54–79 UI in the last 12 months 

Walking (MET-h/wk) 2 vs.1 quantile 

Incident UI, Physical activity, Stress

Physical activity (MET-h/wk) 2 vs.1 quantile Physical activity (MET-h/wk) 3 vs.1 quantile Physical activity (MET-h/wk) 4 vs.1 quantile Physical activity (MET-h/wk) 5 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile 

Danforth, 200744N = 1,566 

54–79 UI in the last 12 months 

Walking (MET-h/wk) 2 vs.1 quantile 

Incident UI, Physical activity, Urge

Physical activity (MET-h/wk) 2 vs.1 quantile Physical activity (MET-h/wk) 3 vs.1 quantile Physical activity (MET-h/wk) 4 vs.1 quantile Physical activity (MET-h/wk) 5 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile 

Danforth, 200744N = 1,566 

54–79 UI in the last 12 months 

Walking (MET-h/wk) 2 vs.1 quantile 

Incident UI, Physical activity, Mixed

Physical activity (MET-h/wk) 2 vs.1 quantile Physical activity (MET-h/wk) 3 vs.1 quantile Physical activity (MET-h/wk) 4 vs.1 quantile Physical activity (MET-h/wk) 5 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile Walking (MET-h/wk) 2 vs.1 quantile 

Danforth, 200744N = 1,566 

54–79 UI in the last 12 months 

Walking (MET-h/wk) 2 vs.1 quantile 

Incident UI, Social supportWaetjen, 200749

N = 3,302 

42-52 UI at least monthly Social support <25th percentile vs. >25th 

percentile 
Table14. Association between behavioral and environmental factors and UI in women (continued) 

F266 

Author, Sample Age Definition UI Risk Factors 

Prevalent UI, Education

Mild=0-6 days/month Education (>12 years) Moderate=7-20days/month Education (>12 years) 

Fultz, 1999357

N = 3,991 

>70 

Severe ≥21 days/month Education (>12 years) 

Stress ≥2/hour during the day and ≥2/night Educational level (o-no education, 4- 

degree level) 

Kuh, 1999Kuh, 1999 

179

N = 1,333 

48 

≥2/hour during the day and ≥2/night Educational level (o-no education, 4- 

degree level) 

Bortolotti, 2000165

N = 2,767 

≥40 Within the past year Secondary/higher vs. none/primary 

Schmidbauer, 200162

N = 1,262 

≥20 Within the past 4 weeks Secondary/higher vs. primary 

Mild-moderate incontinence - ≤15 days/last 

month 

Nygaard, 2003 Education 

79

N = 5,701 

50-69 

Severe incontinence- >15 days in the last month 

Education 

Any leakage Education (university) Any leakage Education (university);Women with 

depression 

Moghaddas, 2005359

N = 6,642 

50-64 

Any leakage Education (university) 

Waetjen, 200749

N = 3,302 

42-52 Urge UI at least monthly High school or less vs. college or more 

Sampselle, 2002151

N = 3,302 

42-52 Frequency score is multiplied by volume 

score 

College and above vs. below college level 

Prevalent UI, Employment typeChen, 2003123

N = 1,247 

>20 Stress UI in the past 2 weeks Labor work vs. non-labor work 

Prevalent UI, Environmental barriersLandi, 2003Landi, 2003 #937} N = 3,194 

79.5+-

9.5 

0 (complete control)-4 (inadequate control with multiple daily episodes) 

Yes 

Prevalent UI, Marital status

>1 symptom: nocturia, urgency, stress UI, urge UI 

Widowed/divorce/separated vs. Married with partner 

>1 symptom: nocturia, urgency, stress UI, urge UI 

Never married vs. Married with partner 

Muscatello, 2001160

N = 262 

>16 

>1 symptom: nocturia, urgency, stress UI, urge UI 

No private health insurance vs. yes 

Prevalent UI, Physical activityBrown, 1996194

N = 7,949 

69-101 Daily Physical exercise (prior year) vs. no regular 

exercise 

Schmidbauer, 200162 ≥20 Within the past 4 weeks Physical activity1+ per week 
Table14. Association between behavioral and environmental factors and UI in women (continued) 

F267 

Author, Sample Age Definition UI Risk Factors 

N = 1,262 

Physical activity ,sport < 4 hrs/wk or light activities Physical activity Sedentary activities Physical activity sport <4 hrs/wk or light activities 

Van Oyen, 2002157

N = 3,804 

≥15 ≥1/week, ≥1/month, <1/month 

Physical activity Sedentary activities 

Ostbye, 200428

N = 5,322 

>65 In the last 12 months, have you lost any 

amount of urine beyond your control 

Exercise 

Prevalent UI, Social supportNuotio, 2003136N = 227 

>70 Stress UI, ever Low social activity ( < 3 events or visits vs. 

3+) 

Frequency: at least monthly Social support < 25th percentile vs. >25th 

percentile 

Frequency: >weekly/daily Social support < 25th percentile vs. >25th 

percentile 

Waetjen, 200749

N = 3,302 

42-52 

Mixed UI at least monthly Social support <25th percentile vs. >25th 

percentile 

Prevalent UI, Psychological StressSchmidbauer, 200162

N = 1.262 

≥20 Within the past 4 weeks Feeling stressed 

Muscatello, 2001160

N = 262 

>16 >1 symptom: nocturia, urgency, stress UI, 

urge UI 

High stress vs. low 

Prevalent UI, Body compositionWaetjen, 200749

N = 3,302 

42-52 Mixed UI, at least monthly Waist circumference, cm per cm increase 

Brown, 1999353

N = 2,763 

Mean: 67 

(SD: 7) 

Mixed UI in the past week Waist/hip ratio (per 0.1 unit) 

Waetjen, 200749

N = 3,302 

42-52 Stress UI at least monthly Waist circumference, cm per cm increase 

Brown, 1999353

N = 2,763 

Mean: 67 

(SD: 7) 

Stress UI in the past week Waist/hip ratio (per 0.1 unit) 

Waetjen, 2007 Frequency: at least monthly Waist circumference, cm per cm increase 

49

N = 3,302 

42-52 

Frequency: >weekly/daily Waist circumference, cm per cm increase 

Brown, 1999353

N = 2,763 

Mean: 67 

(SD: 7) 

Total UI within the past week Waist/hip ratio (per 0.1 unit) 

Bold- significant results at 95% confidence level
F268 

Table F15. Association between dietary intake and UI in women 

Author, Sample Age Definition of UI Risk Factors 

Incident UIOstbye, 200428

N = 8,949) 

>65 UI in the last 12 months Coffee drinker 

Bread daily vs. less than daily Carbonated drinks 1/week vs. < 1 Carbonated drinks 2-6/week vs. <1 

Dallosso, 200314N = 6424 

>40 Stress UI at least several times a month 

Carbonated drinks daily vs. < 1 

Prevalent UIBrown, 1996194

 N= 7949 

69-101 Daily UI Alcohol use (drinks/wk per SD) 

UI at least monthly; mild = 0-6 days/month UI at least monthly; moderate = 7-20days/month 

Fultz, 1999357

N = 3991 

>70 

UI at least monthly; severe ≥21 days/month 

Daily use of alcohol 

Schmidbauer, 2001 1-6 drinks per week vs. 0 

62

N = 1262 

≥20 Leakage within the past 4 weeks 

Daily alcohol vs. never 

Current occasional alcohol drinker vs. non drinker 

Muscatello, 2001 

160

N = 262 

>16 >1 symptom: nocturia, urgency, stress UI, 

urge UI 

Current regular drinker vs. non drinker 

Teleman, 2004 Low alcohol consumption 

360

N = 2682 

50-59 UI at least occasionally 

Moderate alcohol consumption 

Alcoholic drinks/week is 1-7 vs. 0 Alcoholic drinks/week is 8-14 vs. 0 Alcoholic drinks/week is 15-21 vs. 0 

Bortolotti, 2000165

N = 2767 

≥40 UI in the last 12 months 

Alcoholic drinks/week is ≥22 vs. 0 

Alcohol (# glasses per week) 1-7 Alcohol (# glasses per week) 8-14 Alcohol (# glasses per week) 15-21 

Van Oyen, 2002157

N = 3804 

≥15 UI at least once a wee 

Alcohol (# glasses per week) ≥22 

Brown, 1996194

N = 7949 

69-101 Daily UI Coffee drinker vs. non-coffee drinker 

Coffee cups/day 1 vs. 0 Coffee cups/day 2 vs. 0 

Bortolotti, 2000165

N = 2767 

≥40 UI in the last 12 months 

Coffee cups/day ≥3 vs. 0 

Ostbye, 2004165

N = 5322 

>65 UI in the last 12 months Coffee Drinker 

Bold –significant associations
F269 

Table F16. Association between smoking and UI in women 

Author, Sample Age Definition UI Smoking 

Mixed UI 

Cigarettes/day current, 1-19 vs. never Cigarettes/day current, 20+ vs. cigarettes/day never Cigarettes/day former, >20 vs. never Cigarettes/day Former, 1-19 vs. never Pack years current, .15+ vs. never Pack years current, <15 vs. never Pack years Former, <15 vs. never Pack years former, 15+ vs. never Smoking Current vs. never 

Hannestad, 2003361

N = 27,936 

≥20 Moderate UI daily leakage of drops 

Smoking Former vs. never 

Stress UI

Cigarettes/day current, 1-19 vs. never Cigarettes/day current, 20+ vs. never Cigarettes/day former, >20 vs. never Cigarettes/day Former, 1-19 vs. never Pack years current, .15+ vs. never Pack years current, <15 vs. never Pack years Former, <15 vs. never Pack years former, 15+ vs. never Smoking Current vs. never 

Hannestad, 2003361

N = 27,936 

≥20 Moderate UI daily leakage of drops 

Smoking Former vs. never 

Total UI

Occasional: 1-3 times a month. Current vs. never  Frequent: At least weekly. Current vs. never Severe: Wet underwear. Current vs. never Occasional: 1-3 times a month. Former vs. never  Frequent: At least weekly. Former vs. never 

Danforth, 200668N = 83,355 

25-54 

Severe: Wet underwear. Former vs. never 

Van Oyen, 2002 ≥1/week <20 cig/day vs. never 

157

N = 3,804 

≥15 

≥1/week ≥20 cig/day vs. never 

Schmidbauer, 200162

N = 1,262 

≥20 Within the past 4 weeks Cigarettes/day 1+ vs. 0 

Cigarettes/day >10-20 vs. 0 Cigarettes/day >20 vs. 0 

Bortolotti, 2000165

N = 2,767 

≥40 Within the past year 

Cigarettes/day >5-10 vs. 0 

Schmidbauer, 200162

N = 1,262 

≥20 Within the past 4 weeks Cigarettes/day 1-20 vs. 0 
Table F16. Association between smoking and UI in women (continued) 

F270 

Author, Sample Age Definition UI Smoking 

Bortolotti, 2000165

N = 2,767 

≥40 Within the past year Cigarettes/day1-5 vs. 0 

Cigarettes/day current, 1-19 vs. never Cigarettes/day current, 20+ vs. never 

Hannestad, 2003361

 N = 27,936 

≥20 Moderate = daily leakage of drops 

Cigarettes/day former, 1-19 vs. never 

>70 UI at least monthly Current smoker 

Moderate UI: 7-20days/month Current smoker 

Fultz, 1999357

N = 3,991 

Severe UI >21 days/month Current smoker 

Bortolotti, 2000165

N – 2,767 

≥ 40 UI within the past year Current smokers vs. never smokers 

Schmidbauer, 200162

N = 1,262 

≥20 UI within the past 4 weeks Current smokers vs. never smokers 

Swanson, 2005 UI within the past month Ever smoked cigarettes 

106

N = 606 

45-81 

 Ever smoked cigarettes 

Bortolotti, 2000165

N = 2,767 

≥ 40 Within the past year Ex smokers vs. never smokers 

Schmidbauer, 200162

N = 1,262 

≥20 Within the past 4 weeks Ex smokers vs. never smokers 

Cigarettes/day former, >20 vs. never Pack years current, .15+ vs. never Pack years current, <15 vs. never Pack years Former, <15 vs. never 

Hannestad, 2003361

 N = 27,936 

≥20 Moderate = daily leakage of drops 

Pack years former, 15+ vs. never 

Van Oyen, 2002157

N = 3,804 

≥15 UI at least once a week Past smoker vs. never 

Smoked < 1 pack/days Smoked < 1 pack/ days Smoked 1+ packs/ days 

Ostbye, 200428

N = 5,322 

>65 UI in the last 12 months 

Smoked 1+ packs/ days 

Nygaard, 2003 50-69 UI 15 or fewer days in the last month Smoking 

79

N = 5,701 50-69 UI> 15 days in the last month Smoking 

Smoking (yes) Smoking (yes) 

Moghaddas, 2005359N = 6,642 

50-64 any leakage 

Smoking (yes);Women with depression 

Smoking Current vs. never Smoking Former vs. never Cigarettes/day current, 1-19 vs. never Cigarettes/day current, 20+ vs. never Cigarettes/day Former, 1-19 vs. never 

Hannestad, 2003361

 N = 27,936 

≥20 All: (Slight = drops of urine a few times a 

month, Moderate = daily leakage of drops, Severe = larger amounts at least once a week). 

Former, >20 vs. never 
Table F16. Association between smoking and UI in women (continued) 

F271 

Author, Sample Age Definition UI Smoking 

Pack years current, .15+vs. never Pack years current, <15 vs. never Pack years Former, <15 vs. never Pack years former, 15+ vs. never Smoking Current vs. never Smoking Former vs. never Cigarettes/day current, 1-19 vs. never Cigarettes/day current, 20+ vs. never Cigarettes/day former, >20 vs. never Cigarettes/day Smoking Former, 1-19 vs. never Pack years current, <15 vs. never Pack years current, 15+ vs. never Pack years Former, <15 vs. never Pack years former, 15+ vs. never Smoking Current vs. never 

Hannestad, 2003361

 N = 27,936 

≥20 Mixed UI :larger amounts at least once a 

week, 56 g/24 hours 

Smoking Former vs. never Cigarettes/day current, 1-19 vs. never Cigarettes/day current, 20+ vs. never Cigarettes/day former, >20 vs. never Cigarettes/day Former, 1-19 vs. never Pack years current, <15 vs. never Pack years current, 15+ vs. never Pack years Former, <15 vs. never Pack years former, 15+ vs. never Smoking Current vs. never 

Stress UI: larger amounts at least once a week, 56 g/24 hours 

Smoking Former vs. never 

Cigarettes/day current, 20+ vs. never Cigarettes/day current, 1-19 vs. never Cigarettes/day former, >20 vs. never Cigarettes/day Former, 1-19 vs. never Pack years current, <15 vs. never Pack years current, 15+ vs. never Pack years Former, <15 vs. never Pack years former, 15+ vs. never Smoking Current vs. never 

Total UI: larger amounts at least once a week, 56 g/24 hours 

Smoking Former vs. never 

Cigarettes/day current, 1-19 vs. never Cigarettes/day current, 20+ vs. never Cigarettes/day former, >20 vs. never Cigarettes/day Former, 1-19 vs. never 

Hannestad, 2003361

 N = 27,936 

≥20 

Urge UI: larger amounts at least once a week, 56 g/24 hours 

Pack years current, 15+ vs. never 
Table F16. Association between smoking and UI in women (continued) 

F272 

Author, Sample Age Definition UI Smoking 

Pack years current, <15 vs. never Pack years Former, <15 vs. never Pack years former, 15+ vs. never Smoking Current vs. never Smoking Former vs. never 

Miller, 2003 Current smoker <20 per day vs. never 

134

N = 1,500 

21-79 Even a small amount of urine in the 

previous month Current smoker ≥20 per day vs. never 

Sampselle, 2002151

N = 3,302 

42-52 Frequency score is multiplied by volume 

score 

Current smoking vs. never 

Miller, 2003134N = 1,500 

21-79 Even a small amount of urine in the 

previous month 

Ex-smoker vs. never 
F273 

Table F17. Association between cognitive status, depression, dependency, and UI in women 

Author, Sample Age Definition of UI Risk Factors 

Incident UI, Cognitive statusOstbye, 2004 Cognitive status 50 3MS < 78 

28

N = 5,322 

>65 UI in the last 12 months 

Cognitive status 3MS < 50 

Decline in Mini-Mental State Examination (more than 1 SD decline) Decline in Trails B (more than 1 SD decline) Decline in Digit Symbol Substitution test (more than 1 SD decline) Decline in walking speed 

UI in the last 12 months 

Decline in chair stand speed Decline in Mini-Mental State Examination (more than 1 SD decline) Decline in Trails B (more than 1 SD decline) Decline in Digit Symbol Substitution test (more than 1 SD decline) Decline in walking speed 

Huang, 200746

N = 6,361 

>65 

Urine leakage occurring at least 1/week that interfered with activities 

Decline in chair stand speed 

Incident UI, DepressionJackson, 200422

N = 1,584 

70-79 UI at least weekly Depressive symptoms CES-D ≥ 16 

Waetjen, 200749

N = 3,302 

42-52 UI at least monthly Depressive symptoms 

Prevalent UI, CognitiveOstbye, 2004 Cognitive status 50 3MS < 78 

28

N = 5,322 

>65 UI in the last 12 months 

Cognitive status 3MS < 50 

Delirium CPS score24 vs. 0-1 

Landi, 2003Landi, 2003 #937} N = 3,194 

79.5+-9.5 0 (complete control)-4 (inadequate control 

with multiple daily episodes) 

CPS score>5 vs. 0-1 

Prevalent UI, Dependency McGrother, 20066

N = 12,570 

>40 Stress UI, monthly or more ADL 4 vs. 1 

Nuotio, 2003136N = 227 

>70 Stress UI, ever ADL disability (1+) 

McGrother, 2006 Stress UI, monthly or more ADL 2 vs. 1 

6

N = 12,570 

>40 

Stress UI, monthly or more ADL 3 vs. 1 

Van Oyen, 2002 Physical limitations moderate 

157

N = 3,804 

≥15 UI at least once a week 

Physical limitations severe 

Mild=0-6 days/month Difficulties with ADLs Moderate=7-20days/month Difficulties with ADLs 

Fultz, 1999357N = 3,991 

>70 

Severe ≥21 days/month Difficulties with ADLs 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F274 

Author, Sample Age Definition of UI Risk Factors 

Maggi, 2001 ADL disability 

158

N = 1,531 

>65 UI at least once per week 

Mobility disability 

ADL Functional status 

Nygaard, 200379

N = 5,701 

50-69 UI in the last 12 months 

Functional status 

Any leakage in the past year Physical functioning score 51-75 vs. 76-100 

Physical functioning score 0-50 vs. 76-100 Physical functioning score 51-75 vs. 76-100 

Jackson, 2006100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year Physical functioning score 0-50 vs. 76-100 

Landi, 2003Landi, 2003 24 vs. 0-1 #937} N = 3,194 

79.5±9.5 0 (complete control)-4 (inadequate control 

with multiple daily episodes) >5 vs. 0-1 

Van Oyen, 2002 Physical limitations Moderate vs. none 

157

N = 3,804 

≥15 UI at least once a week 

physical limitations Severe vs. none 

Prevalent UI, Depression Waetjen, 2007 49

N = 3,302 

42-52 Mixed UI, at least monthly Depressive symptoms 

Nuotio, 2003136N = 227 

>70 Stress UI, ever Depressed mood (2+ in GDS-5 vs. <2) 

Jackson, 200421

N = 1,584 

70-79 Stress UI, within the past week Depressive symptoms (CES-D >16) 

Mild-moderate incontinence - incontinence on 15 or fewer days in the last month 

Nygaard, 2003 Depression 

79

N = 5,701 

50-69 

Severe incontinence-incontinence on more than 15 days in the last month 

Depression 

Melville, 2005 UI at least monthly. Current major depression 

112

N = 3,596 

30-90 

UI at least monthly Current major depression 

Moghaddas, 2005359

N = 6,642 

50-64 Any leakage Self-reported depression (yes) 

Waetjen, 2007 UI at least monthly Depressive symptoms 

49

N = 3,302 

42-52 

UI >weekly/daily Depressive symptoms 

Buchsbaum, 2002144

N = 149 

39-91 "Current" UI depression 

Landi, 2003Landi, 2003 #937} N = 3,194 

79.5+-9.5 0 (complete control)-4 (inadequate control 

with multiple daily episodes) 

Yes 

Jackson, 200421

N = 1,584 

70-79 Urge UI, within the past week Depressive symptoms (CES-D >16) 
F275 

Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

Author, Sample Age Risk Factors Od

Burgio, 1996362 523 postpartum women 

14-42 years 

White women: previous UI included in model: Previous UI: Education: Nocturia: White women: previous incontinence not included in mode: Education: Number of births: Nocturia: Black women: previous incontinence not included in model: Attended class: 

BMI, smoking during pregnancy, number of pregnancies, coughing a lot, urinary frequency, family member has UI, income level were not associated with UI 

15.8 1.4 1.1 1.7 1.2 1.1 4.0 

Wilson, 1996363 1,505 women 3 months 

after delivery 

All women: 

Mode of delivery  Forceps  Cesarean section Parity 2 3 4 5+ BMI Pelvic floor muscle exercises during pregnancy  None  Few/month  Weekly  Few/week  Daily All women: All women with no previous UI: Mode of delivery  Forceps  Cesarean section Parity 2 3 4 5+ BMI Pelvic floor muscle exercises during pregnancy  None 

1.1 0.4 1.3 1.4 1.1 2.2 

1.07 

1 

0.8 0.8 0.9 0.6 

1.3 0.3 1.5 

1 1 

0.9 

1.02 

1 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F276 

Author, Sample Age Risk Factors Od

 Few/month  Weekly  Few/week  Daily All primiparae: Mode of delivery  Forceps  Cesarean section BMI Pelvic floor muscle exercises during pregnancy  None  Few/month  Weekly  Few/week  Daily Primiparae with no previous UI: Mode of delivery  Forceps  Cesarean section BMI Pelvic floor muscle exercises during pregnancy  None  Few/month  Weekly  Few/week  Daily 

0.8 0.9 

1 

0.9 

1.1 0.4 

1.07 

1 

0.7 0.8 0.8 0.6 

1 

0.2 

1.07 

1 

1.4 1.2 1.1 0.8 

Højberg, 199939 7,795 nulliparous and 

multiparous women 

UI at least once/week Age:  15-24 years: 1  25-29years: Reference  30-34 years:  > 35 years: Parity:  1; First delivery, C-section:  1; First delivery, vaginally:  2; Only C-sections: --  3+; Only vaginal deliveries:  3+; only C-section: --  3; Only vaginal deliveries: Pre-pregnancy BMI  < 20:  20-30: reference 

1.5 1.3 1.2 1.3 5.7 4.8 7.7 1 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F277 

Author, Sample Age Risk Factors Od

 30-35:  > 35: Smoker: Previous miscarriages before 12th week: 

Previous miscarriage after 12th week: 

Previous lower abdominal or urological surgery: Association with SUI or MUI at 16 weeks gestation: Length of second stage (min)  > 90: Episiotomy: Spontaneous perineal laceration > 3 cm: Vacuum extraction: Vaginal laceration:  Third degree anal tear: Infant weight (g) 

≥ 4000: 

Time since last delivery (years) 

≤ 1 year: 

Oxytocin stimulation: Pudental block: 

1.7 2.5 1.4 1.1 1.6 1.2 0.7 1.9 1.3 0.6 1.2 0.01 1.9 1.8 1 1.2 

Farrell, 2001364 595 primiparae with 

vaginal and cesarean deliveries 

UI at 6 months post-delivery: Duration of passive second stage of labor Duration of epidural Forceps delivery Relative risk: UI at 6 weeks: Spontaneous vaginal delivery vs. cesarean delivery: Forceps vs. spontaneous vaginal Forceps vs. cesarean: Labored cesarean vs. elective cesarean Cesarean in second stage vs. elective cesarean Cesarean in labor vs. spontaneous vaginal UI at 6 months: Spontaneous vaginal delivery vs. cesarean delivery: Forceps vs. spontaneous vaginal Forceps vs. cesarean: Labored cesarean vs. elective cesarean 

1.0 1.0 1.3 2.8 1.5 4.3 2.3 1.2 0.4 2.1 1.5 3.1 2.5 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F278 

Author, Sample Age Risk Factors Od

Cesarean in second stage vs. elective cesarean Cesarean in labor vs. spontaneous vaginal Vacuum extraction showed similar risk as forceps at 6 months postpartum 

0.6 0.6 

Pregazzi, 2002150 537 primiparae and 

multiparae women with vaginal deliveries 

Labor onset conditions (spontaneous or induced with intravaginal dinoprostone) Asymptomatic women Women with stress incontinence 

1.736 0.492 

Thompson, 2002154 1,295 primiparae and 

multiparae with vaginal and cesarean deliveries 

Urinary incontinence at 8 weeks unassisted vaginal deliveries, women with cesarean sections Urinary incontinence at 16 weeks unassisted vaginal deliveries, women with cesarean sections Urinary incontinence at 24 weeks unassisted vaginal deliveries, women with cesarean sections 

0.25 0.59 0.55 

Burgio, 2003122 523 aged 14-42 

primiparae and multiparae with vaginal and cesarean deliveries 

Time (month) Age (year) Race (black) Education( > college) Frequency of urination Smoking Type of delivery (vaginal) Body mass index Incontinent during pregnancy Length of breastfeeding Forceps 

1.02 

1.007 0.699 0.629 1.123 2.934 

2.36 

1.055 2.002 1.169 

1.87 

Hvidman, 2003130 376 20-59 years: 

primiparae and multiparae with vaginal and cesarean deliveries 

Predictors of postpartum UI after last delivery: UI before index pregnancy UI during index pregnancy Index delivery by cesarean section 

Years since last index delivery Postpartum UI ≥ 4 weeks: 

UI during index pregnancy Perineal suturing at index delivery Vacuum extraction or forceps delivery Years since index delivery Postpartum UI ≥ 12 weeks 

UI before index pregnancy 

4.7 7 0.2 0.8 11.1 2.4 0.2 0.7 4 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F279 

Author, Sample Age Risk Factors Od

Perineal suturing at index delivery Years since index delivery Depending on model: variables not associated were: age, childhood enuresis, BMI > 30, cystitis, abdominal and/or gynecologic surgery, number of deliveries (total and vaginal), information on index delivery (augmentation, mode of delivery, episiotomy, vacuum/forceps, bladder catheter, birth weigh, breast-feeding 

2.9 0.6 

Eliasson, 2005365 665 nulliparous women Inability to interrupt urine flow 

Perceived discomfort in lower abdomen Varicose veins/hemorrhoids Pre-pregnancy high impact activity Variables that were not associated were: pre-pregnancy leakage, partus normal, regular physical activity, chronic disease, age > 25 years, straining during micturition, and university studies 

2.1 3.6 1.5 1.4 

Glazener, 20065 3,405 nulliparous 

women with singleton births 

Primiparae who are first incontinent after their index delivery compared with continent primiparae Age of mother at index birth <25 25–29 30–34 >35 Delivery type SVD Forceps/breech Vacuum Caesarean section Gestational age (weeks) <37 >37 Birth weight (quartiles) (kg) <3 3.00–3.35 3.36–3.69 >3.70 Head circumference (quartiles) <35 335–344 

1 

1.52 1.46 2.21 

1 

1.12 1.14 0.29 

1 

0.85 

1 

1.26 1.42 1.33 

1 

0.93 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F280 

Author, Sample Age Risk Factors Od

345–354 >355 BMI before pregnancy (quartiles) <20.7 20.7–22.3 22.4–25 >25 primiparae who are first incontinent after their index delivery compared with continent primiparae Age of mother at index birth <25 25–29 30–34 >35 Delivery type SVD Forceps/breech Vacuum Caesarean section primiparae who are first incontinent during their index delivery compared with continent primiparae Age of mother at index birth <25 25–29 30–34 >35 Delivery type SVD Forceps/breech Vacuum Caesarean section Gestational age (weeks) <37 >37 Birth weight (quartiles) (kg) <3 3.00–3.35 3.36–3.69 

0.77 0.76 

1 

1.02 0.95 

1.3 

1 

1.46 1.43 2.02 

1 

1.18 1.16 0.28 

1 

0.9 0.9 

1.47 

1 

0.81 1.05 0.39 

1 

0.73 

1 

1.42 1.72 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F281 

Author, Sample Age Risk Factors Od

>3.70 Head circumference (quartiles) <335 335–344 345–354 >355 BMI before pregnancy (quartiles) <20.7 20.7–22.3 22.4–25 >25 Delivery type SVD Forceps/breech Vacuum Caesarean section Birth weight (quartiles) (kg) <3 3.00–3.35 3.36–3.69 >3.70 BMI before pregnancy (quartiles) <20.7 20.7–22.3 22.4–25 >25 

1.82 

1 

0.88 0.73 

0.8 

1 

1.49 1.35 

1.6 

1 

0.8 

1.06 0.39 

1 

1.33 1.45 1.56 

1 

1.48 1.38 1.68 1.39 

Burgio, 2007366 759; mean age of 28.1 

335 sphincter tear 319 vaginal delivery without tear 105 Cesarean delivery 

Antenatal UI No college education Higher pre delivery BMI Cesarean delivery 

3.5 

2 

1.2 0.5 

Casey, 2005367 3,387 nulliparous 

women with vaginal and Cesarean deliveries 

Oxytocin augmentation Epidural analgesia Second stage > 2 hours Episiotomy 3rd or 4th degree laceration 

Forceps delivery Cesarean delivery Birth weight > 4000 grams 

1.2 0.9 1.1 1.4 1.1 1.50.51.0 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F282 

Author, Sample Age Risk Factors Od

Schytt, 200430 2,390 primiparae and 

multiparae with vaginal and Cesarean deliveries 

Stress incontinence Primiparas Age (years) <25 25–35 >35 Education Elementary school High school College or university Civil status married/cohabitant single Native language Swedish Other than Swedish Multiparas Age (years) <25 25–35 >35 Education Elementary school High school College or university Civil status married/cohabitant single Native language Swedish Other than Swedish Stress incontinence Primiparas Pregravida BMI Underweight (<18.5) Normal (18.5–24.9) Overweight (25–29.9) Obesity (>30) Current pregnancy Constipation* Third trimester 4–8weeks postpartum 1 year after birth Urinary incontinence (overall) 

0.9 

1 

1.3 

1 

2.5 2.9 

1 

1.6 

1 1 

1.1 

1 

1.2 

1 

0.9 1.1 

1 1 1 

1.4 

0 1 

1.2 1.5 1.3 1.5 1.2 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F283 

Author, Sample Age Risk Factors Od

Third trimester 4–8weeks postpartum Mode of delivery Vaginal Vacuum extraction or forceps Elective cesarean section Emergency cesarean section Presentation (vaginal delivery) Vertex Occiput posterior Breech Other Infant birth weight (g) <2500 2500–3499 3500–4499 >4500 Infant head circumference (cm) <33 34 35 36 >37 Spontaneous perineal rupture No perineal rupture First- and second degree Third- and fourth degree Episiotomy* Smoking* Prior to pregnancy Early pregnancy 2months after birth 1 year after birth Multiparas Number of children 1 child 2 children 3–8 children 

2.1 3.2 

1 

1.1 

0 

0.6 

1 

1.6 

0 0 

0.9 

1 

1.1 

1 1 

1.2 1.2 1.5 1.1 

1 

1.3 

1.2 1.2 0.7 

1 1 

0.8 

1 

0.9 

1 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F284 

Author, Sample Age Risk Factors Od

Previous mode of delivery* Vaginal (at least once) Cesarean section (exclusive) Pregravida BMI Underweight (<18.5) Normal (18.5–24.9) Overweight (25–29.9) Obesity >30) Current pregnancy Constipation* Third trimester 4–8weeks postpartum 1 year after birth Urinary incontinence (overall) Third trimester 4–8weeks postpartum Mode of delivery Vaginal Vacuum extraction  or forceps Elective cesarean Section Emergency cesarean section Presentation (vaginal delivery) Vertex Occiput posterior Breech Other Infant birth weight (g) <2500 2500–3499 3500–4499 >4500 Infant head circumference (cm) <33 34 35 36 >37 Spontaneous perineal rupture No perineal rupture First- and second degree 

1 

0.9 

1.4 

1 

1.1 1.3 

1.3 1.3 1.1 2.9 3.1 

1 

1.5 

0.5 0.5 

1 

1.1 

0 0 

1.8 

1 

1.5 1.3 

1 1 

1.4 1.3 1.1 

1 

1.4 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F285 

Author, Sample Age Risk Factors Od

Third- and fourth degree Episiotomy* Smoking* Prior to pregnancy Early pregnancy 2months after birth 1 year after birth All women Age (years) >35 Parity: Multiparas Pregravida BMI: Obesity Constipation 4–8weeks after childbirth Urinary incontinence (overall leakage of urine) 4–8weeks After childbirth Mode of delivery Vaginal Vacuum extraction or forceps Cesarean section Spontaneous perineal rupture No perineal rupture First-and second degree Third-and fourth degree 

1.5 0.9 1.2 1.3 1.2 1.2 1.5 1.4 1.5 1.4 5.7 

1 

1.1 0.5 

1 

1.2 

1 

Chaliha, 1999326 549 primiparae with 

vaginal and cesarean deliveries 

Urge Augmentation Epidural Cesarean compared with spontaneous and instrumental vaginal deliveries Perineal trauma First stage Second stage (active) Second stage (passive) Fetal weight Fetal head circumference Stress Augmentation Epidural 

24.3 

0.1 0.5 0.5 

1 1 1 

11.3 

2 

0.9 0.5 
Table F18. Risk factors for urinary incontinence in child-bearing women (pregnancy, post-partum, and up to 1 year post-deliver

F286 

Author, Sample Age Risk Factors Od

Cesarean compared with spontaneous and instrumental vaginal deliveries Perineal trauma First stage Second stage (active) Second stage (passive) Fetal weight Fetal head circumference 

1 

1.1 

1 1 1 

2.5 0.8 
F287 

Table19. Association between hormonal status and prevalent UI in females 

Author, Sample Age Definition of UI Menstrual status Odds r

Kuh, 1999179

N = 1,333 

48 Stress UI ≥2/hour during the 

day and at ≥2/night 

Naturally postmenopausal (by 48 y) 0.54 (

Frequency score is multiplied by volume score 

Sampselle, 2002 Perimenopausal vs. premenopausal 1.27 (

151

N = 3,302 

42-52 

Frequency score is multiplied by volume score 

Perimenopausal status 1.35 

Chen, 2003123

N = 1,247 

>20 Stress UI within the past 2 

weeks 

Menopause vs. premenopausal 0 .81 

Premenopausal 1.44 (Premenopausal women with depression 1.47 

Moghaddas, 2005359N = 

6,642 

50-64 UI: any leakage 

Premenopausal 1.39 (

Bleeding 0.8 Bleeding use of sanitary towels vs. none 0.8 Bleeding, amount Weak vs. none 0.5 Bleeding, amount Medium vs. none 0.9 Bleeding, amount Heavy vs. none 1.1 Days before expected end of menstrual cycle-15 days 0.6 Days before expected end of menstrual cycle-6-10 days 1 (Days since day one in present menstrual cycle11-15 days 2.1 Days before expected end of menstrual cycle16-20 days 1.1 Days since day one in present menstrual cycle Days 15 0.8 Days since day one in present menstrual cycle Days 6-10 1 (Days since day one in present menstrual cycle Days 11-15 1.3 Days since day one in present menstrual cycle Days 16-20 1.2 Days since day one in present menstrual cycle Days 21-25 1.1 Days since day one in present menstrual cycle Days 26-30 0.5 Days since day one in present menstrual cycle Days 31-35 1.2 Days since day one in present menstrual cycle Unknown 1.2 Decreased duration of bleeding 2.2 Increased duration of bleeding 1.4 Increased menstrual flow 1.2 Recent change in menstrual cycle and bleeding 1.5 Usual duration of menstrual cycle <21 days vs. 21-31 days 1.2 Usual duration of menstrual cycle >32 days vs. 21-31 days 1.2 Usual duration of menstrual cycle >35 days vs. 21-31 days 1.1 Variation of menstrual cycle duration <5 days vs. 6-13 days 1.1 Variation of menstrual cycle duration ≥5 days vs. 6-13 days 1 Variation of menstrual cycle duration ≥14 days vs. 6-13 days 0.8 

Hvidman, 2003356

N = 3,900 

20-59 UI in the past week 

Variation of menstrual cycle duration ≥30 days vs. 6-13 days 1.3 (
Table19. Association between hormonal status and prevalent UI in females (continued) 

F288 

Author, Sample Age Definition of UI Menstrual status Odds r

Menstrual cycle and/or bleeding more irregular 1.2 Menstrual cycle duration 21-32 days and variation range <5 days 

1.4 

Menstrual cycle duration 21-32 days and variation range <5 days, no hormone use 

1.3 

Menstrual cycle regularity, Regular 1.2 Menstrual cycle regularity, Irregular 0.9 

Bold - significant association at 95% level
F289 

Table F20. Association between prevalent UI and hysterectomy 

Author, Sample Age Definition of UI Odd

Stress 

Chiarelli, 1999 45-50 UI in the past year 0

173

N = 41,724 70-75 UI in the past year 1

Van der Vaart, 2002 35-70 Not bothersome UI 1

155

N = 1,626 35-70 Bothersome UI 1

Parazzini, 2003138

N = 2,205 

>40 UI in the past month 

Jackson. 200421

N = 1,584 

70-79 UI in the past week 1

Fritel, 2005110

N = 2,625 

49-61 Daily 

Total UI Parazzini, 2003138

N = 2,205 

>40 UI in the past month 

Brown, 1996194

N = 7,949 

69-101 Daily 

Holtedahl, 1998 1-2 = Slight, 3-4 = Moderate, 6-8 = Severe 

355

N = 507 

50-74 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe 

Bortolotti, 2000165

N = 2,767 

≥40 UI in the past year 

Schmidbauer, 200162

N = 1,262 

≥20 UI in the past month 1

Melville, 2005 UI at least monthly 

112

N = 3,596 

30-90 

UI at least monthly. Severe: Sandvik severity index score of 6-8 

Moghaddas, 2005 Any leakage 

359

N = 6,642 

50-64 

Any leakage 1

Occasional UI: 1-3 times a month. Frequent UI: At least weekly. 

Danforth, 200668

N = 83,355 

25-54 

Severe: Wet underwear. 

Jackson, 2006 Any leakage in the past year 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year 

Urge UI Kuh, 1999179

N = 1,333 

48 At least two hourly during the day and at least twice a night 

Ueda, 2000172

N = 968 

40-75 1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Very Often 1.6

Van der Vaart, 2002 Not bothersome 1

155

N = 1,626 

35-70 

Bothersome 2

Parazzini, 2003138

N = 2,205 

>40 UI in the past month 

Bold- significant association at 95% confidence level 
F290 

Table F21. Association between prevalent UI and gynecological factors 

Author, Sample Age Definition of UI Strata of Risk Factors Od

Mixed UI Waetjen, 200749

N = 3,302 

42-52 UI at least monthly Fibroids 1

Parazzini, 2003138

N = 2,205 

>40 UI in the past month Hysterectomy 

Stress UIChen, 2003123

N = 1,247 

>20 UI in the past 2 weeks Previous gynecological surgery vs. 

none 

Huang, 200670

N = 345 Asian women 

40-69 UI at least weekly in the pas 7 days Hysterectomy in Asian women 2

Van der Vaart, 2002 UI not bothersome Hysterectomy 1

155

N = 1,626 

35-70 

UI bothersome Hysterectomy 1

Parazzini, 2003138

N = 2,205 

>40 UI in the past month Hysterectomy 

Jackson, 200421

N = 1,584 

70-79 UI in the past week Hysterectomy 1

Fritel, 2005110

N = 2,625 

49-61 Often or all of the time Hysterectomy 

Total Brown, 1996 Grip strength (kg per SD) 

194

N = 7,949 

69-101 Daily 

Quadriceps strength (kg per SD) 

Thom, 1997 Within the past year Hysterectomy <45 y vs. >45 1

193

N = 933 

≥60 

Within the past year Hysterectomy <45 y vs. >45 1

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Result of gynecological examination 

(abnormal vs. normal) 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Result of gynecological examination 

(abnormal vs. normal) 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Pelvic muscle contraction (poor vs. 

good) 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Pelvic muscle contraction (poor vs. 

good) 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Previous operation for uterovaginal 

prolapse (yes vs. no) 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Other previous operation on uterus 

(excluding hysterectomies) /adnexae/ovaries (yes vs. no) 

Holtedahl, 1998355

N = 507 

50-74 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Previous operation for uterovaginal 

prolapse (yes vs. no) 
Table F21. Association between prevalent UI and gynecological factors (continued) 

F291 

Author, Sample Age Definition of UI Strata of Risk Factors Od

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Other previous operation on uterus 

(excluding hysterectomies) /adnexae/ovaries (yes vs. no) 

Bortolotti, 2000165

N = 2,767 

≥40 Within the past year Perineal trauma 

Schmidbauer, 200162

N = 1,262 

≥20 Within the past 4 weeks Wertheim 1

Van Oyen, 2002157

N = 3,804 

≥15 At least once a week, at least once a month, 

less than once a month 

Uterine prolapse 4

Sampselle, 2002151

N = 3,302 

42-52 Frequency score is multiplied by volume score History of leiomyomata for all ethnic 

groups but black 

1

Hvidman, 2003356

N = 3,900 

20-59 Within the past seven days Ever gynecologic operation 

Uustal-Fornel, 2004208

N = 1,336 

40 yr and 60 

yr 

Leakage weekly or more often Feeling of pelvic heaviness vs. none 

Moghaddas, 2005359

N = 6,642 

50-64 Any leakage Hysterectomy (yes)Women with 

depression 

Brown, 200695

N = 1,461 

>20 Weekly urinary incontinence Hysterectomy (yes/no)in diabetics 

Atrophic vaginitis Any vaginal symptom (dryness, discharge, itching, dyspareunia) 1.6Vaginal colonization w/E coli 1-3 growth 

Any leakage in the past year 

Vaginal colonization w/E coli 4+ growth 

Atrophic vaginitis Any vaginal symptom (dryness, discharge, itching, dyspareunia) 1.6Vaginal colonization w/E coli 1-3 growth 

Jackson, 2006100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year

Vaginal colonization w/E coli 4+ growth 

Waetjen, 200749

N = 3,302 

42-52 frequency: at least monthly Fibroids 

Brown, 1996194

N = 7,949 

69-101 Daily Hysterectomy vs. none 

Holtedahl, 1998 1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Hysterectomy (yes vs. no) 

355

N = 507 

50-74 

1-2 = Slight, 3-4 = Moderate, 6-8 = Severe Hysterectomy (yes vs. no) 

Bortolotti, 2000165

N = 2,767 

≥40 Within the past year Hysterectomy 
Table F21. Association between prevalent UI and gynecological factors (continued) 

F292 

Author, Sample Age Definition of UI Strata of Risk Factors Od

Schmidbauer, 200162

N = 1,262 

≥20 Within the past 4 weeks hysterectomy 

Frequency: at least monthly. Severe: Sandvik severity index score of 6-8 

Melville, 2005 Hysterectomy 

112

N = 3,596 

30-90 

Frequency: at least monthly. Severe: Sandvik severity index score of 6-8 

Hysterectomy 

Moghaddas, 2005 Any leakage Hysterectomy (yes) 

359

N = 6,642 

50-64 

Any leakage Hysterectomy (yes) 

Occasional: 1-3 times a month. Hysterectomy  Frequent: At least weekly. Hysterectomy 

Danforth, 200668

N = 83,355 

25-54 

Severe: Wet underwear. Hysterectomy 

Jackson, 2006 Any leakage in the past year Hysterectomy 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year Hysterectomy 

Hysterectomy+prolapse vs. none or unknown 

1

Hysterectomy+oophorectomy vs. none or unknown 

1

Hysterectomy+prolapse+oophorectomy vs. none or unknown 

1

Prolapse vs. none or unknown 2Oophorectomy+prolapse vs. none or unknown 

0

45-50 Rarely, sometimes, often experience leaking 

urine in the last year 

Oophorectomy 0

Hysterectomy and oophorectomy vs. none or unknown 

1

Hysterectomy+prolapse repair vs. none or unknown 

2

Hysterectomy+prolapse repair+oophorectomy vs. none or unknown 

1

Prolapse repair vs. none or unknown 1Oophorectomy+prolapse repair vs. none or unknown 

1

Chiarelli, 1999173

N = 41,724 

70-75 Rarely, sometimes, often experience leaking 

urine in the last year 

Oophorectomy vs. none or unknown 1

Miller, 2003134

N = 1,500 

21-79 Even a small amount of urine in the previous 

month 

No Hysterectomy vs. yes 0

Chiarelli, 1999 Hysterectomy vs. none or unknown 0

173

N = 41,724 

45-50 Rarely, sometimes, often experience leaking 

urine in the last year Hysterectomy vs. none or unknown 1

Urge Waetjen, 200749 42-52 Frequency: at least monthly Fibroids 1
Table F21. Association between prevalent UI and gynecological factors (continued) 

F293 

Author, Sample Age Definition of UI Strata of Risk Factors Od

N = 3,302 Kuh, 1999179

N = 1,333 

48 At least two hourly during the day and at least 

twice a night 

Hysterectomy 

Ueda, 2000172

N = 968 

40-75 1 = Never, 2 = Seldom, 3 = Sometimes, 4 = 

Very Often 

Hysterectomy 1.6

Van der Vaart, 2002 Not bothersome Hysterectomy 

155

N = 1,626 

35-70 

Bothersome Hysterectomy 2

Parazzini, 2003138

N = 2,205 

>40 Within the past month Hysterectomy 
F294 

Table F22. Association between urinary symptoms and prevalent UI in women 

Author, Year, Sample Age Definition UI Urinary symptoms 

Urine that burns and stings: Rarely vs. never Urine that burns and stings: Sometimes vs. never 

18-23 UI in the last year 

Urine that burns and stings: Often vs. never Urine that burns and stings: Rarely vs. never Urine that burns and stings: Sometimes vs. never 

45-50 UI in the last year 

Urine that burns and stings: Often vs. never Urine that burns and stings: Rarely vs. never Urine that burns and stings: Sometimes vs. never 

Chiarelli, 1999173

N = 41,724 

70-75 UI in the last year 

Urine that burns and stings: Often vs. never 

Kuh, 1999179

N = 1,333 

48 UI ≥2/hour during the day and ≥2/night Enuresis 

Urine that burns and stings: Rarely vs. never Urine that burns and stings: Sometimes vs. never Urine that burns and stings: Often vs. never Urine that burns and stings: Rarely vs. never Urine that burns and stings: Sometimes vs. never Urine that burns and stings: Often vs. never 

Miller, 2003134N = 1,500 

21-79 UI even a small amount in previous month 

Urine that burns and stings: Unit increase in responscategory 

Van Oyen, 2002 Urinary tract infections 

157

N = 3,804 

≥15 UI at least once a week 

Urinary tract infections 

Kok, 1992 Frequency 

202

N = 719 

≥60 UI at least twice a week 

Nocturia 

Bortolotti, 2000165N = 

2,767 

≥40 UI in the past year Enuresis 

Schmidbauer, 200162

N = 1,262 

≥20 UI in the past 4 weeks Lower urinary tract symptoms 

Hvidman, 2003356

N = 3,900 

20-59 UI in the past week Enuresis 

Kocak, 2005368

N = 1,012 

≥18 UI once a week or less- Nocturnal enuresis 

Kuh, 1999179

N = 1.333 

48 Urge UI: ≥2/hour during the day and 

≥2/night 

Enuresis 

Bold- significant association at 95% confidence level 
F295 

Table F23. Association between urinary tract infection and prevalent UI in women 

Author, Sample Age Definition of UI Urinary tract infection 

Mixed UI 

Brown, 1999 UTI in past year: 1 vs. 0 

353

N = 2,763 

Mean: 67 (SD: 

7) 

UI in the past week 

UTI in past year: 2+ vs. 0 

Parazzini, 2003138

N = 2,205 

>40 UI in the past month Recurrent UTIs 

Kuh, 1999179

N = 1,333 

48 ≥2/hourl during the day and ≥2/night Urinary or kidney infections (15-43 yr) 

Stress UI

Brown, 1999 UTI in past year: 1 vs. 0 

353

N = 2,763 

Mean: 67 (SD: 

7) 

UI in the past week 

UTI in past year: 2+ vs. 0 

Kuh, 1999Kuh, 1999179

N = 1,333 

48 UI at least two hourly during the day and at least 

twice a night 

urinary or kidney infections (15-43 yr) 

Nuotio, 2003136

N = 227 

>70 Ever UI UTI (1+/year vs. <1/year) 

Parazzini, 2003138

N = 2,205 

>40 UI in the past month Recurrent UTIs 

Huang, 200670

N = 345 Asian women 

40-69 UI at least weekly Frequent UTIs in White women 

Total UIBortolotti, 2000165

N = 2,767 

≥40 UI in the past year Recurrent UTI 

Buchsbaum, 2002144

N = 149 

39-91 "Current" UI UTI 

Van Oyen, 2002157

N = 3,804 

≥15 UI at least once a week UTIs 

Hvidman, 2003356

N = 3,900 

20-59 UI in the past week Cystitis 1997 

Landi, 2003131N = 3,194 

79.5+-9.5 0 (complete control)-4 (inadequate control with 

multiple daily episodes) 

UTI 

Ozerdogan, 200429

N = 625 

>20 Ever UI Recurrent UTIs 

Oskay, 2005111

N = 500 

>50 <1/month (rare) - >1/day (serious). Severity: 

drops lost, underwear wet, dresses wet, leaks through legs 

UTI after menopause 

Kocak, 2005368

N = 1,012 

≥18 Frequency: ≤1/week - always. Severity: small, 

moderate, large 

Recurrent UTI 

Any leakage in the past year Asymptomatic bacteriuria Severe: Sandvik score of 6-8 over the past year Asymptomatic bacteriuria 

Lifetime UTI's 1-5 

Jackson, 2006100

N = 1,017 

55-75 

Any leakage in the past year 

Lifetime UTI's 6+ 
Table F23. Association between urinary tract infection and prevalent UI in women (continued) 

F296 

Author, Sample Age Definition of UI Urinary tract infection 

UTI in past year Lifetime UTI's 1-5 Lifetime UTI's 6+ 

Severe: Sandvik score of 6-8 over the past year 

UTI in past year 

Brown, 1999 UTI in past year: 1 vs. 0 

353

N = 2,763 

Mean: 67 (SD: 

7) 

UI in the past week 

UTI in past year: 2+ vs. 0 

Kuh, 1999179

N = 1,333 

48 UI at least 2/x hour during the day and ≥2/night Urinary or kidney infections (15-43 yr) 

Ueda, 2000172

N = 968 

40-75 1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Very 

Often 

Cystitis 

Parazzini, 2003138

N = 2,205 

>40 UI in the past month Recurrent UTIs 

Van Oyen, 2002 UI at least once a week UTI 

157

N = 3,804 

≥15 

UI at least once a month UTI 

Bold- significant association at 95% confidence level
F297 

Table F24. Association between glucose metabolism and UI

Author, Sample Age Definition Risk Factor 

Incidence Ostbye, 200428

N = 5,322 

>65 In the last 12 months, have you lost any amount of urine 

beyond your control 

Diabetes 

Frequency: weekly amount: severe - wet underwear. Very severe - wet out clothing/floor 

Diabetes >10 years (Any UI) 

Frequency: weekly amount: severe - wet underwear. Very severe - wet out clothing/floor 

Diabetes >10 years (Severe UI) 

Lifford, 2005109

N = 81,845 

50-75 

Frequency: weekly amount: severe - wet underwear. Very severe - wet out clothing/floor 

Diabetes >10 years (Very severe UI) 

Waetjen, 200749

N = 3,302 

42-52 Frequency: at least monthly Diabetes 

Prevalence Nuotio, 2003136N = 227 

>70 Stress UI, ever Fasting glucose serum level, mg/dl 

Fecal incontinence vs. continence 

Sampselle, 2002151N = 3,302 

42-52 Stress UI, Frequency score is multiplied by volume score Diabetes 

Fritel, 2005110

N = 2,625 

49-61 Stress UI, often or all of the time Diabetes 

Waetjen, 200749

N = 3,302 

42-52 Frequency: >weekly/daily Diabetes 

Severe - wet underwear. Very severe - wet out clothing/floor 

Lifford, 2005 Diabetes (Severe UI) 

109

N = 81,845 

50-75 

Very severe - wet out clothing/floor Diabetes (Very severe UI) 

Sandvik Index Diabetes duration < 10 years Sandvik Index Diabetes duration >10 years Sandvik Index , mild UI Diabetes treatment ,diet Sandvik Index Diabetes treatment ,insulin Sandvik Index Diabetes treatment ,med 

Jackson, 2005101

N = 1,017 

55-75 

Sandvik Index Diabetic peripheral neuropathy 

Any leakage in the past year Diabetic peripheral neuropathy 

treatment vs. no diabetes 

Jackson, 2006 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year Diabetic peripheral neuropathy 

treatment vs. no diabetes 

Jackson, 2005101

N = 1,017 

55-75 Sandvik Index Diabetic retinopathy 

Any leakage in the past year Diabetic retinopathy treatment vs. no 

diabetes 

Jackson, 2006 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year Diabetic retinopathy treatment vs. no 

diabetes 
Table F24. Association between glucose metabolism and UI (continued)

F298 

Author, Sample Age Definition Risk Factor 

Any leakage in the past year Diet-treated diabetes treatment vs. no 

diabetes 

Severe: Sandvik score of 6-8 over the past year Diet-treated diabetes treatment vs. no 

diabetes Fasting glucose serum level, mg/dl>123 vs. <110 

Schmidbauer, 200162

N = 1,262 

≥20 Within the past 4 weeks 

Fasting glucose serum level, mg/dl110-123 vs. <110 

Sandvik Index HbA1c<7.5% Sandvik Index HbA1c> 8.5% 

Jackson, 2005101

N = 1,017 

55-75 

Sandvik Index HbA1c7.68.5% 

Jackson, 2006 Any leakage in the past year Insulin treated diabetes vs. no diabetes 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year Insulin treated diabetes vs. no diabetes 

Microalbuminuria vs. no in diabetics Microalbuminuria vs. no in impaired glucose tolerance 

Brown, 200695

N = 1,461 

>20 Weekly urinary incontinence 

Neuropathic pain (yes/no)in diabetics 

Jackson, 2005 No Diabetic peripheral neuropathy 

101

N = 1,017 

55-75 Sandvik Index 

No Diabetic retinopathy 

Jackson, 2006 Any leakage in the past year Pill-treated diabetes vs. no diabetes 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year Pill-treated diabetes vs. no diabetes 

Danforth, 2006 Frequent: At least weekly. Type 2 Diabetes 

68

N = 83,355 

25-54 

Severe: Wet underwear. Type 2 Diabetes 

Bold- significant association at 95% confidence level 
F299 

Table F25. Association between neurological diseases and UI in women 

Author, Sample Age Definition of UI Risk Factors Odds Ratio (95% CI) 

Incident UI, Total UIOstbye, 200428

N = 5,322 

>65 UI in the last 12 months Stroke 1.58 (1.13; 2.22) 

Prevalent UI, Total UIParazzini, 2003138

N = 2,205 

>40 UI in the past month Neurological diseases 3.7 (1.8; 7.3) 

Brown, 1996 UI daily Gait speed (m/sec per SD) 0.8 (0.6; 1) 194

N = 7,949 

69-101 

UI daily Parkinson disease vs. none 0.3 (0.1; 1.6) 

UI at least monthly Poor sensory status 1.94 (1.6; 2.35) Moderate =7-20days/month Poor sensory status 1.22 (0.82; 1.82) 

Fultz, 1999357N = 3,991 

>70 

Severe ≥21 days/month Poor sensory status 1.53 (1.2; 1.94) 

Bortolotti, 2000165

N = 2,767 

≥40 UI in the last 12 months Neurological disease 1.8 (0.7; 4.3) 

Maclennan, 200084

N = 3,010 

15-97 UI in the last 12 months Osteoporosis 1.8 (1; 3.2) 

Maggi, 2001158

N =1,531 

>65 Rarely, 1 to 2 times per month, at 

least once per week, or every day 

Parkinsonism 2.27 (1.14; 4.54) 

Ozerdogan, 200429

N = 625 

>20 Ever Neurological disorders 3.8 (1.7; 8.6) 

Rohr, 2005 UI in the past month Paraplegia 1.56 (1.14; 2.64) 107N = 5,795 

>45 

UI in the past month Parkinson 1.46 (0.75; 2.86) 

Fultz, 1999357N = 3,991 

>70 Severe ≥21 days/month Stroke (ever) 1.85 (1.44; 2.37) 

Finkelstein, 2002145

N = 29,520 

≥30 As diagnosed by a health 

professional 

Back problems 1.76 (1.33; 2.32) 

0 (complete control)-4 (inadequate control with multiple daily episodes)

Landi, 2003 Hip Fracture 1.26 (0.99; 1.59) 131N = 3,194 

79.5±9.5 

0 (complete control)-4 (inadequate control with multiple daily episodes)

Parkinson’s disease 0.99 (0.68; 1.43) 

Van Oyen, 2002157

N = 3,804 

≥15 UI at least once a week, Sensorial limitation vs. no 1.9 (1.36; 2.65) 

Prevalent UI, Urge UIParazzini, 2003138

N = 2,205 

>40 UI in the past month Neurological diseases 2.1 (0.7; 5.9) 

UI in the past month Paraplegia 1.8 (1.27; 2.53) UI in the past month Parkinson 1.66 (0.81; 3.39) 

Rohr, 2005107N = 5,795 

>45 

UI in the past month Stroke 1.84 (1.2; 2.8) 
Table F25. Association between neurological diseases and UI in women( continued) 

F300 

Author, Sample Age Definition of UI Risk Factors Odds Ratio (95% CI) 

Prevalent UI, Stress UI Parazzini, 2003138

N = 2,205 

>40 UI in the past month Neurological diseases 0.3 (0.04; 2.3) 

UI in the past month Paraplegia 1.29 (0.93; 1.8) UI in the past month Parkinson 1.89 (0.97; 3.71) 

Rohr, 2005107N = 5,795 

>45 

UI in the past month Stroke 1.8 (1.19; 2.72) 

Bold- significant association at 95% confidence level 
F301 

Table F26. Association between health status, comorbidities, and UI in women 

Author, Sample Age Definition of UI Health Condition O

Comorbidity, Incident UI

Arthritis Kidney 

Ostbye, 200428

N = 5,322 

>65 UI In the last 12 months 

Foot and ankle trouble 

Comorbidity, Prevalent UIParazzini, 2003138

N = 2,205 

>40 UI in the past month Chronic obstructive pulmonary 

disease 

UI at least two hourly during the day and at least twice a night 

Kuh, 1999 GP consultations High vs. low 

179

N =1,333 

48 

Stress UI at least two hourly during the day and at least twice a night 

GP consultations High vs. low 

Nuotio, 2003136

N = 227 

>70 Stress UI, ever Comorbidity (3 diseases) vs. <3 

Parazzini, 2003138

N =2,205 

>40 Stress UI, within the past month Chronic obstructive pulmonary 

disease 

Jackson, 200421

N = 1,584 

70-79 Stress UI, within the past week Chronic obstructive pulmonary 

disease 

Rohr, 2005107N = 5,795 

>45 Stress UI, within the past month Chronic lung disease 

Van Oyen, 2002 1 disease 

157

N = 3,804 

≥15 UI at least once a month 

≥2 diseases 

Brown, 1996194

N = 7,949 

69-101 UI daily Chronic obstructive pulmonary 

disease vs. none 

Maclennan, 200084

N = 3,010 

15-97 UI within the past year Most/ every day vs. 

never/occasionally COPD Hip fracture 

Maggi, 2001158

N = 1,531 

>65 UI at least once per week 

Night awakening 

Finkelstein, 2002145

N = 29,520 

≥30 UI diagnosed by a health professional COPD 

Van Oyen, 2002 1 disease 

157

N = 3,804 

≥15 UI at least once a week 

≥2 diseases 

Nygaard, 2003 Mild-moderate: UI ≤15/days in the last month Comorbidity index 

79

N = 5,701 

50-69 

Severe: UI>15 days in the last month Comorbidity index 

Oskay, 2005111N = 500 >50 UI in the last month Chronic illness Melville, 2005 30-90 UI at least monthly Medical comorbidity score 

112

N = 3,596 30-90 Severity index score of 6-8 Upper half of RxRisk score 
Table F26. Association between health status, comorbidities, and UI in women (continued) 

F302 

Author, Sample Age Definition of UI Health Condition O

Arthritis Kidney 

Ostbye, 200428

N = 5,322 

>65 UI in the last 12 months 

Foot and ankle trouble 

Kocak, 2005368

N = 1,012 

≥18 UI once a week or less Other chronic diseases 

Rohr, 2005107N = 5,795 

>45 UI in the past month Chronic lung disease 

Cough Headaches Swollen ankles 

Swanson, 2005106

N = 606 

45-81 UI in the past month 

Usually have a cough 

Kuh, 1999179

N =1,333 

48 Urge UI, ≥2/hourl during the day and at ≥2/night GP consultations High vs. low 

Parazzini, 2003138

N = 2,205 

>40 Urge UI, within the past month Chronic obstructive pulmonary 

disease 

Rohr, 2005107N = 5,795 

>45 Urge UI, within the past month Chronic lung disease 

Health status, Incident UIJackson, 200421

N = 1,584 

70-79 At least weekly Health ABC Performance score 

UI: >weekly/daily Health status Fair to poor vs. good 

to excellent 

(Waetjen, 2007 

49

N = 3,302 

42-52 

Urge UI, frequency: at least monthly Health status Fair to poor vs. good 

to excellent 

Health status, Prevalent UIBrown, 1999 Mixed UI within the past week Poor health 

353

N = 2,763 

Mean: 

67 (SD: 

7) 

Stress UI, within the past week Poor health 

Jackson, 200421

N = 1,584 

70-79 Stress UI, within the past week Poor health 

Stress UI, monthly or more Health status Good vs. excellent Stress UI, monthly or more Health status fair vs. excellent Stress UI, monthly or more Health status poor vs. excellent 

McGrother, 20066

N = 12,570 

>40 

Stress UI, monthly or more Long-term illness 

Huang, 200670

N = 345 

40-69 Stress UI, at least weekly incontinence (recall # of 

episodes in past week) 

Poor/fair health in White women 

Brown, 1996194

N = 7,949 

69-101 Daily Poor overall health vs. good overall 

health 
Table F26. Association between health status, comorbidities, and UI in women (continued) 

F303 

Author, Sample Age Definition of UI Health Condition O

Muscatello, 2001 >1 symptom: nocturia, urgency, stress UI, urge UI Good health vs. excellent 

160

N = 262 

>16 

>1 symptom: nocturia, urgency, stress UI, urge UI Faire or poor health vs. excellent 

Brown, 1999353

N = 2,763 

Mean: 

67 (SD: 

7) 

Urge UI, within the past week Poor health 

Kok, 1992202

N = 719 

≥60 At least twice a week poor mobility 

Heart diseases, Prevalent UI

Brown, 1996194

N = 7,949 

69-101 Daily congestive heart failure vs. none 

Schmidbauer, 2001 ≥20 Within the past 4 weeks SBP, 146+ vs. <=145 

62

N = 1,262 ≥20 Within the past 4 weeks DBP, 91+ vs. <=90 

Finkelstein, 2002 ≥30 As diagnosed by a health professional Heart problems 

145

N = 29,520 ≥30 As diagnosed by a health professional Hypertension 

Chen, 2003123

N = 1,247 

>20 Stress UI, within the past 2 weeks Hypertension 

0 (complete control)-4 (inadequate control with multiple daily episodes) 

Landi, 2003 Atrial Fibrillation 

131

N = 3,194 

79.5+-

9.5 

0 (complete control)-4 (inadequate control with multiple 

daily episodes) 

Heart Failure 

Kocak, 2005368

N = 1,012 

≥18 UI once a week or less Hypertension 

UI in the past month Myocardial infarction Stress UI, within the past month Myocardial infarction 

Rohr, 2005107N = 5,795 

>45 

Urge UI, within the past month Myocardial infarction 

Bold- significant association at 95% confidence level 
F304 

Table F27. Association between gastrointestinal symptoms, surgery, and UI in females 

Author, Sample Age Definition of UI Risk Factors 

Prevalent UI, Constipation

Constipation, Rarely vs. never Constipation, Sometimes vs. never Constipation, Often vs. never Constipation, Rarely vs. never Constipation, Sometimes vs. never Constipation, Often vs. never Constipation, Rarely vs. never Constipation, Sometimes vs. never 

Chiarelli, 1999173

N = 41,724 

18-23 UI in the last year 

Constipation, Often vs. never 

Ueda, 2000172

N = 968 

40-75 UI Sometimes Constipation, Yes vs. no 0

Landi, 2003131

N = 3,194 

79.5+-9.5 UI weekly Constipation, yes vs. no 

Oskay, 2005111

N = 500 

>50 UI weekly Constipation, yes vs. no 

Jackson, 2006 Any leakage in the past year Constipation, yes vs. no 

100

N = 1,017 

55-75 

Severe: Sandvik score of 6-8 over the past year 

Constipation, yes vs. no 

Prevalent UI, Gastrointestinal SymptomsUusta-Fornel, 2004208

N = 1,336 

40 yr and 

60 yr 

UI weekly or more often Digitation by defecation 

Bowel problems Rarely vs. never Bowel problems Sometimes vs. never Bowel problems Often vs. never Bowel problems, Rarely vs. never Bowel problems, Sometimes vs. never Bowel problems, Often vs. never Bowel problems, Rarely vs. never Bowel problems, Sometimes vs. never 

Chiarelli, 1999173

N = 41,724 

18-23 UI in the last year 

Bowel problems, Often vs. never 

Uusta-Fornel, 2004208

N = 1,336 

40 yr and 

60 yr 

Leakage weekly or more often Groin hernia vs. none 

Prevalent UI, Surgery Bortolotti, 2000165

N = 2,767 

≥40 UI in the past year Abdominal surgery 

Hvidman, 2003356

N = 3,900 

20-59 UI in the past seven days Ever abdominal or gynecologic 

operation 

Parazzini, 2003 UI in the past month Abdominal surgery 

138

N = 2,205 

>40 

Stress UI in the past month Abdominal surgery 
Table F27. Association between gastrointestinal symptoms, surgery, and UI in females (continued) 

F305 

Author, Sample Age Definition of UI Risk Factors 

Mixed UI in the past month Abdominal surgery 

Uustal Fornel, 2004208

N = 1,336 

40 yr and 

60 yr 

Leakage weekly or more often Varicose vein surgery vs. none 

Fritel, 2005110

N = 2,625 

49-61 Stress UI often or all of the time Pelvic organ prolapse surgery 

Jackson, 2006 Any leakage in the past year Bladder or urinary surgery 

100

N = 1,017 

55-75 

Severe UI: Sandvik score of 6-8 over the past year 

Bladder or urinary surgery 

Prevalent UI, UI surgerySchmidbauer, 200162

N = 1,262 

≥20 UI in the past 4 weeks UI surgery 

Stress UI often or all of the time UI surgery 

UI surgery 

Fritel, 2005110

N = 2,625 

49-61 

UI surgery 

Bortolotti, 2000165

N = 2,767 

≥40 UI in the past year Urological surgery 

Prevalent UI, UI during pregnancyFoldspang, 1999 UI during pregnancy: 

175

N = 4,710 

20-59 Stress UI in the past year 

UI following childbirth: 

 Bold- significant association at 95% confidence level 
F306 

Table F28 Association between pharmacological agents and UI in women 

Author, Sample Age Definition of UI Drug 

Incident UI

UI at least weekly Insulin UI at least weekly Oral medications for diabetes 

Jackson, 200422

N = 1,584 

70-79 

UI at least weekly Not on medication for diabetes 

Prevalent UI, Stress

Nuotio, 2003 UI ever Polypharmacy (>3 drugs vs. <3) 

136

N = 227 

>70 

UI ever Sleeping medication vs. none 

Rohr, 2005107N = 5,795 

>45 UI in the past month Diuretics 

Prevalent UI, TotalBrown, 1996194

N = 7,949 

69-101 UI daily Non-thiazide diuretics vs. none 

Pain medication Tranquilizers Antidepressants Hypnotics Narcotics Laxatives Asthma medication BP medication Heart medication Diuretics 

Finkelstein, 2002145

N = 29,520 

≥30 UI diagnosed by a health professional 

Antibiotics 

Van Oyen, 2002157

N = 3,804 

≥15 UI at least once a week Diuretics 

Moghaddas, 2005 UI, any leakage Antidepressants 

359

N = 6,642 

50-64 

UI, any leakage Antidepressants In women with 

depression 

Rohr, 2005107N = 5,795 

>45 UI in the past month Diuretics 

Nygaard, 2003 Mild-moderate incontinence - ≤15/days in the last month Psychiatric medication 

79

N = 5,701 

50-69 

Severe incontinence- >15 days in the last month Psychiatric medication 

Prevalent UI, Urge

Insulin Oral medication 

Jackson, 200421

N = 1,584 

70-79 UI in the past week 

Not on medication 

Rohr, 2005107N = 5,795 

>45 UI in the past month Diuretics 

Bold- significant association at 95% confidence level 
F307 

Table F29. Association between hormone use and UI in women

Author, Year, Sample Age Definition of UI Hormone Use 

Incident UI Brown, 1996194

N = 7,949 

69-101 UI daily Oral estrogen vs. none 

Dose of oral conjugated estrogen 0.3mg vs. none Dose of oral conjugated estrogen 0.625mg vs. none Dose of oral conjugated estrogen1.25mg vs. none Oral estrogen alone or with progestin<1 year vs. never Oral estrogen alone or with progestin11.9 years vs. never Oral estrogen alone or with progestin24.9 years vs. never Oral estrogen alone or with progestin59.9 years vs. never Oral estrogen alone or with progestin>10 years vs. never Transdermal estrogen alone or with progestin<1 year vs. never Transdermal estrogen alone or with progestin11.9 years vs. never Transdermal estrogen alone or with progestin24.9 years vs. never Transdermal estrogen alone or with progestin59.9 years vs. never Transdermal estrogen alone or with progestin>10 years vs. neveDuration of past use<2 years vs. never Duration of past use25 years vs. never Duration of past use69 years vs. never Duration of past use>10 years vs. never Time since last use<2 years vs. never Time since last use25 years vs. never Time since last use69 years vs. never Time since last use >10 years vs. never Oral estrogen alone vs. never Transdermal estrogen alone vs. never Oral estrogen and progestin vs. never Transdermal estrogen and progestin vs. never 

Grodstein, 200416N = 39,436 

50-75 Occasional: 1-3 times a 

month. 

Past hormone use vs. never 

Jackson, 200422

N = 1,584 

70-79 UI at least weekly Current estrogen use vs. none 

Miller, 2003134N = 1,500 

21-79 even a small amount of 

urine in the previous month 

Ever used HRT 

Jackson, 200421

N = 1,584 

70-79 Stress UI in the past week Current estrogen use 

Thom, 1997 ≥60 UI within the past year ever used estrogen replacement therapy vs. never 

193

N = 933 UI within the past year ever used estrogen replacement therapy vs. never 
Table F29. Association between hormone use and UI in women (continued) 

F308 

Author, Year, Sample Age Definition of UI Hormone Use 

Van Oyen, 2002157

N = 3,804 

≥15 UI at least once a week, at 

least once a month, less than once a month 

postmenopausal hormones 

Present hormone use vs. none Present hormone use indication, contraception vs. none Present hormone use indication, menstrual disorder vs. none Present hormone use indication, Menopause vs. none Present hormone use indication, Not specified vs. none Hormone use 1997 vs. none Hormone use 1997 indication, contraception vs. none Hormone use 1997 indication, menstrual disorder vs. none Hormone use 1997 indication, menopause vs. none Hormone use 1997 indication, not specified vs. none Hormone use ever vs. never Hormone use ever Indication, contraception vs. never Hormone use ever indication, menstrual disorder vs. never Hormone use ever indication, menopause vs. never Hormone use ever indication, urinary incontinence vs. never 

Hvidman, 2003356

N = 3,900 

20-59 UI within the past seven 

days 

Hormone use ever indication, not specified vs. never 

Teleman, 2004360

N = 2,682 

50-59 At least occasionally HRT use 

Oral contraceptives, ever Peri- or postmenopausal women with current systemic hormone therapy use in the hormonal status Oral contraceptives, ever; Women with depression Peri- or postmenopausal women with current Women with depression Systemic hormone therapy use in the hormonal status Oral contraceptives, ever 

Moghaddas, 2005359

N = 6,642 

50-64 Any leakage 

Peri- or postmenopausal women with current systemic hormone therapy use in the hormonal status 

Occasional: 1-3/month. Oral contraceptive use Former vs. never Occasional: 1-3/month. Oral contraceptive use Current vs. never  Frequent: At least weekly. Oral contraceptive use Former vs. never  Frequent: At least weekly. Oral contraceptive use Current vs. never Severe: Wet underwear. Oral contraceptive use Former vs. never 

Danforth, 200668N = 83,355 

25-54 

Severe: Wet underwear. Oral contraceptive use Current vs. never 

Any leakage in the past year Oral estrogen use in past month Any leakage in the past year Estrogen cream past month Severe: Sandvik score of 6-8 over the past year 

Oral estrogen use in past month 

Jackson, 2006100

N = 1,017 

55-75 

Severe: Sandvik score of 6- Estrogen cream past month 
Table F29. Association between hormone use and UI in women (continued) 

F309 

Author, Year, Sample Age Definition of UI Hormone Use 

8 over the past year 

Brown, 1996194

N = 7,949 

69-101 Daily Oral estrogen vs. none 

Jackson, 200421

N = 1,584 

70-79 Urge UI: within the past 

week 

Current estrogen use 

Huang, 200670

N = 345 Asian women 

40-69 Urge UI: at least weekly 

incontinence to recall the number of episodes in the past 7 days 

Oral estrogen use 
F310 

Table F30. Prevalence of UI among males with risk factors 

Author 

Sample Risk factor UI % 

UI 50.40 

Urge 43.20 

Arthritis 

Stress 45.50 

UI 6.90 

Urge 2.30 

Cardiovascular problems 

Stress 10.00 

UI 10.10 

Urge 7.70 

Stroke 

Stress 9.10 

UI 14.70 

Urge 11.30 

Mobility Problems 

Stress 0.00 

UI 38.60 

Urge 34.90 

Hearing and vision problems 

Stress 27.30 

UI 28.80 

Urge 15.60 

Any vision problems 

Stress 20.00 

UI 20.30 

Urge 20.00 

Diabetes 

Stress 36.40 

UI 15.70 

Urge 26.70 

Pulmonary problems 

Stress 9.10 

UI 11.20 

Urge 11.10 

Bowel problems 

Stress 9.10 

UI 44.00 

Urge 26.70 

Genital surgery 

Stress 45.50 

UI 13.40 

Urge 9.60 

Diokno, 1990314

N = 651 

UTI 

Stress 27.30 

Diuretics UI 35.60 

Antispasmodic agents UI 60.00 

Prostate active agents UI 38.10 

Bladder surgery UI 58.30 

Smoger, 2000169

N = 809 

Prostate surgery UI 46.60 

Van Kampen, 1997 Transurethral resection of prostate UI 19 369

N = 216 1 year after transurethral resection UI 1.50 

Transvesical prostatectomy for benign 

prostatic hyperplasia 

Van Kampen, 1997 UI 15.00 369

N = 298 

1 years after transvesical prostatectomy 

for benign prostatic hyperplasia 

UI 1.00 
F311 

Table F31. Prevalence and incidence of UI in males with prostate cancer 

Author 

Sample Patient Population UI N % 

Lee, 1996370 Prostate cancer with no history of prior 

transurethral resection of the prostate 

UI 626 0.20 

Talcott, 1998184 Localized prostate cancer UI 279 2.00 

Adolfsson, 1998 Prostate cancer UI 342 30.00 252

Men not reporting any treatment for 

prostate cancer 22 months after 

diagnosis 

UI 139 30.00 

Joly, 1998316 Localized prostate cancer UI 71 9.00 

Smoger, 2000169 Prostate cancer UI 809 43.50 

Augustin, 2002371 Prostate cancer UI 368 6 

Liu, 2005 Prostate cancer UI 1,192 2.9 372

Prostate cancer with prior transurethral 

resection of the prostate 

 1,192 7.8 

148 4.1 

29 0 

Prostate cancer pad weight gain > 8 

gm/24h ours 

28 7.4 

172 4 

Jacobsen 200747

Localized prostate cancer UI 

67 3.5 

non-Hispanic Whites with prostate 

cancer 

Occasional leakage 1,475 8.8 

non-Hispanic Whites with prostate 

cancer 

Frequent leakage 1,475 2.1 

African-American with prostate cancer Occasional leakage 321 9.5 

African-American with prostate cancer Frequent leakage 321 2 

Hispanic with prostate cancer Occasional leakage 279 11.2 

Johnson, 200423

Hispanic with prostate cancer Frequent leakage 279 6.5 

Lee, 1996370 Prostate cancer with history of prior 

transurethral resection of the prostate 

UI 132 2.00 

Sandhu, 2000373 Prostate cancer patients with a prior 

history of a transurethral resection of 

the prostate 

incident stress UI with 1 

pad daily or occasional 

leakage 

120 8.00 
F312 

Table F32. Prevalence or incidence of UI after treatments for prostate cancer 

Author Treatment UI N % 

Radical prostatectomy 

3 months after prostatectomy for 

localized prostate cancer 

Talcott, 1998 125 58.00 184

1 year after prostatectomy for localized 

prostate cancer 

Pad use 

125 35.00 

Adolfsson, 1998252 22 months after radical prostatectomy UI 22 65.00 

Radical prostatectomy for localized 

prostate cancer 

Van Kampen, 175 66.00 

1997369

1 year after radical prostatectomy for 

localized prostate cancer 

UI 

175 2.00 

3.3 years after radical retropubic 

prostatectomy 

Goluboff, 1998 480 8.2 313

6 months after radical retropubic 

prostatectomy 

regular use of pads 

480 8.00 

Wears >2 pads/day 23 22.00 

Must wear pads at all 

times 

23 26.00 

Leak with minimal effort 23 13.00 

2.7 years after Perineal radical 

prostatectomy 

Pads are completely 

soaked 

6 17.00 

Wears .2 pads/day 49 22.00 

Must wear pads at all 

times 

49 35.00 

Leak with minimal effort 49 18.00 

2.7 years after retropubic radical 

prostatectomy 

Pads are completely 

soaked 

24 17.00 

Gray, 1999374

2.7 years after radical prostatectomy UI 209 43.00 

Catalona, 1999375 18 months after retropubic 

prostatectomy 

UI 1,325 8.00 

protection against urinary 

incontinence 

368 27.2 

one pad per day 368 14.7 

two or more pads per day 368 12.5 

Augustin, 2002371 12 months after radical retropubic 

prostatectomy 

surgical treatment for 

incontinence 

368 1.4 

UI 674 56.3 

Several episodes per 

week 

674 10.8 

<1/day 674 19.4 

1/day 674 16.8 

>1/day 674 9.2 

Pad use 0–1/day 674 12.9 

Pad use 1–2/day 674 8.9 

Pad use 2–3/day 674 3.7 

Pad use 3–4/day 674 2.5 

Pad use >4/day 674 2.7 

Sudden urge/no time 674 17.4 

Physical exertion 674 50.8 

Urge incontinence only 

(no stress 

674 5.2 

While in bed/running to 

bathroom 

674 7.6 

Sebesta, 2002152 younger than 65 years of age 18 

months after radical prostatectomy 

Dry in AM/Leak only in PM 674 13.4 

Radical prostatectomy, 1991 12,079 20 

Radical prostatectomy, 1992 12,079 25 

Radical prostatectomy, 1993 12,079 19 

Hu, 200332

Radical prostatectomy, 1994 

UI 

12,079 11 
Table F32. Prevalence or incidence of UI after treatments for prostate cancer (continued) 

F313 

Author Treatment UI N % 

Radical prostatectomy, 1995 12,079 4 

Age 65–69,Radical prostatectomy, 1991 12,079 23 

Age 65–69,Radical prostatectomy, 1992 12,079 24 

Age 65–69,Radical prostatectomy, 1993 12,079 20 

Age 65–69,Radical prostatectomy, 1994 12,079 10 

Age 65–69,Radical prostatectomy, 1995 12,079 4 

Age 70–74,Radical prostatectomy, 1991 12,079 19 

Age 70–74,Radical prostatectomy, 1992 12,079 25 

Age 70–74,Radical prostatectomy, 1993 12,079 18 

Age 70–74,Radical prostatectomy, 1994 12,079 11 

Age 70–74,Radical prostatectomy, 1995 12,079 4 

Age >75,Radical prostatectomy, 1991 12,079 19 

Age >75,Radical prostatectomy, 1992 12,079 26 

Age >75,Radical prostatectomy, 1993 12,079 19 

Age >75,Radical prostatectomy, 1994 12,079 11 

Age >75,Radical prostatectomy, 1995 12,079 8 

29 months after radical retropubic 

prostatectomy for clinically intracapsular 

prostate cancer 

stress UI requiring 1-3 

pads/day 

Maffezzini, 2003 295 8.8 132

29 months after radical retropubic 

prostatectomy for clinically intracapsular 

prostate cancer 

UI, >4 pads/day 295 2.3 

Hisasue, 2004376 12 months after radical retropubic 

prostatectomy 

stress UI 300 4.3 

3 months after Radical prostatectomy pad weight gain of more 

than 8 gm during a 24-

hour period 

148 42 

12 months after Radical prostatectomy pad weight gain of more 

than 8 gm during a 24-

hour period 

148 12.8 

3 months after open retropubic 

prostatectomy 

UI 172 42 

Jacobsen 

12 months after open retropubic 

prostatectomy 

UI 172 12.8 

12 Months after radical prostatectomy 

for non-Hispanic whites with prostate 

cancer 

Occasional leakage 1,475 50.2 

12 Months after radical prostatectomy 

for non-Hispanic whites with prostate 

cancer 

Frequent leakage 1,475 15.6 

12 Months after radical prostatectomy 

for African-American with prostate 

cancer 

Occasional leakage 321 51.4 

12 Months after radical prostatectomy 

for African-American with prostate 

cancer 

Frequent leakage 321 9 

12 Months after radical prostatectomy 

for Hispanic with prostate cancer 

Occasional leakage 279 46.9 

12 Months after radical prostatectomy 

for Hispanic with prostate cancer 

Frequent leakage 279 14.9 

60 Months after radical prostatectomy 

for non-Hispanic whites with prostate 

cancer 

Occasional leakage 1,475 53.7 

60 Months after radical prostatectomy 

for non-Hispanic whites with prostate 

cancer 

Frequent leakage 1,475 14.3 

Johnson, 200423

60 Months after radical prostatectomy 

for African-American with prostate 

cancer 

Occasional leakage 321 39.7 
Table F32. Prevalence or incidence of UI after treatments for prostate cancer (continued) 

F314 

Author Treatment UI N % 

60 Months after radical prostatectomy 

for African-American with prostate 

cancer 

Frequent leakage 321 10.4 

60 Months after radical prostatectomy 

for Hispanic with prostate cancer 

Occasional leakage 279 47.4 

60 Months after radical prostatectomy 

for Hispanic with prostate cancer 

Frequent leakage 279 18.7 

Laparoscopic radical prostatectomy 

1 month after laparoscopic radical 

prostatectomy for clinically localized 

prostate cancer 

101 90.10 

3 months after laparoscopic radical 

prostatectomy for clinically localized 

prostate cancer 

77 71.40 

6 months after laparoscopic radical 

prostatectomy for clinically localized 

prostate cancer 

61 42.60 

12 months after laparoscopic radical 

prostatectomy for clinically localized 

prostate cancer 

Incident UI 

37 43.2 

1 months after laparoscopic radical 

prostatectomy for clinically localized 

prostate cancer 

78 22.8 

Olson, 2001377

3 months after laparoscopic radical 

prostatectomy for clinically localized 

prostate cancer 

Daily pad use, >1/day 

61 20.8 

3 months after Laparoscopic 

prostatectomy (first half procedures) 

29 70.4 

12 months after Laparoscopic 

prostatectomy (first half procedures) 

29 20.72 

3 months after Laparoscopic 

prostatectomy (last half procedures) 

28 60 

12 months after Laparoscopic 

prostatectomy (last half procedures) 

pad weight gain > 8 

gm/24-hour 

28 14.3 

3 months after laparoscopic 

prostatectomy (second half) 

67 60 

3 months after laparoscopic 

prostatectomy (first half) 

67 70.4 

12 months after laparoscopic 

prostatectomy (second half) 

67 19.2 

Jacobsen, 200747

12 months after laparoscopic 

prostatectomy (first half) 

UI 

67 16 

Radiation for prostate cancer 

More than 3 months after prostate 

cancer treated with definitive externalbeam radiation therapy 

Incident late grade 2 or 

higher urinary 

incontinence 

Lee, 1996 758 0.50 370

5 years after definitive external-beam 

radiation therapy for prostate cancer 

actuarial urinary 

incontinence rate 

758 1.30 

 3 months after radiotherapy for 

localized prostate cancer 

Talcott, 1998 135 5.00 184

1 year after radiotherapy for localized 

prostate cancer 

Pad use 

135 5.00 

Adolfsson, 1998252 22 months after External radiation UI 37 33.00 

4-8 years after external beam irradiation 

and brachytherapy 

UI 65 40.00 

4-8 years after external beam irradiation 

and brachytherapy 

invaliding UI 65 9.00 

Joly, 1998316

4-8 years after external beam irradiation 

and brachytherapy 

diagnosed UI (charts) 65 11.00 
Table F32. Prevalence or incidence of UI after treatments for prostate cancer (continued) 

F315 

Author Treatment UI N % 

5 years after radiation with acute >/= 

Grade 2 GU symptoms 

Sandhu, 2000 110 18.00 373

5 years after radiation with Grade 1 or 

no acute urinary symptoms 

incident stress 

incontinence requiring 1 

pad daily for protection or 

experienced occasional 

leakage 

110 7.00 

Incident Grade 1 

incontinence 

1,192 4.9 

Incident Grade 2 

incontinence 

1,192 0.6 

Liu, 2005372 54 months after external beam 

radiotherapy 

Incident Grade 3 

incontinence 

1,192 0.6 

Sandhu, 2000373 5 years after high-dose 3-dimensional 

conformal radiotherapy in patients with 

a prior history of a transurethral 

resection of the prostate 

incident stress 

incontinence requiring 1 

pad daily for protection or 

experienced occasional 

leakage 

110 9.00 

Adolfsson, 1998 22 months after endocrine treatment 109 24.00 252

22 months after endocrine treatment 

subsequent to external or radical 

prostatectomy 

UI 

35 20.00 

Fowler, 1996378 3-5 years after high energy external 

beam radiation therapy 

Dripping or leaking urine 621 29 
F316 

Table F33. Prevalence and severity of post-prostatectomy UI 

Author Country Method UI Definition Surgical Procedure(s) Response Rate Number Followup (Months) 

Ramon, 1993379

France Clinical evaluation Stress UI RRP 6 Months: 100% 

12 Months: 82% 

6 Months: 

484 

12 

Months: 

398 

6, 12 

Lowe, 1996380 USA Patient interviews 

and questionnaires 

Any loss of urinary control requiring protection 

RRP 91% 188 1, 3, 6, 12 

Weldon, 1997381 USA Prospective clinical evaluation Daily pad use RPP Not reported 220 18 Bishoff, 1998382 USA Mailed survey Any UI Pad use RRP and RPP 80% RRP 78% RPP 784 RRP 123 RPP ≥12 Goluboff, 1998313 USA Mailed survey Any UI Daily or pad 

use Continuous UI 

RRP 78.2% 480 Mean: 39 

Range: 1 - 8.8 years 

Catalona, 1999375 USA Self-reported questionnaire. Requiring protection to 

keep outer garments dry. 

RRP 70.9% 1,325 Minimum 

of 18 

Gray, 1999374 USA Mailed survey Pad use 

Incontinence more than once per week 

RRP 

RPP 

80% RRP: 96 

RPP: 71 

Median: 32 

Range: 4 - 

65 

Horie, 1999383 Japan Self reported at 

clinic visits 

Pad use RRP 97% 104 1, 3, 6, 12 

Benoit, 2000384 USA Review of Medicare 

records 

Daily urinary leakage and pad use 

RRP 100% 25,651 12 
Table F33. Prevalence and severity of post-prostatectomy UI (continued) 

F317 

Author Country Method UI Definition Surgical Procedure(s) Response Rate Number Followup (Months) 

Poon, 2000385 USA Self-reported 

telephone interviews 

Pad use RRP 85% 165 12 

Olsson, 2001377 France Self-reported questionnaires Pad use LRP 1 Month: 44.3% 3 Months: 33.8% 

6 Months: 26.8% 

12 Months: 16.2%

228 12 

Sebesta, 2002152

USA 

(multiple 

states) 

Mailed survey Urine leakage 

in past week 

RRP 78% 674 Within 18 

months of surgery 

Hu, 200332 USA Data was taken 

from random sample of standard Medicare files. 

Not reported. Taken from Medicare data, definition of incontinence was not listed. 

RRP Not reported 12,079 36 

Maffezini, 2003132 Italy Consecutive series. Data came from 

review of charts and records from patients. 

UI: Use of 4 or more pads/day SUI: Usually wore protection but less than 4 pads/day 

RRP 98.3% 300 29 

Moinzadeh386, 

2003 

USA Self-administered 

questionnaire and/or third party telephone interview 

Pad use RRP 100% 200 3, 6, 12, 15 

Salomon, 2003387

USA and 

France 

Self-administered questionnaire 

Pad use RRP 100% 146 12 

Talcott, 2003142 USA Self-administered 

questionnaire 

Frequency and magnitude of urine loss 

RRP 85.2% at 3 

month followup 

76.6% for 24 

months 

613 Baseline, 3 

months, 1 and 2 years 

Deliveliotis, 200415

Greece Self-administered 

questionnaire 

Daily urine leakage 

105 RRP 

98 TURP 

73.9% RRP 

64.9% TURP 

54.1% controls 

203 2 years 

T

Deliveoliotis, 2002388

Greece Self-administered 

questionnaire 

Pad use RRP 100% 149 3, 6, 9, 12 
Table F33. Prevalence and severity of post-prostatectomy UI (continued) 

F318 

Author Country Method UI Definition Surgical Procedure(s) Response Rate Number Followup (Months) 

Johnson, 200423

USA Self-administered 

questionnaire 

Self reported level of urinary control: total, occasional leakage, frequent leakage or no control, and unknown or missing. 

RRP 62.3% 3,533 Baseline, 

6, 12, 24, and 60 months after prostate cancer diagnosis 

Moore, 2007389 Canada Clinical evaluation More than 8 

grams of urine loss on 24 hour pad test 

RRP 

Lap RRP 

93% RRP: 

198 

Lap RRP: 

48 

3 and 12 
Table F33. Prevalence and severity of post-prostatectomy UI (continued) 

F319 

Author Country Method UI Definition Surgical Procedure(s) Response Rate Number Followup (Months) 

Smither, 200748 USA Prospective cohort with clinic 

evaluation. Chart reviews. 

≤1 gram of 

urine loss on a 

1 hour pad test 

RRP 100% 203 2, 6, 18, 

30, 42, and 54 weeks postprocedure 

Eastham, 1996390

USA Clinical evaluation 

and self-reported questionnaires 

Leaking urine 

onto ≥1/pads 

daily, patients 

who were wet 

with normal 

activity 

RRP 

RRP (With 

new 

anastomic 

technique, 

1990) 

95% RRP: 191 

RRP (Post 

1990 

w/new 

technique)

: 390 

1 Year and 2 year 

Begg, 2002391 USA Diagnostic tests Leakage or 

absence of 

urinary control 

>2 times/day 

RRP 100% 11,522 >1 year 

Stanford, 2000392

USA Mailed, selfreported 

questionnaires or 

Leakage of 

urine 

RRP 62.3% 3,533 12 months 

and 24 months 
Table F33. Prevalence and severity of post-prostatectomy UI (continued) 

F320 

Author Country Method UI Definition Surgical Procedure(s) Response Rate Number Followup (Months) 

telephone and inperson interviews 
Table F33. Prevalence and severity of post-prostatectomy UI (continued) 

F321 

Author Country Method UI Definition Surgical Procedure(s) Response Rate Number Followup (Months) 

Emberton, 1996393

UK Mailed, selfreported 

questionnaires 

Leakage of 

urine 

RRP 82.4% 4,226 3 Months 

“

Fowler, 1995394 USA Self-reported 

mailed questionnaires and telephone interviews 

Dripping or 

leaking urine 

over the past 

month 

RRP 92% 1,072 2-4 years 

after surgery 

““2“

Kundu, 2004395 USA Self-reported 

questionnaires 

Use of pads or 

other protection 

RRP 78.7% 2,737 Minimum 

of 18 months 

Y56

Harris, 2003396 USA Surgeon evaluation Pad usage RPP 100% 508 1, 2, 4, 6, 

and 12 months 

2 4 6 

Varkarakis, 2004397 Austria In person interviews Pad usage RRP 84.9% 526 1, 6, and 12 months 3 

6 

Lepor, 2004398 USA Self-reported, 

mailed questionnaires 

Pad usage RRP 94.2% 500 3, 6, 12, 

and 24 months 

3 6 2
Table F33. Prevalence and severity of post-prostatectomy UI (continued) 

F322 

Author Country Method UI Definition Surgical Procedure(s) Response Rate Number Followup (Months) 

Penson, 2005399 USA Self-reported questionnaires or 

telephone interviews 

Leakage of 

urine 

RRP 62.3% 3,533 6, 12, 24, 

and 60 months 

6 

26

Sacco, 2006400 Italy Telephone or inperson interviews Pad usage RRP 86% 985 3, 6, 12, and 24 

months 

3 6 2

Saranchuk, 2005401 USA Clinical database Pad usage RRP 100% 647 12 and 24 months 

2

Van Randenborgh, 2004402

Germany Self-administered 

questionnaires 

Pad usage RRP 100% 1,013 Up to 12 

months 

W36

w36

Mettlin, 1997403 USA Hospital cancer 

registries 

Pad usage RRP 85.3% 2,922 Up to 5 

years 

2T

TURP: Transurethral retropubic prostatectomy; RRP= radical retropubic prostatectomy; RPP = radical perineal prostatectomy; Lap RRP prostatectomy; UI=urinary incontinence; SUI=stress urinary incontinence 
F323 

Table F34. Association between race and FI 

Author 

Sample 

Fecal 

Incontinence Race , Population Groups Odds Ratio (95%CI) 

Women 

Fecal 

incontinence 

Asian vs. Non-Asian, 6 years postpartum 3.42 (2.36; 4.94)* 

Persistent fecal 

incontinence 

Asian vs. Non-Asian, 6 years postpartum 

among primiparae at index delivery 

13.46 (5.88; 30.81)* 

Macarthur, 2005404

N = 4,046 

1,793 primiparae 

3,813 included in 

the model Persistent fecal 

incontinence 

Asian vs. Non-Asian, 6 years postpartum 6.00 (3.66; 9.86)* 

MacArthur, 2001405

N = 7,879 

Fecal 

incontinence 

Asian vs. Non-Asian, 3 months postpartum 3.21 (2.04; 5.05)* 

Richter, 2005406

N = 180 

Anal 

incontinence 

Non Whites vs. Whites with morbid obesity 

before laparoscopic weight loss surgery 

0.58 (0.28; 1.16) 

Nursing homes 

Fecal 

incontinence 

Nelson1998, Non-Caucasian vs. Caucasian, 1,992 1.00 (1.00; 1.00) 306

N = 18,224 

Fecal 

incontinence 

Non-Caucasian vs. Caucasian, 1,993 1.30 (1.00; 1.70) 

Combined urinary 

and fecal 

Nelson2005, Non Whites vs. Whites 2.00 (1.20; 3.40)* 407

N = 8,170 

Fecal 

incontinence 

Non Whites vs. Whites 2.10 (1.30; 3.40* 

Bold- multivariate odds ratios 

*- Significant incontinence odds ratio 95% CI 
F324 

Table F35. Prevalence of FI in community dwelling adults by diet, body mass index, and the presence of 

diabetes 

Author Population subgroup Symptoms Prevalence, % 

Alcohol 

Melville, 2005338

N = 3,444 

Moderate alcohol, women Fecal incontinence 0.84 

BMI in women 

Richter, 2005406

N = 180 

BMI>40, undergoing laparoscopic weight loss surgery Anal incontinence 32.00 

Ng, 2002408

N = 320 

Body mass index >20 Anal incontinence 12.81 

BMI>40, undergoing laparoscopic weight loss surgery Flatus 14.44 

BMI>40, undergoing laparoscopic weight loss surgery Flatus and liquid 

feces 

7.79 

BMI>40, undergoing laparoscopic weight loss surgery Liquid feces 6.68 

Richter, 2005406 

N = 180 

BMI>40, undergoing laparoscopic weight loss surgery Solid or liquid feces 2.79 

Diabetes 

Meschia, 2002409

N = 881 

Women Anal incontinence 0.91 

Melville, 2005338

N = 3,444 

Women Fecal incontinence 1.13 

Jackson, 1997303

N = 14 

Women Fecal incontinence 21.4 

Bytzer, 2001 Men and women Solid feces 2.60 351

N = 423 Solid or liquid feces 12.80 
F325 

Table F36. Association between severity of FI and BMI 

Author 

Sample Definition of Incontinence Risk Factors in Population 

Groups 

Relative Risk 

(95%CI)) 

Guise, 2007410

N = 8,774 

Persistent Incontinence of stool BMI before the birth ≥30 vs. <30 1.70 (1.37; 2.11)* 

Isolated flatus incontinence at least 

once a week 

Hojberg, 2000 Pre-pregnancy BMI < 20 vs. 20-30 0.90 (0.70; 1.20) 215

N = 7,557 

Isolated flatus incontinence at least 

once a week 

Pre-pregnancy BMI >35 vs. 30-35 0.90 (0.30; 2.90) 

Bliss, 2004308

N = 1,352 

Soils underwear or floor Overweight men and women older 

than 75 years 

1.40 (1.00; 2.00) 

Bold = multivariate odds ratios 

* Significant difference 
F326 

Table F37. Association between physical activity and FI 

Author 

Sample Fecal Incontinence Physical Activity in 

Population Groups 

Odds Ratio 

(95%CI 

Prevalence of fecal incontinence Frequent exercise in women 0.75 (0.53; 1.05) 

Incidence of fecal incontinence Frequent exercise in women 0.9 (0.69; 1.16)) 

Prevalence of fecal incontinence Frequent exercise in men 0.67 (0.4; 1.14) 

Ostbye, 200428

N = 8,949 

Incidence of fecal incontinence Frequent exercise in men 1.05 (0.7; 1.57) 

Bradley, 200564

N = 297 

Fecal urgency Exercise ≥ weekly vs.< weekly 0.3 (0.2; 0.8)* 

Bold = multivariate odds ratios 

* Significant difference 
F327 

Table F38. Prevalence of FI in patients with cancer 

Author Age Definition of Fecal Incontinence Risk Factor 

Kienle, 2007 Anal incontinence, Grade 1 Deep or standard anterior resection for rectal cancer 

411

N = 100 

65 

Anal incontinence, Grade 2 Deep or standard anterior resection for rectal cancer 

Welsh, 2003412

N = 124 

76 Anal incontinence Survivors of anterior resection of the rectum 

Tanum, 1991413

N = 106 

35-91 Anal incontinence Chemotherapy and radiation therapy for carcinoma of 

the anal canal 

Proctocolectomy Proctocolectomy with J-pouch anastomosis 

Norderval, 2004414

N = 205 

 Anal incontinence 

Proctocolectomy with W-pouch anastomosis 

Pad use, always Deep or standard anterior resection for rectal cancer Pad use, daytime Deep or standard anterior resection for rectal cancer Pad use, nighttime Deep or standard anterior resection for rectal cancer 

Kienle, 2006411

N = 100 

65 

Pad use, occasionally Deep or standard anterior resection for rectal cancer 
F328 

Table. F39. Prevalence of FI in community dwelling adults after stroke 

Author 

Sample Gender Condition Prevalence, % 

Combined urinary and fecal incontinence

Brittain, 2006348

N = 1,483 

Women and Men Stroke survivors 4.3 

Fecal Incontinence 

Brittain, 2006348

N = 1,483 

Women and Men Stroke survivors 7.4 

Otegbayo, 2006 Women Acute stroke 3.4 239

N = 54 Men Acute stroke 8.0 

Women 6 months after stroke 5.3 

Women and Men 1 year after stroke 10.9 

Women and Men 3 months after stroke, <65 years old 1.7 

Women and Men 3 months after stroke 10.8 

Women and Men 3 years after stroke 15.0 

Women and Men 3 months after stroke, 65–79 year old 5.0 

Women and Men 3 months after stroke , >80 years old 4.1 

Women and Men 7 to 10 days after stroke 29.7 

Women and Men Nonwhite 3 months after stroke 2.2 

Harari, 2003415

N = 846 

Women and Men White 3 months after stroke 8.4 

Women and Men 6 months after stroke 5.0 

Women and Men acute stroke 34.0 

Nakayama, 1997416

N = 935 

Women and Men At Discharge after stroke 12.0 

Women and Men Ischemic acute stroke 9.7 

Women and Men Left acute stroke 3.6 

Women and Men Right acute stroke 7.7 

Otegbayo, 2006239

N = 54 

Women and Men Acute stroke 5.6 

Women and Men Stroke survivors 0.8 

Women and Men Furnishing or bedding in stroke survivors 27.0 

Women and Men Stroke survivors 7.0 

Brittain, 2006, 348

N = 1,483 

Women and Men Soiling underwear in stroke survivors 66.0 

Major fecal incontinence

Brittain, 2006, 348

N = 1,483 

Women and Men Stroke survivors 5.0 

Partial fecal incontinence

Women and Men 6months after stroke 4.0 

Women and Men Acute stroke 6.0 

Nakayama, 1997416

N = 935 

Women and Men At discharge after stroke 6.0 
F329 

Table F40. Prevalence of fecal incontinence in patients with neurological disease 

Author Neurological Disease Fecal Incontinence Prevalence, % 

Sakakibara, 2001 Parkinson's disease in men Fecal incontinence 10 282

N = 323 men and 183 

women 

Parkinson's disease in women Fecal incontinence 5 

Spinal cord injury Fecal incontinence 6.3 

Tetraplegia Fecal incontinence 13.8 

Paraplegia Fecal incontinence 3.7 

Menter, 1997266

N = 227 

Incomplete injuries (ASIA 

Impairment D) 

Fecal incontinence 2.1 

Hinds, 1990213

N = 280 

Multiple sclerosis Fecal incontinence 51.0 

Ho, 2005417

N = 434 

Multiple sclerosis Fecal incontinence 20.7 

Hinds, 1990213

N = 280 

Multiple sclerosis Fecal incontinence, >1/week 25.0 

Major soiling of underclothes 7.6 

Minimal soiling of underclothes 11.3 

Passive soiling, always 2.5 

Passive soiling, never 6.7 

Passive soiling, sometimes 11.3 

Soiling weekly 4.8 

Soiling daily 2.3 

Soiling less often 9.2 

Soiling monthly 3.2 

Soiling of furniture 0.7 

Soiling of outer clothes 0.9 

Wear pad 7.1 

Active soiling, always 1.4 

Active soiling, never 4.4 

Ho, 2005417

N = 434 

Multiple sclerosis 

Active soiling, sometimes 15.0 

Multiple sclerosis Bowel dysfunction (constipation 

and/or fecal incontinence) 

Hinds, 1990 68.0 213

N = 280 

Multiple sclerosis Constipation 43.0 

Consistency of soiling: mainly 

formed 

Ho, 2005 5.1 417

N = 434 

Multiple sclerosis 

Consistency of soiling: mainly 

watery 

9.0 
F330 

Table F41. Association between FI and pressure ulcers in residents of nursing homes 

Author 

Sample Definition of Incontinence Relative Risk 

(95%CI) 

Nelson, 2005407

N = 8,170 

Combined urinary and anal incontinence 1.00 (1.00; 1.00) 

Nelson, 1998 Fecal incontinence in 1992 2.60 (2.20; 3.00) 306

N = 18,224 Fecal incontinence 1993 2.30 (2.00; 2.60) 

Bold = multivariate odds ratios 
F331 

Table F42. Association between FI and gastrointestinal conditions in residents of nursing homes 

Author 

Sample Risk Factors Odds Ratio 95%CI 

Combined UI and FI 

Constipation 1.00 (1.00; 1.00) 

Diarrhea 1.00 (1.00; 1.00) 

Nelson, 2005407

N = 8,170 

Fecal impaction 1.00 (1.00; 1.00) 

FI 

Constipation 1.00 (1.00; 1.00) 

Diarrhea 1.00 (1.00; 1.00) 

Nelson, 2005407

N = 8,170 

Fecal impaction 1.00 (1.00; 1.00) 

Constipation, 1992 1.40 (1.30; 1.60)* 

Diarrhea, 1992 3.30 (2.70; 4.20)* 

Fecal impaction, 1992 1.50 (1.10; 2.10)* 

Constipation, 1993 1.30 (1.20; 1.40)* 

Diarrhea, 1993 2.40 (1.90; 3.10)* 

Nelson, 1998306

N = 18,224 

Fecal impaction, 1993 2.10 (1.30; 3.30)* 

Bold = multivariate odds ratios 

* Significant difference 
F332 

Table F43. Association between type and severity of FI and gastrointestinal conditions 

Author 

Sample Age Risk Factors in Population Groups Fecal Incontinence Odds Ratio 95%CI 

Bowel resection Severity, fecal incontinence ≥1 times/day 3.2 (1.5; 6.6Defecation urgency always Severity, soils underwear or floor 11.9 (4.9; 28.Defecation urgency most of the time Severity, soils underwear or floor 5 (3; 8.6)* Defecation urgency some of the time Severity, soils underwear or floor 2.8 (2; 4.1)Loose or liquid stool consistency Severity, having fecal incontinence ≥1 

times/day 

2.4 (1.3; 4.3

Loose or liquid stool consistency Severity, soils underwear or floor 3 (1.5; 5.8)Urgency always Severity, having fecal incontinence ≥1 

times/day 

11.4 (5.1; 25.

Urgency most of the time Severity, fecal incontinence ≥1 times/day 4.7 (2.8; 7.6Urgency some of the time Severity, fecal incontinence ≥1 times/day 3 (2.1; 4.3)* Hemorrhoids Severity, fecal incontinence ≥1 times/day 1.6 (1.1; 2.3Hemorrhoids Severity, soils underwear or floor 1.5 (1.1; 2.2Defecation urgency some of the time Type, liquid feces 2.1 (1.4; 3.2Defecation urgency always Type, solid feces 20.3 (2.9; 11.Defecation urgency most of the time Type, solid feces 4.3 (0.9; 17.4Loose or liquid stool consistency Type, liquid feces 2.8 (1.3; 6.1

Bliss, 2004308

N = 1,352 

Mean age of 75+-6 

Had surgery for hemorrhoids Type, liquid feces 2.5 (1.4; 4.3

Frequent diarrhea Type, liquid feces 2.5 (1.5; 4.2Straining Type, solid feces 0.7 (0.3; 0.9Straining Type, liquid feces 0.7 (0.5; 0.9

Johanson, 1997418N = 388 

31-103 

Watery stool Type, liquid feces 2.5 (1.5; 4)

Flatus 1.60 (0.50; 4.Type, liquid feces 2.60 (1.00; 6.

Uustal Fornell, 2004208N = 885 

>40 Hemorrhoid operation in women 

Type, solid feces 1.50 (0.00; 9.

Bold = multivariate odds ratios * Significant difference 
F333 

Table F44. Prevalence of FI after gastro-intestinal surgery 

Author Gastro-Intestinal Surgery Definition of FI Prevalence of F

Double stapled ileoanal reservoir ulcerative colitis or familial adenomatous polyposis 

Fecal incontinence during the day 

Reissman, 1996 7% 419

N = 14 >60 years N = 126 <60 years Double stapled ileoanal reservoir ulcerative colitis or familial 

adenomatous polyposis 

Fecal incontinence during the day 

5% 

Inflammatory bowel disease after ileal pouch-anal anastomosis and Pouchitis 

Frequent fecal incontinence 

11% 

Inflammatory bowel disease after ileal pouch-anal anastomosis 

Frequent fecal incontinence 

8% 

Inflammatory bowel disease after ileal pouch-anal anastomosis and Pouchitis 

Occasional fecal incontinence 

43% 

Lohmuller, 1990420

N = 734 

Inflammatory bowel disease after ileal pouch-anal anastomosis 

Occasional fecal incontinence 

35% 

Gonzalez-Argente, 2001421N = 32 

Surgery for rectal prolapse in women Fecal incontinence 97% 
F334 

Table F45. Association between FI and surgical procedures 

Author 

Sample Age Risk Factors in Population Groups Odds Ratio (95% CI) 

Anal incontinence Chen, 2003284

N = 1,253 100% female 

≥20 Gynecological surgery 1.8 (1.1; 2.9)* 

Ng, 2002408

N = 320 100% female 

 Prior pelvic surgery 1.64 (0.79; 3.42) 

Fecal incontinence Bharucha, 2006422N = 2,800 100% female 

≥20 Anorectal surgery 1.2 (0.7; 2.1) 

Kalantar, 2002339

N = 642 55% female 

> 18 Perianal surgery 4.62 (2.05; 10.4)* 

Severity of incontinenceBliss, 2004 308

N = 1,352 60% female 

mean 

age of 

75+-6 

Soils underwear or floor after bowel resection 2.2 (1.1; 4.5)* 

Hojberg, 2000215N = 1726 

≥15 Isolated flatus incontinence ≥1/week after previous lower 

abdominal or urological surgery 

1.5 (1.1; 2.1)* 

Flatus incontinence

Groin hernia needing surgery 1.50 (0.40; 5.40) Hiatus hernia 1.10 (0.30; 3.60) 

Uustal Fornell, 2004208

N = 885 100% female 

>40 

Varicose veins needing surgery 1.00 (0.60; 1.50) 

Liquid feces

Groin hernia needing surgery 3.00 (1.10; 8.30)* Hiatus hernia 4.30 (1.60; 11.30)* 

Uustal Fornell, 2004208

N = 885 100% female 

>40 

Varicose veins needing surgery 1.00 (0.60; 1.70) 

Solid feces Johanson, 1997418

N = 338 76% female 

31-103 Rectal surgery 0.4 (0.2; 0.9) 

Groin hernia needing surgery 4.00 (0.00; 16.30) Hiatus hernia 5.90 (1.80; 19.80)* 

Uustal Fornell, 2004208

N = 885 100% female 

>40 

Varicose veins needing surgery 1.90 (0.80; 4.10) 

Bold = multivariate odds ratios * Significant difference 
F335 

Table F46. Association between fecal incontinence and drug administration 

Author 

Sample Age Drug Odds Ratio (95%CI) 

Combined urinary and fecal incontinenceEndo, 2002 Cathartic/laxative use 1.902 (1.078; 3.355)* 304

N = 605 Diuretic use 2.226 (1.264; 3.921)* 

Fecal incontinence 

Antacids 1.4 (0.90; 2.00) Anticonvulsant 1.90 (1.90; 3.20)* Antidepressants 1.90 (1.20; 3.00)* Anti Parkinson 4.30 (2.50; 5.30)* Antipsychotic 3.90 (2.50; 6.20)* Beta blocker 0.8 (0.60; 1.10) Benzodiazepine 0.8 (0.50; 1.50) Calcium channel blocker 0.7 (0.60; 0.90) Diuretic 1.1 (0.90; 1.40) Estrogen 0.7 (0.40; 1.40) Fiber 1.6 (0.90; 2.90) Hypnotics 3.10 (1.80; 4.80)* Iron 0.8 (0.20; 2.50) 

Quander232

N = 6,099 

>65 

Narcotics 1.70 (1.20; 2.50)* 

Bliss, 2004308

N = 1,352 

mean 

age of 

75+-6 

Fecal incontinence ≥1 times/day after daily administration 

of stool softener for constipation 

2.1 (1.1; 3.7)* 

Richter, 2005406N = 180 

16-55 Anal incontinence: Diuretics in morbid obese before 

laparoscopic weight loss surgery 

0.78 (0.39; 1.58) 

Hormone therapy in womenRichter, 2005406N = 180 

16-55 Anal incontinence: hormone replacement therapy in 

morbid obese before laparoscopic weight loss surgery 

0.87 (0.40; 1.92) 

Bharucha, 2006 Fecal incontinence: hormone therapy - current 1 (0.8; 1.6) 422N = 2,800 

≥20 

Fecal incontinence: contraceptive use 1.3 (0.98; 1.8) 

Bold = multivariate odds ratios * Significant difference 
F336 

Table F47. Prevalence of FI in men with prostate diseases 

Author 

Sample Risk Factor Definition of Fecal Incontinence Prevalence, % 

Korman, 2004 Perineal prostatectomy Fecal incontinence 5.4 288N = 201 Retropubic prostatectomy Fecal incontinence 6.4 

Prostate surgery more than a year ago Fecal incontinence >1/day 3.4 Prostate surgery more than a year ago Fecal incontinence >1/week 3.9 Prostate surgery more than a year ago Fecal incontinence 1/day 8.2 

O'Connell, 2007423N = 212 

Prostate surgery more than a year ago Loosing control of stools as a big problem 1.1 

Prostate cancer Solid or liquid feces 8.0 Prostate cancer Urgency 22.0 

Adolfsson, 1998252N = 661 Prostate cancer Constipation 20.0 
F337 

Table F48. Association between FI and abortion in women 

Author 

Sample Definition of Fecal Incontinence Abortion Odds 

(95

Hojberg, 2000 Severity, isolated flatus incontinence ≥1/week Previous abortions <12 weeks of gestation 1 (0.

215

Severity, isolated flatus incontinence ≥1/week Previous abortions >12 weeks of gestation 0.7 (0

Bold = multivariate odds ratios 
F338 

Table F49. Association between FI and menopause 

Author 

Sample Age Definition of Fecal Incontinence Odds Ratio 

(95%CI) 

Ng, 2002408

N = 320 

 Anal incontinence 0.91(0.52; 1.60) 

Chen, 2003284

N = 1,253 

≥20 Anal incontinence 0.6 (0.3; 1.1) 

Abramov, 2005 Fecal incontinence 2.1 (1.15; 3.8)* 424

N = 542 

26-86 

Flatus incontinence 2.11 (1.43; 3.13)* 

Bold = multivariate odds ratios 

* Significant difference
F339 

Table F50. Association between FI and UI in residents of nursing homes 

Author Year of Observation Age Odds Ratio 

(95%CI) 

Nelson, 1998 1992 84 12.60 (11.50; 13.70)* 306

N = 18,224 1993 84 11.30 (10.30; 12.40)* 

Bold = multivariate odds ratios 

* Significant difference 
F340 

Table F51. Prevalence of FI in patients with prolapse and in women with UI 

Author 

Sample Risk Factor Prevalence, 

% 

Anal incontinence

Vaginal prolapse 16.10 

Vaginal prolapse - Stage 0 8.70 

Vaginal prolapse - Stage 1 39.10 

Vaginal prolapse - Stage 2 30.40 

Weber,1998425

N = 143 

Vaginal prolapse - Stage 3 21.80 

Rose, 2002223

N = 150 

Rectal prolapse in men and women 30.70 

Fecal incontinence

Soligo, 2006426

N = 786 

Urogynecologic symptoms 20.00 

Meschia, 2002409

N = 881 

Genital prolapse >2 grade 8.17 

Genuine stress incontinence 3.75 

Mixed urinary incontinence 2.8 

Overactive bladder 6.25 

Ng,2002408

N = 320 

Prior pelvic surgery for prolapse 6.88 

Meschia, 2002409

N = 881 

Prolapse repair 2.16 

Leroi, 1999427

N = 409 

Stress urinary incontinence 28.00 

Meschia, 2002409

N = 881 

Urinary incontinence and/or genital prolapse 20.00 

Ng,2002 Urinary symptoms 15.90 408

N = 320 Uterovaginal prolapse 12.19 

Parmentier, 2004428

N = 291 

Pelvic organ prolapse 26.10 

Combined urinary and fecal incontinence

Soligo, 20034292 

N = 504 

Urogynecologic symptoms 20.24 

Meschia, 2002409

N = 881 

Urinary incontinence and/or genital prolapse 13.90 

Jelovsek, 2005430

N = 152 

Urinary incontinence or pelvic organ prolapse 22.00 

Fecal incontinence 

Melville,2005338

N = 3,444 

Urinary incontinence 4.82 

Jelovsek, 2005430

N = 302 

Urinary incontinence or pelvic organ prolapse 19.00 

Anterior colporrhaphy (n=27) 22.22 

Posterior colporrhaphy (n=22) 22.73 

Prolapse >1st degree (n=139) 24.46 

Prolapse >2nd degree (n=71) 26.76 

Prolapse >3rd degree (n=46) 26.09 

Prolapse repair (n=46) 26.67 

Jackson, 1997303

Urinary incontinence or pelvic organ prolapse (n=247) 17.00 

Flatus incontinence

Leroi, 1999427

N = 409 

Stress urinary incontinence 18.30 

Ng,2002408

N = 320 

Urinary symptoms 12.30 

Liquid feces incontinence

Leroi, 1999427

N = 409 

Stress urinary incontinence 9.50 

Passive fecal incontinence
Table F51. Prevalence of FI in patients with prolapse and in women with UI (continued) 

F341 

Author 

Sample Risk Factor Prevalence, 

% 

Soligo, 2003429

N = 504 

Urogynecologic symptoms 8.73 

Soiling

Jelovsek, 2005430

N = 302 

Urinary incontinence or pelvic organ prolapse 12.00 

Solid and liquid feces

Ng,2002 408

N = 320 

Urinary symptoms 3.60 

Leroi, 1999427

N = 409 

Stress urinary incontinence 3.60 

Solid feces

Leroi, 1999427

N = 409 

Stress urinary incontinence 1.00 

Jelovsek, 2005430

N = 302 

Urinary incontinence or pelvic organ prolapse 7.00 

Solid or liquid feces

Mild stress urinary incontinence 14.81 

Moderate stress urinary incontinence 24.19 

Khullar, 1998276

N = 465 

Severe stress urinary incontinence 11.70 

Urge fecal incontinence

Soligo, 2003429

N = 504 

Urogynecologic symptoms 9.33 

Soligo, 2006426

N = 786 

Urogynecologic symptoms 11.20 
F342 

Table F52. Association between FI and prolapse in women 

Author 

Sample Age Risk Factor Odds Ratio (95%CI) 

Anal incontinence 

Douglas >grade 2 1.50 (0.60; 3.50) Perineum >grade 2 1.40 (0.70; 2.80) Prolapse of Bladder >2 grade 0.90 (0.60; 1.20) Prolapse of Cervix/cuff >2 grade 0.80 (0.50; 1.30) Prolapse of Douglas >2 grade 2.20 (1.10; 4.40)* Prolapse of Perineum >2 grade 1.80 (1.00; 3.30) Prolapse of Rectum >2 grade 2.00 (1.20; 3.10) Prolapse of Urethra >2 grade 0.90 (0.60; 1.40) 

Meschia, 2002409

N = 881 

58.6 

Rectum >grade 2 1.90 (1.10; 3.30)* 

Ng, 2002408

N = 320 

 Utero vaginal prolapse 5.02 (2.19; 11.54)* 

Chen, 2003284

N = 1,253 

≥20 Utero vaginal prolapse 3.2 (1.1; 8.9)* 

Flatus incontinence

Bulge 2.80 (1.20; 6.40) Digitation by defecation 2.10 (1.30; 3.60)* 

Uustal Fornell, 2004208

N = 885 

>40 

Pelvic heaviness 2.30 (1.50; 3.60)* 

Liquid incontinence

Bulge 1.40 (0.50; 3.50) Digitation by defecation 1.80 (1.10; 3.00)* 

Uustal Fornell, 2004208

N = 885 

>40 

Pelvic heaviness 4.20 (2.70; 6.40) 

Solid incontinence

Bulge 1.80 (0.00; 7.20) Digitation by defecation 1.40 (0.60; 3.70) 

Uustal Fornell, 2004208

N = 885 

>40 

Pelvic heaviness 3.30 (1.60; 7.00) 

Bold = multivariate odds ratios * Significant difference 
F343 

Table F53. Association between severity of FI and UI 

Author 

Sample Fecal Incontinence Urinary Symptoms 

Urgency (n = 508) Burch colposuspension for urinary incontinence vs. 

healthy controls 14 years after surgery 

1

Severity, flatus, weekly or more often (n = 495) 

Burch colposuspension 1

Severity, liquid, weekly or more often (n = 495) 

Burch colposuspension 3

Severity, solid, weekly or more often (n = 495) 

Burch colposuspension 2

Severity, soils underclothes (soiling from the bowel) (n = 495) 

Burch colposuspension 2

Soiling underclothes Burch colposuspension for urinary incontinence vs. 

healthy controls 14 years after surgery 

1

Wear pad during a day Burch colposuspension for urinary incontinence vs. 

healthy controls 14 years after surgery 

3

Adverse affect on general well-being Burch colposuspension for urinary incontinence vs. 

healthy controls 14 years after surgery 

2

Adverse effect on social activities/social life Burch colposuspension for urinary incontinence vs. 

healthy controls 14 years after surgery 

1

Kjolhede, 2005431

N = 508 

Avoiding activities because of incontinence Burch colposuspension for urinary incontinence vs. 

healthy controls 14 years after surgery 

2

Stage II pelvic organ prolapse and/or urinary incontinence vs. stage 0 or I pelvic organ prolapse and no urinary incontinence 

Nichols, 2005 5

432

N = 190 

Bothersome anal incontinence 

Stage II pelvic organ prolapse and/or urinary incontinence vs. stage 0 or I pelvic organ prolapse and no urinary incontinence 

4.

Bliss, 2004308

N = 1,352 

Severity, having fecal incontinence≥1 time/day 

Urinary incontinence in men and women 

Kjolhed, 2005431

N = 508 

Frequent soiling underclothes Burch colposuspension for urinary incontinence vs. 

healthy controls 14 years after surgery 

2

Bold = multivariate odds ratios * Significant difference 
F344 

Table F54. Prevalence of FI related to pregnancy and birth 

Author 

Sample Risk Factors Prevalence, 

% 

Anal incontinence

No posterolateral episiotomy 2.30 

1 year after delivery 4.67 

Groutz, 1999433

N = 300 

3 months after delivery 7.00 

Bugg, 2005434

N = 275 

10 months postpartum 9.10 

Complete 3rd-degree perineal laceration, n = 65 16.92 

Complete 3rd-degree tear as a nullipara, n = 234 14.53 

Complete 3rd-degree tear as a nullipara and > 2 deliveries, n = 40 30.00 

Complete 3rd-degree tear as a nullipara and 1 delivery, n = 67 16.42 

Sze, 2005435

Complete 3rd-degree tear as a nullipara and no vaginal delivery, n = 

65 

16.92 

4th-degree sphincter tear as a nullipara, n = 148 30.20 

4th-degree sphincter tear as a nullipara, n = 50 40.00 

1- Delivery after 4th-degree sphincter tear as a nullipara, n = 60 23.33 

2- Delivery after 4th-degree sphincter tear as a nullipara, n = 36 27.78 

Sze, 2005436

Sphincter tears and ≥ 2 additional vaginal deliveries, n = 37 27.03 

Hojberg, 2000215

N = 1,726 

Pregnant women with one previous delivery 8.60 

Parmentier, 2004428

N = 291 

Forceps delivery 5.16 

Forceps delivery 2.38 

Episiotomy 12.94 

Infant weighing >3800g 8.85 

Meschia, 2002409

N = 881 

Vacuum 0.57 

Ng,2002408

N = 320 

Vaginal delivery history 13.44 

Any fecal incontinence

Chiarelli, 2003 Multiparous, n = 270 8.50 286

Primiparous, n = 298 5.40 

Bothersome fecal incontinence

30 years postpartum after Cesarean, n = 33 15.20 

30 years postpartum after Episiotomy, n = 89 25.80 

Nygaard,1997437

30 years postpartum with anal disruption, n = 29 27.60 

Combined urinary and fecal incontinence

Bugg, 2005434

N = 275 

10 months postpartum 5.50 

Groutz, 1999433

N = 300 

2 year after delivery 1.67 

Fecal incontinence

Jackson, 1997 Episiotomy, n = 218 12.84 303

Forceps, n = 192 6.25 

Nonoperative vaginal delivery 2.90 

Nulliparous 1.05 

Melville,2005338

N = 3,444 

Cesarean sections only 0.29 

McKinnie, 2005438

N = 1,004 

Pregnant women 12.75 

Goldberg,2003285

N = 733 

Previous multiple pregnancy 10.00 

Walsh, 1996439

N = 81 

3rd-degree tear primary repair 7.00 

Fecal urgency

Mazouni, 2005228

N = 159 

12 months after instrumental delivery 8.20 
Table F54. Prevalence of FI related to pregnancy and birth (continued) 

F345 

Author 

Sample Risk Factors Prevalence, 

% 

Flatus incontinence

Chiarelli, 2003286

N = 568 

12 months after instrumental delivery and/or a high birth weight 

infant 

24.40 

Groutz, 1999433

N = 300 

3 months after delivery 6.30 

30 years postpartum after Cesarean, n = 33 15.20 

30 years postpartum after Cesarean, n = 33 57.60 

30 years postpartum after Episiotomy, n = 89 30.30 

30 years postpartum after Episiotomy, n = 89 69.70 

30 years postpartum with anal disruption, n = 29 58.60 

Nygaard,1997437

30 years postpartum with anal disruption, n = 29 75.90 

Chiarelli, 2003286

N = 270 

Multiparous 24.80 

Hojberg, 2000215

N = 1,726 

Pregnant women with 1 previous delivery 4.20 

Goldberg,2003285

N = 733 

Previous multiple pregnancy 25.20 

Chiarelli, 2003286

N = 298 

Primiparous 24.10 

Walsh, 1996439

N = 81 

3rd-degree tear primary repair 12.00 

Mazouni, 2006228

N = 159 

13 months after instrumental delivery 7.50 

Liquid feces incontinence

Chiarelli, 2003286

N = 568 

12 months after instrumental delivery and/or a high birth weight 

infant 

4.90 

Hojberg, 2000215

N = 1,726 

Pregnant women with 1 previous delivery 2.30 

Chiarelli, 2003 Multiparous, n = 270 5.90 286

Primiparous, n = 298 4.00 

Soiling

Chiarelli, 2003286

N = 270 

Multiparous 14.80 

Goldberg,2003285

N = 733 

Previous multiple pregnancy 10.00 

Chiarelli, 2003286

N = 298 

Primiparous 7.40 

Solid feces incontinence

Bugg, 2005434

N = 275 

10 months postpartum 3.00 

Chiarelli, 2003286

N = 568 

12 months after instrumental delivery and/or a high birth weight 

infant 

2.60 

Groutz, 1999433

N = 300 

3 months after delivery 0.70 

Hojberg, 2000215

N = 1,726 

Pregnant women with 1 previous delivery 0.60 

Chiarelli, 2003 Multiparous, n = 270 3.00 286

Primiparous, n = 298 2.30 

Urgency

Multiparous, n = 270 18.90 

Primiparous, n = 298 11.00 

Chiarelli, 2003286

12 months after instrumental delivery and/or a high birth weight 

infant, n = 568 

14.80 

Urgency and incontinence

Sangalli, 2000234

N = 129 

13 years obstetrical anal sphincter tear 22.48 
F346 

Table F55. Incidence and severity of FI related to pregnancy and birth 

Author 

Sample Risk Factors Fecal Incontinence 

Incidence of anal incontinence, total Incidence of Flatus Incidence of Flatus <1/week Incidence of Flatus >1/week Incidence of Flatus Daily Incidence of Incontinence to liquid stool Incidence of Incontinence to liquid stool <Incidence of Incontinence to liquid stool >Incidence of Incontinence of solid feces Incidence of Incontinence of solid feces <

Norderval, 2004414

N = 150 

25 months after primary repair of obstetric sphincter tears 

Incidence of Incontinence of solid feces D

Impact on life

1- Delivery after 4th-degree sphincter tear as a nullipara Little effect on daily activities, n = 60 2- Delivery after 4th-degree sphincter tear as a nullipara Little effect on daily activities, n =36 4th-degree sphincter tear as a nullipara Little effect on daily activities, n =50 1- Delivery after 4th-degree sphincter tear as a nullipara No effect on daily activities, n =60 2- Delivery after 4th-degree sphincter tear as a nullipara No effect on daily activities, n =36 

Sze, 2005436

4th-degree sphincter tear as a nullipara No effect on daily activities, n =50 

Macarthur,2005404

N = 4,214 

3 months and 6 years postpartum Persistent fecal incontinence Complete 3rd-degree perineal laceration Severe anal incontinence, n =65 Complete 3rd-degree tear as a nullipara Severe anal incontinence, n =234 Complete 3rd-degree tear as a nullipara and > 2 deliveries Severe anal incontinence, n =40 Complete 3rd-degree tear as a nullipara and 1 delivery Severe anal incontinence, n =67 Complete 3rd-degree tear as a nullipara and no vaginal delivery 

Severe anal incontinence, n =65 

Sze, 2005435

15970289 

Sphincter tears and ≥ 2 additional vaginal deliveries Severe fecal incontinence, n =37 

1- Delivery after 4th-degree sphincter tear as a nullipara Severe effect on daily activities, n =60 2- Delivery after 4th-degree sphincter tear as a nullipara Severe effect on daily activities, n =36 4th-degree sphincter tear as a nullipara Severe effect on daily activities, n =50 1- Delivery after 4th-degree sphincter tear as a nullipara Severe incontinence, n =60 2- Delivery after 4th-degree sphincter tear as a nullipara Severe incontinence, n =36 

Sze, 2005436

4th-degree sphincter tear as a nullipara Severe incontinence, n = 50 

Soiling Chiarelli, 2003286

N = 568 

12 months after instrumental delivery and/or a high birth weight infant 

Soiling of the underwear 

Solid fecesChiarelli, 2003286

N = 568 

12 months after instrumental delivery and/or a high birth weight infant 

Solid and liquid feces 
Table F55. Incidence and severity of FI related to pregnancy and birth (continued) 

F347 

Author 

Sample Risk Factors Fecal Incontinence 

Sangalli, 2000234

N = 129 

13 years obstetrical anal sphincter tear Solid or liquid feces 

Solid or liquid feces, once daily Solid or liquid feces, <once weekly Solid or liquid feces, >once daily 

Eason, 2002283

N = 949 

3 months post partum 

Solid or liquid feces, 1–6 times weekly 

Sangalli, 2000234

N = 129 

13 years obstetrical anal sphincter tear Solid or liquid feces, flatus 

Norderval, 20044142 

N = 150 

25 months after primary repair of obstetric sphincter tears Incontinence solid feces >1/week 

Bowel control

6 months after delivery N = 831 4-degree lacerations Worse bowel control, n = 165 

Fenner,2003 287

3rd-degree lacerations Worse bowel control, n= 666 
F348 

Table F56. Association between fetal characteristics and FI 

Author 

Sample Fetal Risk Factors Fecal Incontinence 

Chaliha, 1999 Fecal urgency, 3 months postpartum 

326

N = 549 

Fetal head circumference 

Flatus incontinence, 3 months postpartum 

Frudinger, 2002440N = 134 

Fetal head circumference Anal incontinence 1.

Chaliha, 1999 Fecal urgency, 3 months postpartum 

326

N = 549 

Fetal weight 

Flatus incontinence, 3 months postpartum 2

Eason, 2002283

N = 252 

Fetal weight, <4,000g Anal incontinence, 3 months postpartum 

Casey, 2005367

N = 3,887 

Fetal weight, >4,000g Anal incontinence, within 7 months of delivery, at or 

before their 6month contraceptive follow up after delivery 

2

Frudinger440

N = 134 

Fetal weight, (kg) Anal incontinence 1.

Guise, 2007410

N = 8,774 

Fetal weight, ≥4,000g Solid feces incontinence 0.

Abramov, 2005 Fecal incontinence 1.

424

N = 274 

At least 1 Fetal weight, >4,000g 

Flatus incontinence 1.

Faltin, 2001 Fetal weight ≤4,000g Fecal urgency 

328

N = 1,228 Fetal weight >4,000g Fecal urgency 

Mazouni, 2005228

N = 159 

Fetal weight (g) Fecal incontinence,18 months instrumental delivery 1.

Casey, 2005367

N = 3,887 

Fetal weight t, ≤4,000g Fecal incontinence, within 7months of delivery, at or 

before their 6-month contraceptive follow up after delivery 

van Brummen, 2006 Fetal weight, 3,107g Fecal incontinence, 1 year after delivery 0

441

N = 487 Fetal weight, 3,445g Fecal incontinence, 1 year after delivery 1

Guise, 2007410

N = 8,774 

Heaviest fetal weight, ≥4,000g Solid feces incontinence 0.

Eason, 2002283

N = 252 

Fetal weight, ≥4,000g Anal incontinence, 3 months postpartum 

Hojberg, 2000215 Fetal weight, >4,000g Flatus incontinence at least once a week, at 16 weeks of 

gestation in the index-pregnancy 

2

Faltin, 2006442

N = 540 

Fetal weight, >4,000g vs. <3,000g 

>2 symptoms at least once a week or 3 symptoms (flatus, liquid or solid Incontinence, pad use pad; lifestyle alteration), 18 years after rupture of anal sphincter tear during childbirth 

1.

Faltin, 2001328

N = 1,228 

Fetal weight, >4,000g vs. <4,000g 

Anal incontinence 
Table F56. Association between fetal characteristics and FI (continued) 

F349 

Author 

Sample Fetal Risk Factors Fecal Incontinence 

Fetal weight, 3,000-3,499g >2 symptoms at least once a week or 3 symptoms (flatus, 

liquid or solid Incontinence, pad use pad; lifestyle alteration), 18 years after rupture of anal sphincter tear during childbirth 

Faltin, 2006 0

442

N = 540 

Fetal weight, 3,500-3,999g >2 symptoms at least once a week or 3 symptoms (flatus, 

liquid or solid Incontinence, pad use pad; lifestyle alteration), 18 years after rupture of anal sphincter tear during childbirth 

0.

Bold = multivariate odds ratios * Significant difference
F350 

Table F57. Association between FI and mode of delivery 

Author 

Sample Risk Factor Definition of Fecal Incontinence Time From Exposure to Fecal Incontinence O

Augmentation Fecal incontinence urgency 3 months postpartum 0.Augmentation Flatus 3 months postpartum 0.

Chaliha, 1999326

N = 549 

Epidural analgesia Flatus 3 months postpartum 0.

Casey, 2005367

N = 3,887 

Epidural analgesia Anal incontinence Within 7 months of delivery, at 

or before their 6-month contraceptive follow up after delivery 

1.2 

Chaliha, 1999326

N = 549 

Epidural analgesia Fecal incontinence urgency 3 months postpartum 0.

Faltin, 2006442

N = 540 

Episiotomy vs. no episiotomy 

Severity, at least 2 symptoms at least once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

18 years after rupture of anal sphincter tear during childbirth 

1.04 

Casey, 2005367

N = 3,887 

Episiotomy Anal incontinence Within 7 months of delivery, at 

or before their 6-month contraceptive follow up after delivery 

1 

De Leeuw, 2001307N = 250 

Mediolateral episiotomy, primiparity 

Fecal incontinence After anal sphincter damage 

during delivery 

0.17 

Eason, 2002283

N = 252 

Episiotomy without extension into anal sphincter perineal injury 

Anal incontinence 3 months postpartum 1.

Chiarelli, 2003 Instrumental delivery Fecal incontinence At twelve months postpartum 0.8

286

N = 568 Marked abdominal striae Fecal incontinence At twelve months postpartum 2.34 

Oxytocin augmentation Anal incontinence Within 7 months of delivery, at 

or before their 6-month contraceptive follow up after delivery 

Casey, 2005 0.

367

N = 3,887 

Cesarean delivery Anal incontinence 0

Eason, 2002283

N = 252 

Cesarean delivery Anal incontinence 3 months postpartum 0.

Cesarean in this delivery 0.94 Cesarean in this delivery, cesarean labored without push 

0.81 

Cesarean in this delivery, Cesarean never labored 

Guise, 2007410

N = 8,774 

Cesarean labored and pushed 

Solid feces 

0.92 
Table F57. Association between FI and mode of delivery (continued) 

F351 

Author 

Sample Risk Factor Definition of Fecal Incontinence Time From Exposure to Fecal Incontinence O

Ever had cesarean 0.92 Pushing time ≥1 hour in 

this delivery 

Severity, incontinence of stool 1.22 

Chaliha, 1999 Fecal incontinence urgency 3 months postpartum 0.

326

N = 549 

Cesarean compared with spontaneous and instrumental vaginal deliveries 

Flatus 3 months postpartum 1.

Melville, 2005338

N = 6,888 

Cesarean deliveries only Fecal incontinence 0.8

MacArthur, 2001405

N = 7,879 

Breech delivery Fecal incontinence 3 months postpartum 1.49 

Frudinger, 2002440N = 134 

Caesarean delivery Anal incontinence 0.31 

MacArthur, 2001 Fecal incontinence 3 months postpartum 0.58 

405

N = 7,879 

Caesarean Section 

Frequent Fecal incontinence 3 months postpartum 0.36 

persistent Fecal incontinence 6 years postpartum among 

primiparae at index delivery 

Macarthur, 2005 0.56 

404

N = 4,046 

Caesarean Section 

Persistent Fecal incontinence 6 years postpartum 1.07 

Faltin, 2006442

N = 240 

Cesarean delivery Severity, at least 2 symptoms at least 

once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

18 years after rupture of anal sphincter tear during childbirth 

0.61 

Cesarean delivery vs. spontaneous vaginal delivery 

0.61 

Cesarean delivery with labor vs. vaginal delivery 

1.66 

Lal, 2001443

N = 184 

Cesarean delivery without labor vs. vaginal delivery 

Anal incontinence 10 months postpartum 

1.62 

Abramov, 2005 Fecal incontinence 0.39 

424

N = 346 

Cesarean only delivery 

Flatus 0.92 

Uustal Fornell, 2004208N = 885 

Cesarean section only Anal incontinence 1.00 

Bharucha, 2006422N = 2,800 

Cesarean section only, no surgery 

Fecal incontinence 0.

Richter, 2005406N = 180 

Number of cesarean deliveries 

Anal incontinence Morbid obesity before 

laparoscopic weight loss surgery 

0.84 
Table F57. Association between FI and mode of delivery (continued) 

F352 

Author 

Sample Risk Factor Definition of Fecal Incontinence Time From Exposure to Fecal Incontinence O

Macarthur, 2005404N = 4,046 

Only caesarean section(s) 

Fecal incontinence 6 years postpartum 1.04 

Abramov, 2005 Fecal incontinence 1.03 

424

N = 274 

At least 1 episiotomy 

Flatus 1.22 

Eason, 2002283

N = 252 

Episiotomy Anal incontinence 3 months postpartum 1.

Mazouni, 2005228

N = 159 

Episiotomy Fecal incontinence 16 months instrumental 

delivery 

1.00 

Hojberg, 2000215 Episiotomy Severity, isolated flatus incontinence 

at least once a week 

At 16 weeks of gestation in the index-pregnancy 

1.

Fecal incontinence 3 months postpartum 3.20 

6 months postpartum 2.90 3 months postpartum 2.10 

Episiotomy v 2nd/3rd/4th degree tear 

Flatus 

6 months postpartum 2.10 

Fecal incontinence 3 months postpartum 5.50 

6 months postpartum 3.70 3 months postpartum 1.70 

Signorello, 2000444

N = 626 

Episiotomy v intact/1st degree tear 

Flatus 

6 months postpartum 2.30 

De Leeuw, 2001307N = 250 

Mediolateral episiotomy, multiparity 

Fecal incontinence after anal sphincter damage 

during delivery 

1.25 

Casey, 2005367

N = 3,887 

Forceps delivery Anal incontinence Within 7 months of delivery, at 

or before their 6-month contraceptive follow up after delivery 

1.2 

Eason, 2002283

N = 252 

Forceps delivery Anal incontinence 3 months postpartum 1

Guise, 2007410

N = 8,774 

Forceps use, ever severity, incontinence of stool 1.29 

Abramov, 2005 Fecal incontinence 0.9

424

N = 274 

At least 1 forceps delivery 

Flatus 0.76 

Frudinger, 2002440N = 134 

Forceps delivery Anal incontinence 1.36 

Sultan, 1993445

N = 90 

Forceps delivery Fecal incontinence 1.81 

MacArthur, 2001405

N = 7,879 

Forceps delivery Fecal incontinence 3 months postpartum 1.94 

Sultan, 1993 Forceps delivery Urgency 7.23 

445

N = 90 Forceps delivery Fecal incontinence and urgency 19

MacArthur, 2001405

N = 7,879 

Forceps delivery Frequent fecal incontinence 3 months postpartum 1.94 
Table F57. Association between FI and mode of delivery (continued) 

F353 

Author 

Sample Risk Factor Definition of Fecal Incontinence Time From Exposure to Fecal Incontinence O

Forceps deliver; n = 1,793 Persistent fecal incontinence 6 years postpartum among 

primiparae at index delivery. 

Macarthur, 2005 2.50 

404

N = 4,046 

Forceps delivery; n =3,813 

Persistent Fecal incontinence 6 years postpartum 2.06 

Meyer, 2000446

N = 107 

Forceps delivery vs. spontaneous delivery 

Fecal incontinence 10 month after delivery 0.80 

Forceps delivery vs. Spontaneous delivery 

Fecal incontinence incident 3-4 years after delivery 1.25 

Forceps delivery vs. Spontaneous delivery 

Fecal incontinence 3-4 years after delivery 0.80 

Forceps delivery vs. Spontaneous delivery 

Fecal incontinence Grade 2 3-4 years after delivery 0.67 

Forceps delivery vs. Spontaneous delivery 

Fecal incontinence Grade 3 3-4 years after delivery 1.23 

Schraffordt Koops, 2003447N = 479 

Forceps delivery vs. Spontaneous delivery 

Fecal incontinence Grade 4 3-4 years after delivery 1.68 

Guise, 2007410

N = 8,774 

Forceps use, this delivery Severity, incontinence of stool 1.6

Macarthur, 2005404N = 4,046 

≥1 forceps deliveries Fecal incontinence 6 years postpartum 1.48 

Hojberg, 2000215 Outlet forceps Severity, isolated flatus incontinence 

at least once a week 

At 16 weeks of gestation in the index-pregnancy 

3.5 

Bharucha, 2006422N = 2,800 

Vaginal delivery with forceps or stitches, no surgery 

Fecal incontinence 1.2 

Mahony, 2007448

N = 500 

Instrumental delivery Fecal incontinence 3.10 

Pain on opening bowels 6 weeks postpartum 1.34 Constipation 6 weeks postpartum 0.85 Increased passage of flatus 6 weeks postpartum 1.44 Hemorrhoids 6 weeks postpartum 1.34 Loss of control of bowels 6 weeks postpartum 1.25 Pain on opening bowels 1 year postpartum 1.53 Constipation 1 year postpartum 2.55 Increased passage of flatus 1 year postpartum 1.66 Hemorrhoids 1 year postpartum 1.70 

Liebling, 200425

N = 393 

Instrumental delivery vs. Cesarean 

Loss of control of bowels 1 year postpartum 1.74 

Faltin, 2001 Operative delivery Anal incontinence 1.

328

N = 1,228 Operative delivery Fecal incontinence urgency 1 
Table F57. Association between FI and mode of delivery (continued) 

F354 

Author 

Sample Risk Factor Definition of Fecal Incontinence Time From Exposure to Fecal Incontinence O

Nichols, 2005432

N = 190 

Operative delivery vs. vaginal delivery in stage II pelvic organ prolapse and/or urinary incontinence 

Bothersome anal incontinence 4.50 

Nichols, 2004449

N = 100 

Operative vaginal delivery Anal incontinence 3.75 

Nichols, 2005432

N = 190 

Operative vaginal delivery pelvic floor disorders vs. not operative delivery 

Bothersome anal incontinence 3.60 

Faltin, 2006442

N = 540 

Overactive vaginal delivery 

Severity, at least 2 symptoms at least once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

18 years after rupture of anal sphincter tear during childbirth 

1.83 

Hojberg, 2000215 Oxytocin stimulation vs. 

stimulation 

Severity, isolated flatus incontinence at least once a week 

At 16 weeks of gestation in the index-pregnancy 

0.

% of days perineal massage performed <33 % of days perineal massage performed ≥ 67 

0.

Eason, 2002283

N = 252 

% of days perineal massage performed; 33-66 

Anal Incontinence 3 months postpartum 

1 

Abramov, 2005 Fecal incontinence 1.12 

424

N = 274 

At least 1 prolonged second stage of labor (>2 hrs) 

Flatus 1.04 

Mazouni, 2005228

N = 159 

Length of labor 1 Fecal incontinence 15 months instrumental 

delivery 

1.00 

Hojberg, 2000 

215 Length of second stage 

≤90 minutes 

Severity, isolated flatus incontinence at least once a week 

At 16 weeks of gestation in the index-pregnancy 0.

Length of second stage of labor, ≥1.5 hour(vaginal delivery only) 

0.

Length of second stage of labor, 0.5-0.9 hour(vaginal delivery only) 

0.

Eason, 2002283

N = 252 

Length of second stage of labor, 1-1.4 hour(vaginal delivery only) 

Anal incontinence 3 months postpartum 

0.
Table F57. Association between FI and mode of delivery (continued) 

F355 

Author 

Sample Risk Factor Definition of Fecal Incontinence Time From Exposure to Fecal Incontinence O

Guise, 2007410

N = 8,774 

Pushing time ever ≥1 hour 

Severity, incontinence of stool 1.07 

Frudinger, 2002440N = 134 

Second stage (hours) Fecal incontinence 0.89 

Casey, 2005367

N = 3,887 

Second stage >2 hours vs. ≤2 hours 

Fecal incontinence Within 7 months of delivery, at 

or before their 6-month contraceptive follow up after delivery 

0.4 

Flatus 1.40 Liquid 2.00 

Uustal Fornell, 2004208N = 885 

Delivery by vacuum extractor 

Solid 1.20 

Schraffordt Koops, 2003447N = 479 

Vacuum extraction vs. Spontaneous delivery 

Fecal incontinence Grade 4 3-4 years after delivery 0.71 

Eason, 2002283

N = 252 

Vacuum delivery Anal incontinence 3 months postpartum 1.

Guise, 2007410

N = 8,774 

Vacuum only, ever Severity, incontinence of stool 1.12 

MacArthur, 2001 Fecal incontinence 3 months postpartum 1.26 

405

N = 7,879 

Vacuum delivery 

Frequent fecal incontinence 3 months postpartum 1.29 

Vacuum delivery; n = 1,793 

Persistent Fecal incontinence 6 years postpartum among 

primiparae at index delivery. 

Macarthur, 2005 0.41 

404

N = 4,046 

Vacuum delivery; n =3,813 

persistent Fecal incontinence 6 years postpartum 0.47 

Hojberg, 2000215 Vacuum extraction Severity, isolated flatus incontinence 

at least once a week 

At 16 weeks of gestation in the index-pregnancy 

1.

Fecal incontinence Incident 3-4 years after delivery 0.85 Fecal incontinence 3-4 years after delivery 1.18 Fecal incontinence Grade 2 3-4 years after delivery 0.97 

Schraffordt Koops, 2003447N = 479 

Vacuum extraction vs. Spontaneous delivery 

Fecal incontinence Grade 3 3-4 years after delivery 0.97 

Guise, 2007410

N = 8,774 

Vacuum only, this delivery 

Severity, incontinence of stool 1.12 

Anal incontinence 6-24 weeks postpartum 0.83 Fecal incontinence urgency 6-24 weeks postpartum 1 (0Flatus incontinence >1/week 6-24 weeks postpartum 1.7Incontinence for liquid stood >1/week 6-24 weeks postpartum 7.4Incontinence for solid stool >1/week 6-24 weeks postpartum 3.0

Peschers, 2003450

N = 100 

Vacuum vs. spontaneous vaginal delivery 

Flatus 6-24 weeks postpartum 1 (0
Table F57. Association between FI and mode of delivery (continued) 

F356 

Author 

Sample Risk Factor Definition of Fecal Incontinence Time From Exposure to Fecal Incontinence O

Liquid 6-24 weeks postpartum 1 (0Solid 6-24 weeks postpartum 3.1Fecal incontinence soiling 6-24 weeks postpartum 0.6

Faltin, 2006442

N = 540 

Non operative vaginal delivery 

Severity, at least 2 symptoms at least once a week or 3 symptoms (symptoms: incontinence to flatus, liquid or solid stool; need to wear a pad; lifestyle alteration) 

18 years after rupture of anal sphincter tear during childbirth 

De Leeuw, 2001307N = 250 

Subsequent vaginal delivery 

Fecal incontinence After anal sphincter damage 

during delivery 

2.32 

Boreham, 2005331

N = 457 

Vaginal parity (per delivery) 

Anal incontinence 1.1Fecal incontinence 6 weeks postpartum 1.1 Fecal incontinence 6 months postpartum 1.01 Fecal incontinence urgency 6 weeks postpartum 0.67 Fecal incontinence urgency 6 months postpartum 0.53 Flatus 6 weeks postpartum 1.3 

Borello-France, 2006451N = 472 

Vaginal control 

Flatus 6 months postpartum 0.48 

Ng, 2002408

N = 320 

Vaginal delivery Anal incontinence 1.09 

Chen, 2003284

N = 1,253 

Vaginal delivery Anal incontinence 1.

Flatus 1.10 Flatus 1.50 Liquid 0.80 Liquid 1.00 

Uustal Fornell, 2004208N = 885 

Vaginal delivery 

Solid 1.00 

Bharucha, 2006422N = 2,800 

Vaginal delivery without forceps or stitches, no surgery 

Fecal incontinence 0.

MacLennan, 2000 Fecal incontinence 1.50 

84

N = 3,010 

Vaginal vs. Caesarean delivery Flatus 1.80 

H/O operative vaginal delivery 

Melville, 2005 Fecal incontinence 1.52 

338

N = 6,888 

Mixed/unknown delivery types 

Fecal incontinence 1.44 

Bold = multivariate odds ratios * Significant difference 
F357 

Evidence Tables — Clinical Interventions to Reduce Risk of Incidence aProgression of Urinary Incontinence in Adults 
F358 

Clinical Interventions on Urinary Incontinence in Adults in Long-term Care Settings and NursinTable F58. Effects of implementation of evidence based guidelines on urinary incontinence in residents of nursing homes 

Study Participants Clinical Interventions Outcomes 

Ryden, 2000452

Quasiexperimental RCT to examine the effect of scientifically based protocols implemented by advanced practice gerontological nurses for incontinence in nursing home residents Duration: 6 months 

Consecutive cohorts of newly admitted residents in 3 licensed proprietary nursing homes certified for Medicare, 

located in the suburban area comparable by occupancy 

rates, staff-to-resident ratios, staff turnover, resident 

acuity, and percentage of residents whose medical care

was monitored by external nurse practitioners employed by physician group practices or managed care groups with 

201-262 beds. Loss of followup: 86 treatment residents (2.4% withdrew, 

18.0% were discharged, and 27.5% died) and 111 

comparison group residents (2.0% withdrew, 9.2% were 

discharged, and 16.3% died). 

1. Implementation of evidencebased protocol by advanced practice gerontological nurses: in-service staff education and direct resident care. 2. Usual care by nursing home staff. 

Urinary incontinerecorded by nurshome staff in 

Incontinence monitoring schedobservations evehours, 24 hours a day for 3 days; percentage of wetness 5; averanumber of times per day for the 3-period. 

Schnelle, 1995453

Multicenter non controlled intervention to examine computerized total quality management model for implementation of incontinence system in nursing homes. Duration: 6 months. 

9 nursing homes, members of state long-term care association location within 1.5 hours driving distance from one another, agree to train staff. Exclusion criteria: not representative staffing rates and resident mix compared to nursing homes in the area. 

Gradual implementation of computerized quality management model based on the federal guidelines for medical assessment and individualized prompted voiding protocols of incontinence. 

% of wet residencollected using random hour wet check procedure independent research assistanwith nursing homexperience 
F359 

Table F59. Comparative effectiveness of implementation of evidence-based guidelines on urinary incontinence in residents of nur

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

% of times wet recorded by nurse 

35 40 21.0 26.0 0.8 (0.5; 1.2) 

% of residents with Improvement in incontinence recorded by nurse 

78 66 47.0 43.0 1.1 (0.9; 1.4) 

Ryden, 2000452N = 319 71% female 

Implementation of evidencebased protocol by advanced practice gerontological nurses: inservice staff education and direct resident care. 

Usual care by nursing home staff 

Incontinence prevalence reported by a nurse 

106 108 63.9 70.6 0.9 (0.8; 1.1) 

Schnelle, 1995453N = 85 

After gradual implementation of computerized quality management model for medical assessment and individualized prompted voiding protocols of incontinence 

Before gradual implementation of computerized quality management model for medical assessment and individualized prompted voiding protocols of incontinence 

% of wet residents 

14 26 17.0 31.0 0.5 (0.3; 1.0) 
F360 

Table F60. Effects of conservative management programs on urinary incontinence in females, residents of nursing homes 

Study Participants Clinical Interventions Outcomes 

Hu, 1990454

RCT to examine the effects of behavioral training therapy on incontinent elderly in nursing homes. Duration: 3 months, followup: 22 weeks. 

133 incontinent elderly females in seven nursing homes, ages 65 or over, incontinent during the daytime, and able to recognize their own name. Exclusion criteria: not reported. Loss of followup: 7%. 

1. Behavioral therapy program for 3 months implemented by project-trained NRAs. With hourly wet checks, prompted and assisted toileting, positive reinforcement, bladder training to hold urine until the next hourly check. 2. Usual care. 

Reported by nursparticipants' wet episodes and patrequests for toile

Hu, 1989455

RCT to examine the effects of behavior therapy program for urinary incontinence on women residents of nursing homes. Duration: 3 months. 

143 women with confirmed stress incontinence in seven nursing homes with ability to recognize her own name. Exclusion criteria: hospitalization, insufficient number of wet episodes per day (an average 0.18). Loss of followup: 6.9% 

1. 13-week behavior therapy program for urinary incontinence which included hourly checking and prompting of individuals to toilet, praising for successful toileting, and social reinforcement (additional personal service). Assisted toileting between scheduled voiding. The program was implemented 14 hours/day, 7 days/week for 3 months. 2. Control group received usual incontinence-related care. 

The change in urinary stress incontinence measured by the as wet checks/tochecks/day (14 times/day). 

Ouslander, 2001456RCT to examine the effects of oral estrogen/progestin on incontinence in female nursing home residents. Duration 6 months 

32 incontinent female residents (average age 88) from 5 nursing homes. Incontinence was diagnosed by nursing home staff and research staff using checks for wetness as involuntary loss of urine at least daily. Exclusion criteria: Medicare reimbursement (indicating a potential short stay and/or medical instability), terminal illness, cognitive impairment; history of breast or cervical cancer; wet <1/day on research staff checks; enteral feeding ; poor cooperation with screening procedures ; severe physical immobility, requiring a lift or 3-person transfer. Loss of follow up: 34% 

1.Oral estrogen (0.625mg) combined with progesterone (2.5mg) and regular toileting assistance (prompted voiding) by trained research aides during 3-day data-collection periods 2. Placebo and regular toileting assistance (prompted voiding) by trained research aides during 3-day data-collection periods 

The frequency of urinary incontinenas wetness rate = the percentage ochecks at which research staff fouresidents to be wduring three 8-hodays of prompted voiding. The appropriate toiletrate was calculatby dividing the number of continvoids by the total number of voids. 
Table F60. Effects of conservative management programs on urinary incontinence in females, residents of nursing homes 9con

F361 

Study Participants Clinical Interventions Outcomes 

Cough tests for stress incontinenas positive (simultaneous leakage with counegative with estimated bladdevolumes of at lea100ml (determineby voided volume plus residual bladvolume by ultrasound), negative, or unabto perform (some subjects would ncough on comma
F362 

Table F61. Comparative effectiveness of conservative management programs on urinary incontinence in females, residents of 

Author Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI)

Num

Nee

to T

(95% 

% improvement in urinary incontinence reported by nursing home staff 

19 6 26.0 8.0 3.1 

(1.3; 7.4)

(2; 

Hu, 1990 

454

N = 143 

Behavioral therapy program for 3 months implemented by the projecttrained NRAs. 

Usual care 

75-99% improvement in urinary incontinence reported by nursing home staff 

4 3 5.0 4.0 1.3 

 (0.3; 5.7) 

Ouslander, 2001456N = 32 

Oral estrogen (0.625 mg) combined with progesterone (2.5 mg) and regular toileting assistance (prompted voiding) by trained research aides during 3-day datacollection periods 

Placebo and regular toileting assistance (prompted voiding) by trained research aides during 3-day datacollection periods 

Positive cough test 

0 3 0 17.6 0.16 

(0.01; 2.88) 

Bold- significant differences in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome inn1 pa

outcome in the control –rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group) ; A- avoided; E- excessive events 
F363 

Table F62. Comparative effectiveness of conservative management programs on urinary incontinence in 143 females, resident

Author Active Treatment Control Treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean Difference 

(95% CI) 

% 

Behavioral therapy program for 3 months implemented by the project-trained registered nurses 

Usual care Urinary wet 

episodes/day reported by nursing home staff 

Hu, 1989 1.7 ± 1.8 1.9 ± 1.3 -0.2 (-0.5; 0.2) -9

455

13-week behavior therapy program for urinary incontinence 

Usual incontinencerelated care 

Number of incontinence episodes/day 

2.2 ± 1.3 2.1 ± 1.1 0.1 (-0.2; 0.5) 6

Ouslander, 2001456N = 32 

Oral estrogen (0.625 mg) combined with progesterone (2.5 mg) and regular toileting assistance (prompted voiding) by trained research aides during 3-day data-collection periods 

Placebo and regular toileting assistance (prompted voiding) by trained research aides during 3-day data-collection periods 

Appropriate toileting rate,% of continent voids by the total number of voids 

37 ± 31 31 ± 29 0.20 (-0.50; 0.90) 0.
F364 

Table F63. Effects of conservative management programs on urinary incontinence in residents of nursing homes

Study Participants Clinical Interventions Outcomes 

Schnelle, 1989457

RCT to examine the effects of prompted voiding treatment of urinary incontinence in nursing home patients. Duration: 5-10 days. 

126 incontinent patients from proprietary nursing homes (bed size 90-150), not affiliated with universities with correct discriminatory responses to instructions to point to shown subjects (pencil or glass). Exclusion criteria: continence, transfer to hospital during run-in period. Loss of followup: 60% during the run-in period, 2.4% after randomization. 

1. Prompted voiding treatment: check for incontinence, asking for needed toileting assistance, prompted voiding, and socially reinforced for appropriate toileting. 2 .Usual care. 

Urinary incontinence measured by nurse as wet checks/total checks and daily percent of appropriate toileting equal number of times the patient voided in any toilet receptacle/total number of appropriate and incontinent voiding. 

Ouslander, 2005458

Crossover RCT to examine the effects of functional incidental training on incontinence in nursing homes. Duration: 8 weeks. 

107 patients in nursing homes, (resided in the facility at least 30 days and not initially admitted for short-term care; able to state their name, or in the presence of aphasia, capable of reliably pointing to two objects; required assistance by two or fewer people for transfer from bed to chair; with life expectancy of at least 6 months; not receiving active physical therapy; and ages 60 and older. Exclusion criteria: continence, severe behavioral changes, terminally ill. Loss of followup: 60%. 

1. Functional incidental training: prompted voiding combined with individualized, functionally oriented endurance and strengthtraining exercises offered 4 times/day, 5 days/week. 2. Usual care. 

Urinary and fecal incontinence measured as wet checks/total checks of the participants every 2 hours. Appropriate toileting rate: number of voids or bowel movements that were continent divided by the total number of voids or bowel movements. 

Schnelle, 2002459

RCT to examine the effects of integrated incontinence care and exercise on urinary incontinence in nursing home residents. Duration: 8 months. 

256 incontinent residents in 4 nursing homes. Exclusion criteria: post-acute skilled care units, terminally ill. Loss of followup: 26%. 

1. Integrated incontinence care and exercise every 2 hours 5 days a week including fluid prompting, prompted toileting, and regular wet checks, arm raise and arm curl exercises. 2. Usual care. 

Fecal and urinary incontinence frequency as % of hourly wet checks and the appropriate toileting ratio calculated by dividing the number of times a resident used a toilet or toilet substitute by the total number of voids. 
Table F63. Effects of conservative management programs on urinary incontinence in residents of nursing homes (continued)

F365 

Study Participants Clinical Interventions Outcomes 

Jirovec, 2001460

RCT to examine the effects of individualized scheduled toileting program on incontinent, memoryimpaired elders being cared for at home. Duration: 6 months. 

118 caregivers for incontinent, memory-impaired elders. Exclusion criteria: fecal continence. Loss of followup: 16.9% during implementation and 37% during 6 months period. 

1. Individualized scheduled toileting procedure of every 2 hours and fluid intake ~six 8-oz glasses /day provided by trained caregivers. 2. Usual care. 

Incontinence calculated as the percentage of time the patient was incontinent by dividing the incontinent episodes by the total number of voiding episodes, both continent and incontinent. 

Colling, 1992461

Quasi-experimental RCT to examine the effects of individualized form of habit training for urinary incontinence among elderly nursing homes residents. Duration: 12-week intervention and 12 week followup. 

113 elderly subjects, 65 years and older with >3 episodes of clinical and urodynamic urinary incontinence/week for the last 12 weeks, cognitively and/or physically impaired, residents of 4 non-profit urban nursing homes with bed size 120-342. Exclusion criteria: toilet with assistance of more than1 staff member, fecal impaction, rectal or pelvic mass, prostate diseases, severe prolapse, atrophic vaginitis, neurological diseases, postresidual volume >200ml. Loss of followup: 21% 

1. Individualized form of habit training for urinary incontinence administered by trained staff: toileting within 30 minutes prior to the mean time of voids within 1 hour block of time. Verbal encouragement to nursing staff to comply with the program. 2. Usual care. 

Episodes of urinary incontinence/day measured by nursing staff. Wet checks were done hourly for one 24-hour period at 3-week intervals. Continuous electronic monitoring of voids for precise voiding schedule for each subject. 
F366 

Table F64. Comparative effectiveness of conservative management programs on urinary incontinence in residents of nursing hmeasures) 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Colling, 1992461N = 113 66% female 

Individualized form of habit training for urinary incontinence administered by trained staff: toileting within 30 minutes prior to the mean time of voids within 1 hour block of time. Verbal encouragement to nursing staff to comply with the program. 

Usual care Incontinent 

volume of urine loss, ml 

500.0 ±

450.0 

600.0 ±

400.0 

-0.2 (-0.6; 0.1

Schnelle, 2002459N = 190 84% female 

Integrated incontinence care and exercise every 2 hours 5 days a week including fluid prompting, prompted toileting, and regular wet checks, arm raise and arm curl exercises 

Usual care Urinary 

incontinence frequency, % of wet checks 

23.0 ± 21.0 35.0 ± 21.0 -0.6 (-0.9; -0.

Percent appropriate toileting 

Schnelle, 59.4 ± 26.7 16.8 ± 22.0 1.7 (1.3; 2.21989457N = 126 75% female 

Prompted voiding treatment: check for incontinence, asking for needed toileting assistance, prompted voiding, and socially reinforced for appropriate toileting 

Usual care 

Percent wet checks/total checks, % 

17.8 ± 13.0 34.5 ± 16.8 -1.1 (-1.5; -0.

Colling, 1992461N = 113 66% female 

Individualized form of habit training for urinary incontinence administered by trained staff: toileting within 30 minutes prior to the mean time of voids within 1 hour block of time. Verbal encouragement to nursing staff to comply with the program. 

Usual care Urinary 

incontinence episodes/day (wet checks) 

3.9 ± 1.0 4.8 ± 1.0 -0.9 (-1.3; -0.

Change after the treatments in wet checks/total checks,% 

Ouslander, -17 (-83.9; 492005458N = 107 10% female 

Functional Incidental training: prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered 4 times/day, 5 days/week 

Usual care 

Wet checks/total checks, % 

25.0 ± 50.0 50.0 ± 28.0 -0.6 (-1.0; -0.
Table F64. Comparative effectiveness of conservative management programs on urinary incontinence in residents of nursing h

measures) (continued) 

F367 

Author 

Sample Active Treatment Control Treatment Outcome Mean 

± STD 

After Active 

Treatment 

Mean 

±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Jirovec, 2001460N = 118 30 % female 

Individualized scheduled toileting procedure of every 2 hours and fluid intake ~six 8-oz glasses/day provided by trained caregivers. 

Usual Care % of urinary 

incontinent episodes/total voids 

37.0 

± 28.0 49.0 

± 36.0 -0.4 (-0.7; 0.0

Bold- significant differences in outcomes at 95%confidence level 
F368 

Table F65. Effects of conservative management programs on urinary incontinence in patients admitted for rehabilitation follow

hemispheric stroke

Study Participants Clinical Interventions Outcomes 

Wikander, 1998462

RCT to examine the effects of rehabilitation governed by functional independence measure on urinary incontinence in patients with acute hemispheric stroke Duration: Length of stay in the ward (~90 days) 

34 incontinent stroke patients admitted for rehabilitation following acute unilateral hemispheric stroke. Exclusion criteria: not reported. Lost of followup: none 

1. Specially designed education for ward staff based on the Functional Independence Measure Scale and for patients to manage incontinence independently. 2. Conventional method inhibiting abnormal muscle tone by handling and guiding the stroke patient in specific ways to relearn normal movements, which makes the patient dependent on ward staff for a longer period of time. 

Urinary incontineand the need for assistance becauof urinary incontinence assessed by the with FIM-G (7-poscale, 7 - independent - 1- totally dependent 
F369 

Table F66. Comparative effectiveness of conservative management programs on urinary incontinence in patients admitted for acute unilateral hemispheric stroke 

Author 

Sample Outcome Active Treatment Control Treatment 

Number 

of Case 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Number cured at discharge 

20 3 95.2 23.1 4.1 (1.5; 11.2) 

Wikander, 1998462N = 34 56% female 

Number discharged to a nursing home due to incontinence 

Specially designed rehabilitation program to increase patient independent management of UI 

Conventional rehabilitation program (patient dependent on ward staff for a longer period of time). 

2 8 9.5 61.5 0.2 

(0.0; 0.6) 

Bold- significant differences in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome inn1 paoutcome in the control –rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group) ; A- avoided; E- excessive events 
F370 

Clinical Interventions on Urinary Incontinence in Adults in the Community Table F67. Effects of implementation of evidence based guidelines on urinary incontinence in adults 

Study Participants Clinical Interventions Outcomes 

Chadha, 2000463

RCT to examine the effects of national guidelines and local protocols in improving hospital care for women with UI. Duration: 12 months 

449 women with urinary incontinence from gynecology units in four district general hospitals across Scotland. Exclusion criteria: not reported. Loss of followup: 7.6% 

National evidence based guidelines adapted locally to protocols, which were disseminated at specific local educational meetings and implemented by placing a copy of the appropriate protocol in women's hospital case notes prior to consultation. 

Self reported perception of urinary incontinence based on questions routinely asked by clinicians. 

No RastsizbablanBacoraSafoou
F371 

Table F68. Comparative effectiveness of evidence based guidelines on urinary incontinence in adults, self reported severity anincontinence 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean Difference 

(95% CI) 

Chadha, 2000463N = 449 100% female 

National evidence based guidelines adapted locally to protocols, which were disseminated at specific local educational meetings and implemented by placing a copy of the appropriate protocol in women's hospital case notes prior to consultation. 

Preguidelines levels 

Self -reported perception of urinary incontinence, scores 

15.5 ± 20.3 13.9 ± 20.7 0.1 (-0.1; 0.2) 
F372 

Table F69. Effects of conservative management programs on urinary incontinence in community-dwelling adults 

Study Participants Clinical Interventions Outcomes 

Williams, 2005464RCT to examine the effects of continence service provided by specially trained nurses delivering evidence-based interventions using predetermined care pathways in adults. Duration: 6 months 

3,746 men and women ages 40 years and over living in private households reporting incontinence several times per month or more, or several times a year and reported significant impact of symptoms on quality of life. Exclusion criteria: pregnancy, urinary fistula, pelvic malignancy, treatment for urinary symptoms. Loss of followup: 37% refused followup at 3 months, 22% refused followup at 6 months. 

1. Continence service that included advice on diet and fluids; bladder training; pelvic floor awareness and lifestyle advice. 2. Existing primary care including GP and continence advisory services in the area. 

Self-reported in validated questionnaire improvement or cure in one or more symptoms of total incontinence, urgency, frequency and nocturia. 

InRhfapcraS

Borrie, 2002465

RCT to examine the effects of combined lifestyle and behavioral interventions led by nurses in the management of urinary incontinence. Duration: 6 months 

421 subjects 26 years of age or older with self reported urinary incontinence at least once per week, resided in the community, and communicated in English. Exclusion criteria: pregnancy, residency of long-term care institutions, dementia. Loss of followup: 10.1% 

1. Lifestyle modification sessions every 4 weeks led by trained "nurse continence advisers" with a physician with expertise in continence management. 2. Usual care 

Self reported urinary incontinent events (measured using bladder diaries) and pad use (measured using the questionnaire) per 24 hours 

InCrap4acrafo

Dowd, 2000466

RCT to examine the effects of cognitive strategies combined with educational programs in urinary incontinence. Duration: 6 weeks 

40 subjects >40 years of age, independent in self-care, with history of incontinence and/or frequency for at least 6 months, able to read and write English, and having hearing adequate for listening to an audiotape. Exclusion criteria: presence of urinary tract infections or severe neurological disorders. Loss of followup: not reported 

1. Education about bladder health, recorded incontinence and frequency episodes in a voiding diary, and listening to the audiotape daily. 2. Education about bladder health and recorded incontinence and frequency episodes in the voiding diary 

Comfort measured with the Urinary Incontinence and Frequency Comfort Questionnaire (UIFCQ) - 23 positive and negative items ranging from strongly agree to strongly disagree scored from 1 to 6 - higher comfort. The number of incontinent episodes and frequency of toileting recorded in a voiding diary with scores 8-96 incontinent episodes and 50-125 frequency episodes per week. 

Nlaarecran
Table F69. Effects of conservative management programs on urinary incontinence in community-dwelling adults (continued) 

F373 

Study Participants Clinical Interventions Outcomes 

Moore, 2003467

RCT to examine the effects of nurse continence advisors and urogynaecologists in conservative management of urinary incontinence. Duration: 12 weeks 

145 consecutive patients with stress and/or urge incontinence with idiopathic detrusor instability, sensory urgency, and mild or moderate leakage (urine loss in 1-hour pad test 2-9.9ml/hour or 10-50ml/hour). Exclusion criteria: previous pelvic radiotherapy, proven recurrent bacterial cystitis, prolapse beyond the introitus, uterine enlargement or incomplete bladder emptying (postvoid residual >100ml). Loss of followup: 22% 

1. 2 nurse continence advisors/patient and consulting urogynecologist for 25-35 minutes/week provided bladder training, gradual increase in fluid intake, individual deferment techniques, pelvic floor muscle exercise and examination, transvaginal electrostimulation. 2. Outpatient regimen with 15-20 minute consultation with referral to physiotherapist and bladder training. 

1-hour pad test, frequency volume charts, a 20-point incontinence score, and two quality of life tests (Incontinence Impact Questionnaire and Urogenital Distress Inventory). Objective cure as dry on 1-hour pad test. Subjective cure as >50% benefit on pad test but the patient felt cured and ready for discharge 

InCrarelebcBaS

McFall, 2000468,469

RCT to examine the effects of communitybased intervention on self-management of urinary incontinence in elderly women Duration: 3 months 

145 women ages 65 or older with self reported urinary incontinence ≥ 3 months, residing in Oklahoma. Exclusion criteria: Severe prolapse of uterus, hematuria, diverticulum, fistula, unresolved urinary tract infection, two or more urinary tract infections within 3 months, urinary obstruction, overflow incontinence, a postvoid residual volume of urine (PVR) >100ml, and blood glucose >300 mg/dl on two or more visits in a 3 month period, functional disability, severe hearing or vision problems, low literacy, and cognitive impairment. Loss of followup: 8.3% 

1. Community-based intervention with 5 biweekly sessions of education and skill-building, for bladder training, managing the urge to urinate, and performing pelvic muscle exercises. Group support by registered nurses; occupational therapist, and public health educator. 2. Usual care 

Self reported episodes of incontinence and frequency of voluntary micturition (voiding) per week. 

Nlaarecraju
F374 

Table F70. Comparative effectiveness of conservative management programs on urinary incontinence in adults (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

% 

Active 

% 

Control 

Relative 

Risk 

(95% CI) 

Numbe

Needed 

Treat 

(95% C

% of mild urinary incontinence or no problem with urine leakage 

2,337 552 79.0 70.0 1.1 (1.1; 1.2) 11 (8; 1

% satisfied with current urinary symptoms for rest of life 

1,893 418 64.0 53.0 1.2 (1.1; 1.3) 9 (6; 15

% cured 828 150 28.0 19.0 1.5 (1.3; 1.7) 11 (7; 2Frequency (≥once hourly) 

710 260 24.0 33.0 0.7 (0.6; 0.8) 11 (9; 1

Improvement 1,834 410 62.0 52.0 1.2 (1.1; 1.3) 10 (7; 1Leakage (several times/month) 

1,804 512 61.0 65.0 0.9 (0.9; 1.0) 

Nocturia (≥3 times/night) 

562 189 19.0 24.0 0.8 (0.7; 0.9) 20 (13; 4

Williams, 2005464N = 3,746 60% female 

Continence service that included advice on diet and fluids; bladder training; pelvic floor awareness and lifestyle advice 

Existing primary care including GP and continence advisory services in the area 

Urgency: very strong or overwhelming 

917 331 31.0 42.0 0.7 (0.7; 0.8) 9 (7; 13

Bold- significant differences in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome inn1 pa

outcome in the control –rate of the outcome in the active group); Number of attributable events= 1000*(rate of the outcome in the contro

the active group) ; A- avoided; E- excessive events 
F375 

Table F71. Comparative effectiveness of combined conservative management programs on urinary incontinence in females (ev

Author 

Sample Active Treatment Control Treatment Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI

Moore, 2003467N = 145 

2 nurse continence advisors/patient and consulting urogynecologist for 25-35 minutes/week provided bladder training, gradual increase in fluid intake, individual deferment techniques, pelvic floor muscle exercise and examination, transvaginal electro stimuli. 

Out patient regimen with 15-20 minute consultation with referral to physiotherapist and bladder training. 

Objective cure as dry on 1-hour pad test 

37 27 50.0 38.0 1.3 (0.9; 1

Self reported urinary continence (100% improvement) 

McFall, 25 15 35.0 20.0 1.7 (1.0; 22000468N = 145 

Community-based intervention: bladder training, managing the urge to urinate, and performing pelvic muscle exercises. 

Usual care 

Self reported Improvement in urinary incontinence of 50% or greater 

44 28 61.0 38.0 1.6 (1.1; 2

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in1 pa

outcome in the control –rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A- avoided; E- excessive events 
F376 

Table F72. Comparative effectiveness of combined conservative management programs on urinary incontinence in females, seimpact on life

Author 

Sample Active Treatment Control Treatment Outcome Mean ± After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Incontinence score 4.0 ± 1.8 3.0 ± 2.0 0.5 (0.2; 0.9) Voids/day 6.0 ± 0.7 6.0 ± 0.7 0.0 (-0.3; 0.3) Voids/night 1.0 ± 0.0 1.0 ± 0.0 Pads/day 1.0 ± 0.0 1.0 ± 0.7 Quality of life urogenital distress inventory 

18.0 ± 6.2 15.5 ± 5.0 0.4 (0.1; 0.8) 

Short urogenital distress inventory 16 

8.0 ± 1.5 6.0 ± 2.5 1.0 (0.6; 1.3) 

Quality of life incontinence impact questionnaire 

36.0 ± 9.3 37.5 ± 3.7 -0.2 (-0.5; 0.1) 

Short incontinence impact questionnaire 7 

11.0 ± 1.3 10.0 ± 2.3 0.5 (0.2; 0.9) 

Leaks/week 3.0 ± 4.7 2.5 ± 3.0 0.1 (-0.2; 0.5) 

Moore, 2003467N = 145 

2 nurse continence advisors/patient and consulting urogynecologist for 25-35 minutes/week provided bladder training, gradual increase in fluid intake, individual deferment techniques, pelvic floor muscle exercise and examination, and trans vaginal electrostimulation 

Out patient regimen with 15-20 minutes consultation with referral to physiotherapist and bladder training. 

Pad test (ml) 2.0 ± 4.2 2.0 ± 4.0 0.0 (-0.3; 0.3) 

Self reported number of urinary incontinent episodes/week 

McFall, 3.6 ± 7.2 5.9 ± 8.5 -0.3 (-0.6; 0.0) 2000468N = 145 

Community-based intervention: bladder training, managing the urge to urinate, and performing pelvic muscle exercises 

Usual care 

Nocturnal micturition 9.9 ± 9.3 9.6 ± 5.9 0.0 (-0.3; 0.4) 

Bold- significant differences in outcomes at 95%confidence level
F377 

Table F73. Comparative effectiveness of conservative management programs on urinary incontinence in adults, self reported s

Author 

Sample Active Treatment Control Treatment Outcomes 

Mean ±

STD After 

Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI)

% 

Change in pad use for urinary incontinence events from baseline 

Borrie, -0.9 ± 4.4 -0.1 ± 3.7 -0.2 (-0.4; 0.0) 1952002465N = 446 73% female 

Lifestyle modification sessions every 4 weeks led by trained "nurse continence advisers" 

Usual care 

Change in urinary incontinence events from baseline 

-1.2 ± 3.0 -0.2 ± 3.0 -0.3 (-0.5; -0.1) 168

Bold- significant differences in outcomes at 95%confidence level 
F378 

Table F74. Comparative effectiveness of educational intervention on urinary incontinence in adults (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Numb

Neede

Trea

(95% 

Improvement in the number of incontinent episodes and frequency of toileting 

Dowd, 18.9 9.88 90.0 52.0 1.7 (1.1; 2.7) 3 (1; 2000466N = 40 74% female 

Education about bladder health, recorded incontinence and frequency episodes in a voiding diary, and listening to the audiotape daily 

Education about bladder health and recorded incontinence and frequency episodes in the voiding diary 

Improvement in Urinary Incontinence and Frequency Comfort Questionnaire 

18.9 12.7 90.0 67.0 1.3 (0.9; 1.8) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in1 paoutcome in the control –rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F379 

Table F75. Effects of dietary and other lifestyle interventions on risk and progression of urinary incontinence in adults 

Study Participants Clinical Interventions Outcomes 

Subak, 2005470

RCT to examine the effect of weight loss on urinary incontinence in overweight and obese women. Duration: 3 months 

48 women 18 to 80 years old with body mass index between 25 and 45 kg/m2, urinary incontinence for at least 3 months and at least 4 incontinent episodes/week, the stable dose of other incontinence therapy . Exclusion criteria: pregnancy, urinary tract infection, significant medical condition, pelvic cancer, neurological condition possibly associated with incontinence, interstitial cystitis or potential inability to complete the study. Lost of followup: 4 women; 1 withdrew from the study, 1 dropped due to medical condition, 2 had missing primary outcome data. 

Weight reduction intervention: 3-month standard low calorie liquid diet (800kcals/day or less), increased physical activity to 60 minutes/day, training by a nutritionist, exercise physiologist or behavioral therapist 1. Immediate intervention group2. Delayed for 3 month intervention 

A 7-day voiding diary to report frequency of voids and incontinent episodes classified by clinical type (urge, stress, other). Urodynamic outcomes. 

InblasstRastinraof coBaadrasiz

Dowd, 1996471

RCT to examine the effects of hydration on the number of urinary incontinence episodes. Duration: 5 weeks 

58 women 50 years old and older with incontinence more than 6 months, independent in self-care, English speakers with >20 scores on Mini-Mental State. Exclusion criteria: not provided. Lost of followup: Not reported, 32 women maintained diaries and included in the analysis.

1. Increase fluid intake by 500cc 2. Maintain fluid intake at baseline level 3. Decrease by 300cc 

Self reported episodes of urinary incontinence per week 

No lacoBaprdifreof 

Swithinbank,2005472

Cross-over RCT to examine the effect of caffeine restriction and fluid manipulation in the treatment of patients with urodynamic stress incontinence. Duration: 4 weeks 

69 women with urodynamically proven stress incontinence naive to surgery. Exclusion criteria: Urinary tract infection, hepatic, cardiac or renal disease and diabetes mellitus, use of antidepressants, anticholinergics or diuretics. Lost of followup: 9 women. 

1. Increased decaffeinated fluids to 3 liters daily (20 cups) or decreased decaffeinated fluids to 750ml (5 cups) daily 2. Caffeine restriction and increased fluid intake to 2, 2,673ml /day 3. Caffeine restriction and decreased fluid intake to 872ml/day 

Detailed urinary diaries that included information concerning episodes of urgency and leakage. A 24-hour pad test. 

No lacoBaprju

Tomlinson, 1999473

Quasi-experimental RCT to examine the effect of behavioral management for continence on involuntary urine loss in older, rural women living at home. Duration: 4 weeks 

94 women living in own home with self reported urinary incontinence at least 2/week. Exclusion criteria: Urinary tract infection, bladder cancer, retention of urine, need for a caregiver. Loss of followup: 41 women completed the reported self-monitoring phase. 

1. Nurse managed behavioral management for continence: caffeine intake 1-2 cups/day, fluid intake 1,800-2,400ml/day before 6:00 P.M., voiding schedule every 4 hours, bowel management. 2. Recommendation on behavioral changes without special training or monitoring. 

Self reported number of episodes and severity of urine incontinence. Pad test to measure grams of lost urine. 

No laouacph44wopronsa
Table F75. Effects of dietary and other lifestyle interventions on risk and progression of urinary incontinence in adults (continu

F380 

Study Participants Clinical Interventions Outcomes 

Manonai, 2006474

Cross-over RCT to examine the effect of a soy-rich diet on urogenital symptoms in peri- and postmenopausal women. Duration: Two 12-week diet periods and two 4-week washout periods. 

42 healthy perimenopausal and postmenopausal women between 45-70 years old reported at least one type of urinary incontinence. Exclusion criteria: Presence or history of sex hormone dependent malignancies, liver or renal disorders, and pathology of urogenital tract. Loss of followup: 5 women withdrew from the study because of their inability to comply with this study and 1 was lost to pelvic examination followup. 

1. Self-selected diet with low-fat and low cholesterol foods and soy protein 25g in various forms of soy foods containing more than 50mg/day of isoflavones 2. Self-selected diet with low fat and low cholesterol foods 

Self reported presence of stress and urge urinary incontinence, urgency and frequency of urination (defined by the International Continence Society) scores of symptoms from none (0), mild (1), moderate (2), and severe (3). 

No SianAlunprfoSa

Brown, 2006475

Placebo controlled multi center RCT to examine the effects of intensive lifestyle intervention or metformin on prevalence of urinary incontinence among overweight pre-diabetic women. Duration: 2.9 years 

2,191 women in the Diabetes Prevention Program RCT older than 25 years, body mass index ≥24kg/m2, a fasting plasma glucose level 

95-125mg/dl, and a 2-hour post-challenge glucose level 140-199mg/dl. 

Exclusion criteria: Taking medications that could affect glucose tolerance or serious medical illness. Loss of followup: 234 (11%) women with 

missing urinary incontinence data were excluded from the analysis. 

1. Intensive lifestyle therapy to lose and maintain at least 7% of initial body weight through a lowfat diet and to engage in 

moderate intensity physical activity for at least 150 

minutes/week. 2. Metformin 850mg twice daily 3. Placebo twice daily. 

Self reported incontinence symptoms by frequency and type using a validated questionnaire 

InblstAluncorasizprpr

Bryant , 2002476

RCT to examine the effects of caffeine restriction on urinary incontinence symptoms Duration: 4 weeks 

95 consecutive adult patients with urinary symptoms with routine intake of caffeine >100mg every 24 hours. Exclusion criteria: Cognitive impairment, pregnancy, urinary tract infection. Lost of followup: 21%, 14 subjects failed to return for followup, 4 had anxiety or family problems, 2 were treated, 1 had intercurrent illness. 

1. Education to reduce caffeine intake to <100mg/day plus bladder training. 2. Bladder training: increasing intervals between voiding; increasing fluid intake to 2 L/day; urinary deferment techniques; ceasing “just in case” voiding 

Self reported frequency, urgency and leakage episodes. 

No lacoBathrasiz
F381 

Table F76. Effects of weight reduction on improvement in urinary continence in females 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Num

Need

Tr

(95% 

Stress incontinent episodes/week, % improved 

22 0 92.0 0.1 45.0 (2.9; 

701.9) 

1 (1

Urge incontinent episodes/week, % improved 

17 3 70.0 11.0 5.7 (1.9; 16.8) 2 (1

Subak, 2005470N = 48 

Weight reduction intervention 

Delayed weight reduction intervention 

Total incontinent episodes/week, % improved 

14 4 60.0 15.0 3.5 (1.3; 9.1) 2 (1

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F382 

Table F77. Effect of dietary intervention on urinary incontinence in females (severity measures)

Author 

Sample 

Active 

Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

% of women reporting urge incontinence and mean scores after treatments 

0.2 0.5 0.3 ± 0.5 -0.1 (-0.6; 0.3) 

% of women reporting stress incontinence and mean scores after treatments 

0.7 ± 0.7 0.7 ± 0.7 0.0 (-0.5; 0.5) 

% of women reporting urgency and mean scores after treatments

0.6 ± 0.7 0.6 ± 0.7 0.0 (-0.5; 0.5) 

Manonai, 2006474N = 42 

Self-selected diet with low fat and lowcholesterol foods and soy protein 25g in various forms of soy foods containing more than 50mg/day of isoflavones. 

Self-selected diet with low fat and low cholesterol foods 

% of women reporting frequency and mean scores after treatments

0.6 ± 0.8 0.6 ± 0.7 0.0 (-0.5; 0.5) 

Dowd, 1996471

N = 58 

Decrease daily fluid intake by 300cc 

Increase daily fluid intake by 500cc 

Weekly episodes of urinary incontinence 

0.1 0.6 

Caffeine restriction and increased fluid intake to 2,673 ml/day 

Caffeine Voiding frequency 6.3 ± 0.4 8.3 ± 1.3 -2.1 (-2.6; -1.5) restriction and decreased fluid intake to 872ml/day Caffeine restriction 

and increased fluid intake to, 2,673 ml/day 

Number of daily wetting episodes 

0.5 ± 0.8 0.7 ± 1.2 -0.2 (-0.6; 0.2) 

Baseline caffeine intake 

Increased Voiding frequency 7.0 ± 1.0 7.2 ± 0.6 -0.3 (-0.7; 0.2) decaffeinated fluids to 3 liters daily (20 cups) or decreased caffeinated fluids to 750ml/day (5 cups) 

Baseline caffeine intake 

Number of daily wetting episodes 

0.8 ± 0.6 1.6 ± 0.6 -1.4 (-1.9; -0.9) 

Swithinbank, 2005472N = 48 

Caffeine restriction and decreased fluid intake to 872ml/day 

Caffeine restriction and increased fluid intake to 2,673ml/day 

24 hour pad weight increase (gm) 

6.9 ± 3.5 7.9 ± 5.9 -0.2 (-0.7; 0.2) 
Table F77. Effect of dietary intervention on urinary incontinence in females (severity measures) (continued)

F383 

Author 

Sample 

Active 

Treatment Control Treatment Outcome 

Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

Increased decaffeinated fluids to 3 liters daily (20 cups) or decreased caffeinated fluids to 750ml/day (5 cups) 

Baseline caffeine intake 

24 hour pad weight increase, gm 

7.1 

± 2.5 7.6 

± 5.4 -0.1 (-0.6; 0.3) 

Bold- significant differences in outcomes at 95%confidence level 
F384 

Table F78. Effects of diet and weight management on urinary incontinence in females (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

% of women reporting frequency and mean scores after treatment 

18 16 50.0 44.4 1.1 (0.7; 1.8) 

% of women reporting stress incontinence and mean scores after treatment 

18 0 51.1 0.1 37.0 (2.3; 591.5

% of women reporting urge incontinence and mean scores after treatment 

6 8 16.7 22.2 0.8 (0.3; 1.9) 

Manonai, 2006474N = 42 

Self-selected diet with low fat and low cholesterol foods and soy protein 25g in various forms of soy foods containing more than 50mg/day of isoflavones 

Self selected diet with low fat and low cholesterol foods 

% of women reporting urgency and mean scores after treatment 

21 18 58.3 50.0 1.2 (0.8; 1.8) 

Prevalence of urge incontinence after treatment 

Brown, 156 169 23.7 25.6 0.9 (0.8; 1.1) 2006475N = 1,957 

Intensive lifestyle therapy to lose and maintain at least 7% of initial body weight through a low fat diet and to engage in moderateintensity physical activity for at least 150 minutes each week 

Placebo twice daily 

Prevalence of stress incontinence after treatment 

206 242 31.3 36.7 0.9 (0.7; 1.0) 
Table F78. Effects of diet and weight management on urinary incontinence in females (events) (continued) 

F385 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Prevalence of stress incontinence after treatment 

Metformin 252 242 39.7 36.7 1.1 (0.9; 1.2) 850mg twice daily 

Placebo twice daily 

Prevalence of urge incontinence after treatment 

182 169 28.7 25.6 1.1 (0.9; 1.3) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in1 pa

outcome in the control –rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F386 

Table F79. Effects of dietary and other lifestyle modifications on perceived urinary incontinence in males and females from the 

measures) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

% Change 

Contro

(95%CI

Number of voids/24 hours 

6.8 ± 2.0 7.9 ± 2.6 -0.5 (-0.9; -0.1) -6.0 (-11.2; 

Occasions of urgency/24 hours 

1.6 ± 1.9 3.2 ± 2.8 -0.7 (-1.1; -0.3) -20.9 (-33.9

Bryant, 2002476N = 95 95% female 

Education to reduce caffeine intake to <100mg/day plus bladder training 

Bladder training 

Occasions of leakage/24 hours 

1.2 ± 1.9 1.4 ± 1.7 -0.1 (-0.5; 0.3) -7.9 (-36.7; 

Bold- significant differences in outcomes at 95% confidence level 
F387 

Table F80. Effects of behavioral interventions on female urinary incontinence related to pregnancy and birth

Study Participants Clinical Interventions Outcomes 

Chiarelli, 2002477

RCT to examine the effectiveness of physiotherapist delivered intervention to prevent urinary incontinence among women three months after giving birth. Duration: 3 months 

720 women 48 hours after forceps or ventouse deliveries or their babies with a birth weight of 4,000g or more. Lost of followup: 6% 

1. Training in pelvic floor exercises and incorporated strategies to improve adherence. 2. Usual postpartum care 

Self reported in bladder diary and during phone survey “occasionally,” “often,” or “always” incontinence symptoms: -leaked even small amounts of urine when coughing, sneezing, laughing, or lifting -gone to the toilet urgently for fear of leak -leaked even small amounts before using the toilet -leaked even small amounts on way to the toilet or immediately as needed 

Reilly, 2003478RCT to examine the effects of supervised pelvic floor exercises antenatally on incidence of postpartum stress incontinence in atrisk primigravidae women. Duration: 5 months 

268 primigravidae women in antenatal clinic at ~20 weeks of gestation with bladder neck mobility, on standardized valsalva, of 5mm or more linear movement. Exclusion criteria: Urge incontinence. Loss of followup: 101 due to unwilling to travel to the hospital dislike of perineometry and ultrasound. 

1. Supervised by physiotherapist pelvic floor exercises 1/month before delivery: 3 repetitions of 8 

contractions each held for 6 seconds to 2 minutes, rest repeated 2/day. At 34 weeks of gestation the number of contractions per repetition was increased to 12. 2. Verbal advice on pelvic floor exercises from their midwives antenatally 

Self reported postpartum stress incontinence. Volume of leakage using one-hour International Continence Society pad test. Pelvic floor muscle strength by perineometry 
Table F80. Effects of behavioral interventions on female urinary incontinence related to pregnancy and birth (continued)

F388 

Study Participants Clinical Interventions Outcomes 

Sampselle,1998479

RCT to examine the effect of pelvic muscle exercise on postpartum symptoms of stress urinary incontinence in primigravidas during pregnancy and postpartum. Duration: 12 months 

72 primigravidas at 20 weeks of gestation, 18 years or older with negative history of genitourinary pathology, permanent residents in the area, able to read and understand English. Loss of followup: 8 not willing to participate, 6 moved from the area, 5 conceived the second child during 12 months after the first birth, 7 provided incomplete incontinence information. 

1. Standardized instruction in pelvic muscle exercise 2. Routine care with no systematic pelvic muscle exercise instruction 

Self reported stress urinary incontinence scores by severity from 0 - no leakage to 3 - soaking. Pelvic muscle strength measured with a new speculum—maximum voluntary contraction force of pelvic muscle 

Chiarelli, 2004480

followup to Chiarelli, 2002477

RCT to examine the effects of physiotherapistdelivered promotion of pelvic floor exercise frequency on continence status for women at 12 months postpartum Duration: 12 months 

720 women 48 hours after forceps or ventouse deliveries or their babies with a birth weight of 4,000g or more. Loss of followup: 13.2% in intervention and 14.3% in the control groups. 

1. Training in pelvic floor exercises and incorporated strategies to improve adherence. 2. Usual postpartum care 

Self reported in bladder diary and during phone survey “occasionally,” “often,” or “always” incontinence symptoms: -leaked even small amounts of urine when coughing, sneezing, laughing, or lifting -gone to the toilet urgently for fear of leak -leaked even small amounts before using the toilet -leaked even small amounts on way to the toilet or immediately as needed. 

Meyer, 2001481

RCT to examine the effect of pelvic floor education after vaginal delivery on pelvic floor characteristics in nulliparous women. Duration: 10 months 

107 white nulliparous women Exclusion criteria: Pregnancy complications (twin gestation, diabetes, or preterm labor, hemorrhage from low-lying placenta), women with beginning labor, history of urinary infections. Loss of followup- not reported. 

1. 12 sessions of pelvic floor exercises with 20 minutes of biofeedback and 15 minutes of electrostimulation with an electrode placed in the lower third of the vagina. 2. No training 

Self reported urinary incontinence using questionnaire, perineosonography, urethral pressure profiles, and intravaginal and intra-anal pressure recordings during pelvic floor contraction. 
Table F80. Effects of behavioral interventions on female urinary incontinence related to pregnancy and birth (continued)

F389 

Study Participants Clinical Interventions Outcomes 

Labrecque, 2000482

RCT to examine the effects of perineal massage performed during pregnancy on perineal symptoms after delivery. Duration of followup: 3 months 

Pregnant women with (n = 493) and without (n = 1,034) a previous vaginal birth. Exclusion criteria: High risk of cesarean delivery, including previous cesarean delivery for cephalopelvic disproportion; multiple gestation; placenta previa; severe fetal growth restriction; breech presentation; preeclampsia; nonparticipating physicians; outbreak of genital herpes during the current pregnancy, inability to speak French or English, inability to understand the instructions, and already doing the massage. Loss of followup: 0.3% 

1. Self administered perineal massage daily from the 34th or 35th week of pregnancy until delivery introducing 1 or 2 fingers 3 to 4cm deep into the vagina and applying and maintaining pressure. 2. Usual obstetric care. 

Self reported urinary and incontinence as ever lost urine involuntarily (accidentally), when coughing, sneezing, laughing, or running. Response choices: never, less than once per week, 1 to 6 times a week, once a day, and more than once a day. 

Glazener, 2001483

RCT to examine the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training among women with persistent postnatal incontinence. Duration: 12 months 

747 women with urinary incontinence (defined as any involuntary loss of urine) 3 months postnatally, living within a 50km radius and who delivered in these units during a 12 month recruitment period. Exclusion criteria: mothers of stillborn or died neonates. Loss of followup: 25% in active and 35% in the control group. 

1. Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises (of 8-10 sessions each day of fast and slow contractions with the aim of 80-100 contractions daily) at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months. 2. The control group did not receive any visits from research nurses but received peripartum preparation, which sometimes included pelvic floor exercises, and could seek medical advice 

Self reported persistence of any urinary incontinence; severe incontinence - at least once a week; type of incontinence, stress - during cough, laugh, sneeze, run, jump, or play sport; urge - feel an urgent desire to pass water and are unable to reach the toilet in time; mixed—combination of stress and urge. 
Table F80. Effects of behavioral interventions on female urinary incontinence related to pregnancy and birth (continued)

F390 

Study Participants Clinical Interventions Outcomes 

Glazener, 2005484

Glazener, 2001483RCT to examine the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training among women with persistent postnatal incontinence 

747 women with urinary incontinence (defined as any involuntary loss of urine) 3 months postnatally, living within a 50km radius and who delivered in these units during a 12 month recruitment period. Exclusion criteria: Mothers of stillborn or died neonates. Loss of followup: 29% in active and 31% in the control group. 

1. Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises (of 8-10 sessions each day of fast and slow contractions with the aim of 80-100 contractions daily) at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months. 2. The control group did not receive any visits from research nurses but received peripartum preparation, which sometimes included pelvic floor exercises, and could seek medical advice 

Self-reported 6 years after intervention persistence of any urinary incontinence; severe incontinence - at least once a week; type of incontinence—stress during cough, laugh, sneeze, run, jump, or play sport; urge—feel an urgent desire to pass water and are unable to reach the toilet in time; mixed—combination of stress and urge. 

Sleep,1987485

RCT to examine the effects of pelvic floor exercise on urinary incontinence in postnatal care. Duration: 3 months postpartum. 

1,800 women 24 hours after vaginal delivery. Exclusion criteria: Mothers of stillborn or ill babies. Loss of followup: 10.6% 

1. Standard care: initial instruction on pelvic floor exercise and advice to repeat as often as possible. 2. Intensive exercise care: initial instruction on pelvic floor exercise, extra session of exercise daily, visits and phone calls by community midwives, reminders, feedback to self measure squeeze pressure, and voiding diary. 

Self reported urinary incontinence and frequency of wet episodes/day 

Mørkved , 2003486

RCT to examine the effects of intensive pelvic floor muscle training during pregnancy on prevention of UI. Duration of intervention: 12 

301 healthy nulliparous women ≥18 years, with a single live fetus at routine ultrasound scan. Exclusion criteria: pregnancy complications, high risk for preterm labor, pain during pelvic floor muscle contractions, ongoing urinary tract infection, diseases that could interfere with participation, residency too far from 

1. Training in intensive pelvic floor muscle and general exercises with physiotherapist for 60 minutes/week. Exercise at home twice a day in a preferred position for 12 weeks (between weeks 20 and 36 of pregnancy). Near maximal contractions of 6–8 seconds for 3-4 fast 

Self-reported symptoms of urinary incontinence: involuntary leakage >1/week during the last month. Pelvic floor muscle strength (vaginal squeeze pressure [cm/H2O]) measured by a vaginal balloon connected to a pressure transducer 
Table F80. Effects of behavioral interventions on female urinary incontinence related to pregnancy and birth (continued)

F391 

Study Participants Clinical Interventions Outcomes 

weeks. Duration of follow up: 36 weeks of pregnancy and 3 months after childbirth 

Trondheim to attend weekly training. Loss of follow up:4% 

contractions and 6 second resting. 2. Control group: customary information given by midwife or general practitioner 
F392 

Table F81. Effects of conservative management on female urinary incontinence related to pregnancy and birth (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Any pad use 41 55 14.9 22.4 0.8 (0.5; 1.1) Any incontinence at 12 months postpartum in women with baseline stress incontinence 

91 87 24.5 23.1 1.1 (0.8; 1.4) 

Severe incontinence (at least once a week) at 12 months postpartum 

55 78 14.8 20.7 0.7 (0.5; 1.0) 

Severe incontinence in women with high initial severity (>1/week) 

43 65 11.6 17.3 0.7 (0.5; 1.0) 

Severe incontinence in women with stress incontinence initially 

29 37 7.8 9.8 0.8 (0.5; 1.3) 

Urinary incontinence (any) 

167 169 59.9 69.0 1.0 (0.9; 1.2) 

Glazener, 2001483N = 747 

Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises supplemented with bladder training. 

Usual peripartum preparation 

Urinary incontinence (severe) 

55 78 19.7 31.8 0.7 (0.5; 1.0) 
Table F81. Effects of conservative management on female urinary incontinence related to pregnancy and birth (events) (contin

F393 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Self reported presence of any urinary incontinence 6 years after randomization 

201 201 76.0 79.0 1.0 (0.9; 1.2) 

Urinary incontinence at 6 years after index delivery in women we severe (>1 week) initial incontinence 

122 102 80.0 80.0 1.2 (1.0; 1.5) 

Urinary incontinence at 6 years after index delivery in women with initial stress incontinence 

111 97 75.0 77.0 1.2 (0.9; 1.5) 

Urinary incontinence at 6 years after index delivery in women with severe initial incontinence (>1/week) 

122 102 80.0 80.0 1.2 (1.0; 1.5) 

Glazener, 2005484N = 747 

Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises supplemented with bladder training 

Usual peripartum preparation 

Using pads 72 59 28.0 24.0 1.2 (0.9; 1.7) 
F394 

Table F82. Effects of conservative management on female urinary incontinence related to pregnancy and birth (self reported selife) 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean Difference 

(95% CI) 

Mean No of pad changes 

Glazener, 0.2 ± 0.0 0.3 ± 0.1 -2.9 (-3.1; -2.7) -2001483N = 747 100% female 

Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises supplemented with bladder training 

Usual peripartum preparation Mean overall rating of 

severity (0=no problem at all to 10=can't think of anything worse) 

2.8 ± 0.2 3.6 ± 0.3 -3.1 (-3.3; -2.9) 

Bold- significant differences in outcomes at 95% confidence level 
F395 

Table F83. Effects of behavioral interventions on female urinary incontinence related to pregnancy and births (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Urinary continence in women with no previous vaginal birth 

381 367 73.5 71.3 1.0 

(1.0; 1.1) 

Labrecque, 2000482N = 1,034 

Self administered perineal massage daily from the 34th or 35th week of pregnancy until delivery introducing 1 or 2 fingers 3 to 4cm deep into the vagina and applying and maintaining pressure 

Usual obstetric care 

Urinary continence in women with previous vaginal birth 

163 151 66.3 61.1 1.1 

(0.9; 1.2) 

Labrecque, 2000482N = 493 

Self administered perineal massage daily from the 34th or 35th week of pregnancy until delivery introducing 1 or 2 fingers 3 to 4cm deep into the vagina and applying and maintaining pressure 

Usual obstetric care 

Urinary incontinence >1/day in women with previous vaginal birth 

9 8 3.7 3.2 1.1 

(0.4; 2.9) 
Table F83. Effects of behavioral interventions on female urinary incontinence related to pregnancy and births (events) (continu

F396 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Labrecque, 2000482N = 1,034 

Self administered perineal massage daily from the 34th or 35th week of pregnancy until delivery introducing 1 or 2 fingers 3 to 4cm deep into the vagina and applying and maintaining pressure 

Usual obstetric care 

Urinary incontinence >1/day in women with no previous vaginal birth 

13 12 2.5 2.4 1.1 

(0.5; 2.3) 

Meyer, 2001481

N = 107 

12 sessions of pelvic floor exercises with 20 minutes of biofeedback and 15 minutes of electro stimulation 

Usual care % recovering 

normal pelvic floor contraction 

21 18 41.0 33.0 1.3 

(0.8; 2.1) 

Prevalence of self reported urinary incontinence 

115 134 31.0 38.4 0.8 

(0.7; 1.0) 

Chiarelli, 2002477N = 720 

Training in pelvic floor exercises and incorporated strategies to improve adherence 

Usual postpartum care 

% of self reported severe mixed incontinence 

37 59 10.1 16.8 0.6 

 (0.4; 0.9) 

Self-reported postpartum stress incontinence 

23 36 19.2 32.7 0.6 

 (0.4; 0.9) 

Reilly, 2002 

478

N = 268 

Supervised by physiotherapist pelvic floor exercises 1 month before delivery 

Verbal advice on pelvic floor exercises 

Positive pad test (+ v >1g) 

7 8 9.5 10.8 0.8 

(0.3; 2.1) 
Table F83. Effects of behavioral interventions on female urinary incontinence related to pregnancy and births (events) (continu

F397 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Routine care with no systematic pelvic muscle exercise instruction 

Odds ratio of improved maximum voluntary contraction force of pelvic muscle 1 year after vaginal birth 

 1.0 

(1.0; 1.0) 

Odds ratio of stress incontinence symptoms 1 year after vaginal and cesarean birth 

 1.0 

(1.0; 1.0) 

Sampselle, 1998479N = 72 

Standardized instruction in pelvic muscle exercise 

Routine care with no systematic pelvic muscle exercise instruction 

Odds ratio of stress incontinence symptoms 1 year after vaginal birth 

 1.0 

(1.0; 1.0) 

Chiarelli, 2004480N = 720 

Training in pelvic floor exercises and incorporated strategies to improve adherence 

Usual postpartum care 

Self-reported incontinence 

101 100 34.4 36.4 0.9 

(0.8; 1.2) 

Cured (no recorded urinary incontinence) 

21 22 2.3 2.4 1.0 

(0.5; 1.7) 

Sleep, 1987485

N = 1,800 

Intensive exercise care: initial instruction on pelvic floor exercise, extra session of exercise daily, 

Standard care: initial instruction on pelvic floor exercise and advice to repeat as 

Self reported urinary incontinence > 3times/day 

9 9 1.0 1.0 1.0 

(0.4; 2.5) 
Table F83. Effects of behavioral interventions on female urinary incontinence related to pregnancy and births (events) (continu

F398 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

visits and phone calls by community midwives, reminders, feedback to self measure squeeze pressure, and voiding diary 

often as possible 

Self reported urinary incontinence: sometimes wearing of pads 

29 33 3.2 3.7 0.9 

(0.5; 1.4) 

Intensive pelvic floor muscle training and general exercises 

Customary information given by midwife or general practitioner 

Self-reported urinary incontinence at 36 wk of pregnancy 

48 74 32.43 48.37 0.67 

 (0.50;0.89) 

Intensive pelvic floor muscle training and general exercises 

Customary information given by midwife or general practitioner 

Self-reported urinary incontinence at 3 months after delivery 

29 49 19.59 32.03 0.61 

(0.41; 

0 .91) 

Mørkved, 2003486N = 301 

Intensive pelvic floor muscle training and general exercises 

Customary information given by midwife or general practitioner 

Self-reported urinary incontinence at 36 wk of pregnancy in Continent before pregnancy 

29 52 19.59 33.99 0.58 

(0.39; 

0.85) 
Table F83. Effects of behavioral interventions on female urinary incontinence related to pregnancy and births (events) (continu

F399 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Intensive pelvic floor muscle training and general exercises 

Customary information given by midwife or general practitioner

Selfreported urinary incontinence at 36 wk of pregnancy in Continent before and at 20 wk 

13 30 8.78 19.61 0.45 

(0.24; 0.82) 

Intensive pelvic floor muscle training and general exercises 

Customary information given by midwife or general practitioner

Selfreported urinary incontinence at 3 months after delivery in Continent before pregnancy

14 28 9.46 18.30 0.52 

(0.28; 0.94) 

Intensive pelvic floor muscle training and general exercises 

Customary information given by midwife or general practitioner

Selfreported urinary incontinence at 3 months after delivery in Continent before and at 20 wk

9 13 6.08 8.50 0.72 

(0.32; 1.62) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control –rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E- excessive events 
F400 

Table F84. Effects of behavioral intervention on urinary incontinence related to pregnancy and birth (urodynamic outcomes) 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment 

Reilly, Change in bladder neck mobility, mm -0.2 ± 0.4 -0.1 ± 0.5 2002478N = 268 

Supervised by physiotherapist pelvic floor exercises once per month before delivery 

Verbal advice on pelvic floor exercises 

Perineometry (cm/H2O) 11.5 ± 7.9 10.5 ± 5.5 

Bladder neck position, standing (mm) 27.0 ± 4.0 27.0 ± 5.0 Bladder neck mobility, supine (mm) 14.0 ± 5.0 15.0 ± 6.0 Functional urethral length (mm) 30.0 ± 6.0 31.0 ± 7.0 Area of continence at stress (mm2) 616.0 ± 299.0 588.0 ±328.0 Maximal urethral closure pressure at stress (cm/H2O) 

83.0 ± 23.0 89.0 ± 30.0 

Pressure transmission ratio values (%) in the central third of the functional urethral length 

81.0 ± 23.0 77.0 ± 27.0 

Intravaginal pressures (cm/H2O) 33.0 ± 22.0 41.0 ± 27.0 

Meyer, 2001481N = 107 

12 sessions of pelvic floor exercises with 20 minutes of biofeedback and 15 minutes of electro stimulation 

Usual care 

Intra-anal pressures (cm/H2O) 36.0 ± 20.0 43.0 ± 24.0 
F401 

Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females 

Study Participants Clinical Interventions Outcomes 

Diokno, 2004487

Duplicate: Sampselle, 2005488

RCT to examine the effects of behavioral modification program on incidence of urinary incontinence in older women. Duration: 1 year. 

359 postmenopausal, continent women (0-5 days of incontinent episodes in the previous year) 55 years and older. At baseline 2 groups reported identical 39% absolute continence and zero UI days. 61% of participants reported 1 to 5 UI episodes in year. Exclusion criteria: neurologic diseases, mini-mental scores <24, positive paper towel cough test, grade 4 uterine prolapse. Loss of followup: 9% in the control and 14% in active groups did not return communication, relocated or experienced changes in personal health or the health of a family member. 

1. 2 hour classroom presentation on behavioral modification program: pelvic floor muscle training, bladder training, and individualized test of knowledge, adherence, and skills to reinforce the technique as needed. 2. Usual care 

Self reported in the standardized Medical Epidemiologic and Social Aspects of Aging (MESA) questionnaire absolute continence: urinary incontinence episodes no more than 5 days in the last 12 months. Voiding frequency and intervoid interval reported in 3-day voiding diary. Displacement and pressure digital scores from test for pelvic floor muscle strength. 

IseRobbAaadn

Dumoulin, 2004489

RCT to compare the effectiveness of multimodal supervised physiotherapy programs among women with persistent postnatal stress urinary incontinence. Duration: 2 months 

64 premenopausal women younger than 45 years presenting symptoms of stress urinary incontinence at least once per week 3 months or more after their last delivery. Exclusion criteria: Current pregnancy, urinary incontinence before pregnancy, previous surgery for stress incontinence, moderate to severe urogenital prolapse, involuntary detrusor contraction on cystometry neurologic or psychiatric disease, or a major medical condition, taking medication that could interfere with their evaluation or treatment, inability to understand French or English instructions. Loss of followup: 2, plus 2 did not attend the final examination and were excluded from the analysis. 

1. Pelvic floor rehabilitation: 15 minute electrical stimulation of the pelvic floor muscle; then 25 minute pelvic floor muscle exercise program with biofeedback, which included strengthening and motor relearning exercises and a home exercise 5 days/week. 2. Pelvic floor rehabilitation plus abdominal training: in addition to PFE 30 minutes of deep abdominal muscle training consisting of isolation, reeducation, and functional retraining of the transversus abdominis 3. Relaxation massage for the back and extremities by physiotherapist. They were asked not to exercise their pelvic floor muscles at home. 

1. 20 minute pad test with standardized bladder volume. 2. Perceived symptoms and burden of incontinence using a Visual Analog Scale Urogenital Distress Inventory (19-items); Incontinence Impact Questionnaire (26 items) focusing on daily living, social interaction, sex life, and self-perception. 3. Pelvic floor maximum strength and rapidity of contraction using static pelvic floor muscle dynamometer 

IsSbtbsa ncBars
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F402 

Study Participants Clinical Interventions Outcomes 

Goode, 2003490RCT to examine whether pelvic floor electrical stimulation increases efficacy of behavioral training for communitydwelling women with stress incontinence Duration: 8 weeks 

200 ambulatory, nondemented, community-dwelling women ages 40 to 78 years with urinary incontinence (at least 2 stress incontinence episodes per week on the 2-week baseline bladder diary) confirmed during urodynamic testing. Exclusion criteria: Continual leakage, postvoid residual urine volume >150ml, severe uterine prolapse, congestive heart failure, hemoglobin

A1C ≥9, or impaired 

mental status (Mini-Mental State 

Examination score <24). Loss of followup: 18.2% in the behavioral group, 11.9% in the pelvic floor electrical 

stimulation group, and 37.3% in the selfhelp booklet. 

1. Behavioral training (biofeedback-assisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder 

diaries). Anorectal biofeedback (~20 minutes) with 3-balloon probe to measure sphincter pressure and rectal pressure. Pelvic floor muscle exercises:15 repetitions of 2- to 4-second contractions with equal periods of 

relaxation/day. Bladder diary to use "stress strategies" for prevention of urine leakage 2. Behavioral training plus pelvic floor electrical stimulation 15 minutes/day 3. Control: self-administered 

behavioral training administered with a self-help booklet with 

suggestions for isolating the pelvic floor muscles, progressive home exercise, self monitoring, 

and bladder control strategies. 

Self reported % reduction in the number of incontinent episodes documented in bladder diaries. Leakage in stress test and bladder capacity during urodynamic examination. 

Ilgti

rscBars
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F403 

Study Participants Clinical Interventions Outcomes 

Wyman, 1998491

RCT to examine the efficacy of bladder training, pelvic muscle exercise with biofeedbackassisted instruction, and combination therapy, on urinary incontinence in women. Duration: 12-week intervention program, 3 month followup 

204 community-dwelling women age 45 years and older diagnosed with genuine stress incontinence, (urine loss at least once per week), with urodynamic evidence of genuine stress incontinence, and mentally intact (Mini-Mental State Examination Score >23). Exclusion criteria: Reversible causes of urinary incontinence, uncontrolled metabolic conditions, residual urine volume after voiding >100ml, urinary tract infection, genitourinary fistula or indwelling catheterization, and inability to correctly perform a pelvic muscle contraction on digital examination. Loss of followup: 6% withdrew either immediately after randomization or during the intervention visits, 8% failed to keep their followup appointment or to mail in completed instruments at the 3-month followup. 

Structured 12-week program of patient education, self-monitoring of voiding behavior with daily treatment logs, compliance assessment, and positive reinforcement administered by trained registered nurses. 1. Bladder training with schedule voiding interval from 30-60 minutes (baseline diary) to increase by 30 minutes each week. 2. The pelvic muscle exercise with 5 fast (3 second) contractions and 10 sustained (10 second) contractions with 10-second relaxation periods between contractions twice a day. Sustained contractions were increased by 10 contractions/week so that by the third week a total of 10 fast and 40 sustained contractions were performed daily (total = 50 contractions). Visual and verbal biofeedback to observe pelvic and abdominal muscle pressure during fast, sustained, and preventive contractions recorded with vaginal balloon device and displayed on a strip-chart recorder. 3. Combination therapy of bladder training and pelvic muscle exercise. 

Self-reported in a standardized diary the number of weekly incontinent episodes. Patient perception of improvement and treatment satisfaction. Pad weight test. 

NlcBars
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F404 

Study Participants Clinical Interventions Outcomes 

Theofrastous, 2002492RCT to examine the efficacy of bladder training and pelvic muscle exercise with biofeedbackassisted instruction on urinary incontinence in women. Duration: 12-week intervention program, 3 month followup 

137 community-dwelling women age 45 years and older diagnosed with genuine stress incontinence, (urine loss at least once per week), with urodynamic evidence of genuine stress incontinence, and mentally intact (Mini-Mental State Examination Score >23). Exclusion criteria: Reversible causes of urinary incontinence, uncontrolled metabolic conditions, residual urine volume after voiding >100ml, urinary tract infection, genitourinary fistula or indwelling catheterization, and inability to correctly perform a pelvic muscle contraction on digital examination. Loss of followup: 6% withdrew either immediately after randomization or during the intervention visits, 8% failed to keep their followup appointment or to mail in completed instruments at the 3- month followup. 

1. Pelvic floor muscle training: 4 office biofeedback sessions and home exercise with two sets of 5 quick and 10 sustained contractions with 10-second rest periods increased to 5 quick and 20 sustained contractions 2/day for a total of 50 contractions per day. Reinforcement with home audiocassette tapes, 4 weekly 30-minute biofeedback sessions, and regular contact with the research nurses. 2. Bladder training: initial voiding interval of 30 or 60 minutes increased each week depending on the subject’s tolerance of the schedule to 22.5 hours. 

Self reported urinary incontinence episodes/week using diaries and vaginal pressure measurements by using balloon manometry. 

NlcBars
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F405 

Study Participants Clinical Interventions Outcomes 

Alewijnse,2003493

RCT to examine the effectiveness of pelvic muscle floor exercise therapy supplemented with a health education program urinary incontinence among women. Duration: 14-22 weeks of intervention and 1 year followup. 

129 community-dwelling women over 17 years old with urinary incontinence, able ability to complete questionnaires in Dutch language. Exclusion criteria: Continence, neurological conditions, venereal disease, viral infections, using medication that may impact incontinence, pregnancy or 3 months after delivery, after surgical treatment for incontinence, and women with physical impairments. Severe prolapse, vaginal atrophy, and urinary tract infection were not exclusion criteria. Loss of followup: 20% for different reasons, one died. 

1. Bladder training with voiding frequency of ~7 voidings/day and pelvic floor muscle exercise: 10 slow twitch contractions (10-30 seconds) and 10 fast twitch contractions (2-3 seconds), 5 times/day, each contraction being followed by relaxation; correct toileting and drinking behavior (1,500-2,000ml/day); techniques to prevent leakage. Combination of PFME with Health education therapy. 2. Reminder intervention: information and reminders of PFME therapy and adherence behavior 3. Reminder and self-help guide with individualized information on coping with urinary incontinence, tips to increase adherence behavior, and relapse prevention strategies to support the selfmanagement process. 4. Reminder, self-help guide and counseling intervention: addition of counseling by physiotherapists, structural oral feedback, and reinforcement to promote adherence behavior. 

Self reported weekly frequency of wet episodes and change in frequency of wet episode. 

IlcBars

Aukee, 2004494

RCT to examine the effectiveness of pelvic floor training with home biofeedback device among women with tress urinary incontinence Duration: 12 weeks intervention, 1 year followup. 

35 women 21-70 years old with urodynamically confirmed stress incontinent (maximal urethral closure pressure >20cm/H2O and cough leak point pressure >90cm/H2O). Exclusion criteria: Previous incontinence operations, genital prolapse, inability to understand instructions for home training, pregnancy, severe diseases such as malignancies in the abdominal region, multiple sclerosis and diabetes mellitus requiring insulin. Loss of followup: 1 woman at 1 year. 

1. Home program with given verbal and written instructions for home practice and advise to practice for 20 minutes/day, 5 times/week. 2. Pelvic floor training by physiotherapist 5 times/12 weeks: 3-5 second contractions with 10 second intervals in supine and standing position with home biofeedback using a personal EMG-assisted biofeedback device. 

Review of hospital records to identify gynecologic surgery during 1 year of followup. Pelvic floor muscle activity while supine (

mV). 

IlpnocBars
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F406 

Study Participants Clinical Interventions Outcomes 

Bergman, 1987495

RCT to examine the effects of bladder training on urinary incontinence in women after surgery for stress urinary incontinence. Duration of followup: 3 months 

89 women with a clinically and urodynamically proved diagnosis of genuine stress urinary incontinence after surgery for incontinence (40 revised Pereyra procedure and 49 Burch retropubic urethropexy). Exclusion criteria: Not reported. Loss of followup: None 

1. "Bladder training" scheduled clamping and unclamping of the suprapubic Bonnano catheter throughout postoperative period. 2. "Nonbladder training" continuous bladder drainage with suprapubic Bonnano catheter throughout postoperative period. 

Length of postoperative bladder catheterization 

NluAurj

Wang, 2004496

RCT to examine the efficacy of pelvic floor muscle training, biofeedbackassisted PFMT , and electrical stimulation in the management of overactive bladder. Duration: 12 weeks. 

120 women age 16-75 years, symptoms of overactive bladder for more than 6 months, frequency of voiding eight times or more per day, and urge incontinence one time or more per day. Exclusion criteria: pregnancy, deafness, neurologic disorders, diabetes mellitus, pacemaker or intrauterine device use, genital prolapse greater than Stage II of the International Continence Society grading system, residual urine >100ml, and urinary tract infection. Loss of followup: 14.2% 

1. Pelvic floor muscle training with submaximal to maximal PFM contractions for 6 seconds 5 times and 10 fast contractions per session at least 3 times/day. 2. Biofeedback-assisted pelvic floor muscle training with an intravaginal electromyogram probe to contract or relax PFMs following the visual EMG signals. 3. Electrical stimulation in the management of overactive bladder with intravaginal electrode at the physiotherapy unit. 

Self-reported urge urinary incontinence. The strength of the PFMs using palpation by way of the vagina according to the “PERFECT” scheme to assess the power (P), endurance (E), number of repetitions (R), and number of fast (1-second) contractions (F). The power is graded from 0-5, according to the Oxford grading system. PFM strength - vaginal pressure using a balloon probe connected to a pressure transducer. 

NScr6ados

Bo, 2005497

Followup RCT to examine the effects of intensive exercise on stress urinary incontinence. Duration of followup: 6 months and 15 years 

52 women with urodynamic stress urinary incontinence participated in the original RCT. Exclusion criteria: Response rate 90.4% Loss of followup: 9.6% 

1. Intensive pelvic floor exercise with 8-12 maximum contractions for 6-8 seconds 3 series/day under the supervision of physical therapist for 6 months. 2. Home exercise groups 

Self reported urinary incontinence and severity of lower urinary tract symptoms by the severity index and the International Consultation of Incontinence Questionnaire Urinary Incontinence Short Form 

Ilandos
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F407 

Study Participants Clinical Interventions Outcomes 

Elser, 1999498

RCT to examine the effects of pelvic floor muscle training, bladder training, or both, on urodynamic parameters in women with urinary incontinence. Duration: 12 weeks 

204 women 45 years or older, ambulatory, mentally intact with urodynamic genuine stress incontinence or detrusor instability, with or without stress incontinence, experiencing 1–100 episodes of incontinence per week as recorded on the qualifying 7-day urinary diary, capable of performing a pelvic floor muscle contraction as assessed by digital exam. Exclusion criteria: Reversible cause of incontinence, uncontrolled metabolic conditions (e.g., diabetes mellitus), postvoid residual of >100ml, persistent urinary tract infection, urinary tract fistula, or indwelling catheterization. Loss of followup: 11.3% 

Patient education, selfmonitoring with treatment logs, compliance assessment, and positive reinforcement techniques administered by trained research nurses. 1. Pelvic floor muscle training with10 fast (3 second) contractions and 40 sustained (10 second) contractions with 10 second rest periods between contractions performed daily (total 50 contractions) in two or more exercise sets. Visual and verbal biofeedback via a stripchart recorder of vaginal and abdominal pressures measured by vaginal balloons. 2. Bladder training. 3. Pelvic floor muscle training combined with bladder training. 

Multi-channel urodynamics outcomes: first sensation to void, maximum cystometric capacity, the difference between MCC and FSV (MCC − FSV), functional 

urethral length, maximum urethral closure pressure, urethral closure pressure, maximum Kegel urethral closure pressure, Kegel urethral closure pressure, pressure transmission ratio, maximum pressure transmission ratio, and straining urethral axis. 

NlouarcBcrs
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F408 

Study Participants Clinical Interventions Outcomes 

Tibaek, 2005499

RCT to examine the effect of pelvic floor muscle training in women with urinary incontinence after ischemic stroke. Duration: 12 weeks 

26 women 40 and 85 years old with acute ischemic stroke verified by CAT scan lasting >24 hours; stroke symptoms in at least 1 month; normal cognitive function (mini-mental state examination >25); urinary incontinence related to stroke; independent walking abilities indoors >100 meters with/without aids; independence in toilet visits. Exclusion criteria: Urinary tract infection; symptom of vaginal prolapse; chronic respiratory diseases; psychiatric diseases; other neurological diseases; does not speak Danish. Loss of followup: 8% 

1. Intensive pelvic floor muscle training 1-2 times/day by specialized physiotherapist: group information on incontinence and instruction in self-palpation of PFM, motivation and instruction in home exercises with close to maximum contraction (6 second contraction/6 second rest) and endurance PFM exercise with 30% of maximum contraction as long as possible (maximum 30 second contraction/30 second rest). Group treatment: isolate PFM contraction (6 second contraction/6 second rest); strength exercises (3 second contraction/3 second rest, and 6 second contraction/6 second rest); endurance exercises (maximum 30 second contractions/30 second rest). 2. Usual care 

Self reported in voiding diary time and frequency of voiding, the number of incontinence episodes, and the number of used pads. 

NSRtAndos

Subak, 2002500

RCT to examine the effects of low-intensity behavioral therapy program on urinary incontinence in older women Duration of followup: 6 weeks 

Women 55 years and older with self reported urinary incontinence, members of health maintenance organization, living independently in the community and functionally capable of independent toileting. Exclusion criteria: Uncontrolled diabetes mellitus, urinary tract infection, history of urinary obstruction, overflow, functional incontinence, urinary tract anomalies. Loss of followup: 19.1% 

1. 6 weekly 20-minute group instructional sessions on bladder training by nurse educators and followed individualized voiding schedules. 2. Usual care 

The number of incontinent episodes per week recorded in a 7-day urinary diary. 

NSbAucrs
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F409 

Study Participants Clinical Interventions Outcomes 

Goode, 2002501Placebo-controlled RCT to examine the effect of biofeedbackassisted behavioral training on urinary incontinence in older women. Duration: 8 weeks 

105 ambulatory, non demented, community-dwelling women 55 and older with self-reported urge incontinence at least twice per week for >3 months with urodynamic evidence of bladder dysfunction. Exclusion criteria: Continual leakage, postvoid residual urine volume greater than 200ml, uterine prolapse past the introitus, narrow-angle glaucoma, unstable angina pectoralis, congestive heart failure, history of malignant arrhythmias, or impaired mental status. Loss of followup: 46.7% 

1. Four sessions (over 8 weeks) of biofeedback-assisted behavioral training by nurse practitioners. 2. Placebo control condition, usual care 

Self reported urinary incontinence and urodynamic outcomes. 

NSRaucrs

Lagro-Janssen, 1992502RCT to examine the effects of pelvic floor exercises on stress incontinence and bladder training on urge incontinence. Duration: 3 months 

110 women with self-reported urinary incontinence confirmed with urodynamic as stress or urge. Exclusion criteria: Not reported. Loss of followup: 3.6% 

1. Pelvic floor exercises alone (stress) or bladder training (urge) or its combination (mixed) 2. Usual care 

Self reported urinary incontinence 

IsRandos

Fantl, 1991503

RCT to examine the effects of bladder training on urinary incontinence in older women. Duration: 6 weeks. 

131 noninstitutionalized women 55 years and older with clinical and urodynamic urinary incontinence >1 leakage/week; mentally intact (Mini-Mental State Examination score >23), capable of independent toileting. Exclusion criteria: Uncontrolled diabetes, urinary tract infection, urinary obstruction, reversible cause of incontinence, permanent catheterization. Loss of followup:6.1% 

1. Bladder training using 6 weekly visits included patient education; voiding schedule to have micturition from every 30-60 minutes to every 2.5-3 hours; and positive reinforcement. 2. Usual care 

Self reported number of urinary incontinence episodes/week and urodynamic outcomes using standard urinary diary. 

NlsicBars
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F410 

Study Participants Clinical Interventions Outcomes 

Dougherty, 2002504

RCT to examine the effects of behavioral management for continence on urinary incontinence in older rural women in their homes. Duration: 6 months and followup 2 years. 

218 women 55 years and older, who lived in a private residence in rural area; with involuntary urine loss >2/week of 1g/24 hours or more; without urinary tract infection. Exclusion criteria: Bladder cancer or kidney disease, indwelling urinary catheter, residual urine >100cc, needed caregiver. Loss of followup:18% 

1. Behavioral management for continence: -Self-monitoring and bladder training to reduce caffeinated beverages to <2 cups/glasses, 1,500 <daily fluid intake <4000cc, no fluid consumption after 6 p.m., daytime voiding interval <4 hours, and treatment of constipation. -Pelvic muscle exercise with biofeedback: 15 repetitions per day increased by 15 repetitions every 3 weeks to 45 contractions/day) three times a week for 12 weeks. 2. Control group 

Severity of urine loss was evaluated by pad test. Self reported episodes of urine loss, micturition frequency, voiding interval. 

IlRmseAucrs

Burgio, 2002505

RCT to examine the effects of biofeedback as a part of complex behavioral training program for urge incontinence in communitydwelling older women. Duration: 8 weeks 

222 ambulatory, nondemented, community-dwelling women ages 55 to 92 years with urge incontinence or mixed incontinence >2 times/week for at least 3 months, and with urodynamic evidence of 

bladder dysfunction (detrusor instability during filling or provocation or maximal 

cystometric capacity of ≤400ml). 

Exclusion criteria: Continual leakage, postvoid residual urine volume >150ml, 

severe uterine prolapse past the vaginal 

introitus, decompensated congestive heart failure, or impaired mental status (MiniMental State Examination score <24). 

Loss of followup: 5.7% 

1. Biofeedback-assisted behavioral training implemented by nurse practitioners. Abdominal pressure and sphincter responses were measured with 3-baloon probe inserted in rectum. Pelvic floor muscle exercise with 10 second contractions/10 second relaxation for 45 minutes/day. 2. 4 visits of behavioral training without biofeedback (verbal feedback based on vaginal palpation). Pelvic floor muscle exercise with 10 second contractions/10 second relaxation for 45 minutes/day. 3. Self-administered behavioral treatment using a self-help booklet to advise pelvic floor exercise and bladder control. 

Self reported number of incontinence episodes documented in bladder diaries 

IlsaicBars
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F411 

Study Participants Clinical Interventions Outcomes 

Wyman, 1997506

RCT to examine the effects of bladder training on quality of life in older women with urinary incontinence. Duration: 6 weeks. 

131 women 55 years and older, ambulatory, mentally intact, independent residents in the community with urodynamic stress urinary incontinence >1 episode/week. Exclusion criteria: Metabolic decompensation, urinary tract infection, outlet obstruction, fistula, reversible cause of urinary incontinence, permanent indwelling catheter. Loss of followup: 6% 

1. Bladder training: patient education, progressive scheduled voiding regimen, positive reinforcement. 2. Usual care 

Self reported quality of life measures (Incontinence Impact Questionnaire (IIQ) with 26 items and 4 point scale from 0 - not at all to 3 - greatly. 

NlsicBars

Yoon, 2003507

RCT to examine the effectiveness of bladder training versus pelvic muscle exercises in the treatment of urinary incontinence in women. Duration: 8 weeks 

50 parous women 35–55 years old a with urine loss of 1.0g or more on a 30 minute pad test and 14 voids or more during a period of 48 hours before the preliminary evaluation. Exclusion criteria: Urinary tract infection tested by urinalysis and urine culture, previous experience of surgery for urinary incontinence, HRT and other medication for urinary incontinence. Loss of followup: 8% 

1. Bladder training with increased interval between voluntary voids. 2 Pelvic muscle exercise (30 contractions for 15 to 20 minutes/day) with immediate and simultaneous visual feedback of pelvic muscles during a 20 minute weekly biofeedback session with electromyography. 3. Usual care 

Self reported voids and incontinence scores (5-Likert scale) and urodynamic outcomes 

NSRandos

Janssen, 2001508

RCT to examine the effects of individual and group physiotherapy for urinary incontinence in women. Duration: 3 months, followup 12 months. 

530 women of all ages (mean 47.8 years) with stress, urge, or mixed incontinence. Exclusion criteria: Neurological cause of incontinence, a tumor or infection in the pelvis, severe vaginal prolapse. Loss of followup: 22% 

1. Individual pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 11 30-minute sessions. 2. Group pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 9 2-our sessions. 

Objective changes in the severity of urinary incontinence, frequency of urine loss, and frequency of nocturnal urine loss. 

IbsisAndos
Table F85. Effects of behavioral interventions on risk and progression of incontinence in community dwelling females (continu

F412 

Study Participants Clinical Interventions Outcomes 

Nygaard, 1996509

RCT to examine the effects of pelvic floor muscle exercises in combination with specially designed audiotape on stress, urge, and mixed urinary incontinence in women. Duration: 3 months 

71 women non pregnant women >21 years old with urinary incontinence. Exclusion criteria: Genital prolapse past the vaginal introitus, parturition within the preceding 6 months, and deafness. Loss of followup: 23%. 

1. Pelvic floor muscle exercises with 2 5-minute daily sessions, beginning with contractions for 4-8 seconds in combination with specially designed audiotape with 270 minutes of music and verbal instructions of technique tips, reminders, and exercise cues. 2. Pelvic floor muscle exercises with 2 5-minute daily sessions, beginning with contractions for 4-8 seconds. 

Self reported number of incontinent episodes, documented with a 3-day voiding diary 

IbrbcBrrirS

McClurg, 2006510RCT to examine the effects of pelvic floor training and advice , electromyography biofeedback, and neuromuscular electrical stimulation on urinary incontinence in patients with multiple sclerosis. Duration of treatment: 9 weeks. Duration of follow up: 24 weeks 

30 women >18 years with multiple sclerosis stabilized for the previous 3 months. Expanded Disability Status Scale score <7.5 with at least one of the following: any involuntary leakage of urine, voiding frequency >8/24 hours, nocturia, and/ or reported voiding dysfunction such as hesitancy, straining, poor stream, and incomplete emptying demonstrated by uro-flowmetry. Exclusion criteria: MS relapse necessitating hospitalization 3 months prior to or during the study, symptomatic prolapse, presence of urinary tract infection, current or recent diagnosis of a serious medical condition (other than MS), severe cognitive impairment, contraindications to neuromuscular electrical stimulation. Loss of follow up: 6.7% 

1. Pelvic Floor Training and Advice: education with booklet about normal bladder control, lifestyle interventions (weight reduction, relieving constipation, cessation of smoking, caffeine reduction, fluid management, clothing, reducing emotional stress), bladder training, pelvic floor exercise with individualized contractions/relaxation duration based on assessment of power endurance. 2. Pelvic Floor Training and Advice and EMG Biofeedback . 3. Pelvic Floor Training and Advice with EMG Biofeedback and neuromuscular electrical stimulation. Stimulation at clinic (weekly) initially for 5 min 30 minutes .using pulse rate 40Hz, pulse width 250msec,with 5sec on and10 sec off or 10 Hz, 450msec, 10sec on and 3sec off, at maximum-tolerated intensity 

3-day voiding diary; 24 hr pad-test; Uroflowmetry; Pelvic Floor Muscle Assessment; Incontinence Impact Questionnaire (IIQ); Urogenital Distress Inventory (UDI); King's Health Questionnaire (KHQ), and the Multiple Sclerosis Quality of Life-54 Instrument (MSQoL-54). 

gAcS
F413 

Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females 

Study Participants Clinical Interventions Outcomes 

Laycock, 2001511

RCT to examine the effects of vaginal cones, pressure biofeedback, and pelvic floor exercises on stress urinary incontinence in females. Duration: 3 months. 

101 women 20-64 years old with symptoms of stress urinary incontinence. Exclusion criteria: Moderate or severe urge urinary incontinence, moderate or severe genital prolapse, pregnancy or plans to become pregnant, use of medications that can affect the lower urinary tract, HRT for <3 months, neurological diseases. Loss of followup: 32.7% 

1. Pelvic floor exercise with maximum contraction for 1 second and rest for 4 seconds, 10 minutes/day combined with home pressure biofeedback using intra-vaginal perineometer. 2. Vaginal cones for 10 minutes/day with individually adjusted size and increasing weight. 3. Pelvic floor exercise for 10 minutes/day. 

Pad use/day, wet episodes/day, Pelvic floor muscles contractility 

NObin AcredSju

Bo, 2000512

RCT to examine the effects of pelvic floor muscle exercise on female genuine stress incontinence. Duration: 6 months. 

59 women with clinically and urodynamically proven genuine stress incontinence .4grams of leakage measured by the pad test. Exclusion criteria: Urinary incontinence other than GSI, involuntary detrusor contractions exceeding 10cm/H2O on cystometry, residual urine .50ml, maximal uroflow, 15ml/second, previous surgery for GSI, neurological or psychiatric disease, ongoing urinary tract infections, other diseases that could interfere with participation, use of concomitant treatments during the trial, and inability to understand instructions given in Norwegian. Loss of followup: 6.7%. 

1. Pelvic floor muscle exercise with 8-12 maximum contractions in 3 series/day and 45 minutes/week group sessions. 2. Untreated control group 

Self reported urinary incontinence using 7 point satisfaction scale. Norwegian version of the Quality of Life Scale (QoLS-N) and the Bristol Female Lower Urinary Tract Symptoms (B-FLUTS) questionnaire. 

NOgraslecBcoS
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F414 

Study Participants Clinical Interventions Outcomes 

Bo,1999513RCT to examine the effects of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment on females genuine stress incontinence. Duration: 6 months 

107 women with clinically and urodynamically proved genuine stress incontinence >4g of leakage measured by pad test with standardized bladder volume. Exclusion criteria: urinary incontinence other than genuine stress incontinence, involuntary detrusor contractions >10cm/H2O on cystometry, abnormal bladder function (residual urine >50ml and maximal uroflow <15ml/second), previous surgery for genuine stress incontinence, neurological or psychiatric disease, ongoing urinary tract infections, other diseases that could interfere with participation, use of concomitant treatments during the trial, and inability to understand instructions given in Norwegian. Loss of followup: 12.3% 

1. Pelvic floor exercise with 8-12 contractions 3 times/day and in groups with skilled physical therapists 1/week. 2. The electrical stimulation using vaginal intermittent stimulation with the MS 106 Twin at 50Hz 30 minutes/day. 3. The vaginal cones of 20, 40, and 70g for 20 minutes/day. 4. The untreated control group offered the use of a continence guard. 

Muscle strength measured by vaginal squeeze pressure 1/month. Pad test with standardized bladder volume. 24 hour pad test. Self reported symptoms of severity. Leakage index. Patients indicated on a 5 point scale (5 always, 4 often, 3 sometimes, 2 seldom, 1 never) the frequency of urinary leakage during sneezing, coughing, laughing, walking, walking downhill, running, jumping, and lifting. The mean was calculated as an index of leakage frequency before and after treatment. Objective cure as <2g leakage on the pad test with standardized bladder volume. Subjective cure as (number of women stating that the condition was “unproblematic” after the treatment). 

InSCraslecBcoBcoS
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F415 

Study Participants Clinical Interventions Outcomes 

Cammu,1998514RCT to examine the effects of pelvic floor exercises and vaginal weight cones in the treatment on female genuine stress incontinence. Duration: 12 weeks 

60 ambulatory and fit white women with urodynamic urinary stress incontinence, and vaginal capacity permitting the use of a vaginal probe-EMG biofeedback-or cones post-partum period, and had neither a genital prolapse nor any other associated pathology that warranted surgery. Furthermore, these women had no detrusor instability, no outflow obstruction, and no intrinsic urethral sphincter deficiency. Loss of followup: Not reported 

1. Weekly session of pelvic floor exercises vaginal probe-EMG biofeedback using perineometer 2. Vaginal weight cones (20, 32, 45, 57, and 70g) for 15 minutes, twice daily. 

Self reported urinary incontinence using visual analog scale. Pad test 

InOCraratacadaraSju

Miller, 1998515

RCT to examine the effects of intentionally contracting the pelvic floor muscles before and during a cough on mild and moderate female stress urinary incontinence. Duration: 1 week 

27 women with self reported stress urinary incontinence and demonstrable urine loss during a deep cough with leakage occurring at least weekly and up to 5 times/day. Exclusion criteria: History of systemic neuromuscular disease, previous bladder surgery, active urinary tract infection, leakage that was delayed after coughing and categorized as detrusor instability, leakage that saturated a paper towel and/or pooled on the floor when coughing in the standing posture, inability to demonstrate any voluntary contraction of the pelvic floor muscles despite detailed instruction during the pelvic exam, and significant coexistent pelvic organ prolapse below the hymenal ring. Loss of followup: Not reported 

1. Immediate intervention group taught intentionally contracting the pelvic floor muscles before and during a cough (Knack) 2. Wait-listed control group 

Self report 6-day urination diary, digital test for pelvic muscle strength and self reported symptoms (possible score range: 0-21). 

InsraacredSju
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F416 

Study Participants Clinical Interventions Outcomes 

Aksac, 2003516

RCT to examine the effects of pelvic floor muscle exercises or biofeedback on female urinary stress incontinence. Duration: 2 months 

50 postmenopausal women with female urinary stress incontinence taking HRT. Exclusion criteria: Not reported. Loss of followup: Not reported. 

1. Pelvic floor muscle exercise (contractions for 10 seconds and relaxation for 20 seconds, 10 times/session, 3 sessions/day) via digital palpation at home 2. Pelvic floor muscle exercise (contractions for 10 seconds and relaxation for 20 seconds) via biofeedback (vaginal probe in EMG pressure mode) 3 times/ week. 3. Usual care, hormone replacement therapy 

Pad test, perineometry outcomes, digital palpation based Pelvic floor muscle strength, incontinence frequency: 1=urine loss 1/day, 2=urine loss >1/week, 3=urine loss <1/week, 4=urine loss 1/month). Visual analog scale based social activity index: 0=cannot undertake any social activity, 10=does not have any problem. 

InsRcleto lecadaraSju

Burns, 1993517

RCT to examine the effects of biofeedback and pelvic muscle exercise treatment on stress incontinence in older communitydwelling women. Duration: 6 months 

135 community-dwelling women older than 55 years with sphincteric incompetence, >3 urine losses/week, urodynamic incontinence, >23 scores in Mini-Mental State exam. Exclusion criteria: glycosuira, pyuria, residual urine >50cc, Peak urine flow <15cc/second Loss of followup: 7% 

1. Biofeedback using vaginal EMG probe, contraction for 10 seconds and relaxations for 10 seconds 10 times in each weekly session. 2. Pelvic muscle exercise with 4 sets of 20 increasing by 10/set until maximum 200 sets/day. 3. Usual care. 

Self reported urinary incontinent episodes, improvement in incontinence. Urodynamic outcomes. 

NSRacredaraSju

Sherman, 1997518

RCT to examine the effects of pelvic muscle exercises with urethral biofeedback on exercise-induced urinary incontinence in females soldiers. Duration: 8 weeks. 

39 female active duty soldiers with exercise-induced urinary incontinence (stress or mixed). Exclusion criteria: not reported. Loss of followup: not reported. 

1. Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 5 times/session, 20 minutes twice/day with urethral biofeedback using vaginal EMG probe. 2. Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 5 times/session 20 minutes twice/day alone. 

Self reported urinary incontinence symptoms. Urodynamic outcomes. 

InsRsoinuinAcredaraSju
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F417 

Study Participants Clinical Interventions Outcomes 

Burns,1990519

RCT to examine the effects of pelvic floor exercises or biofeedback on female stress urinary incontinence. Duration: 8 weeks 

128 women with stress or mixed urinary incontinence >3/week with Mini-Mental scores >23. Exclusion criteria: urinary tract infection. Loss of followup: not reported. 

1. Kegel pelvic floor exercises 4 times/day. 2. Biofeedback with vaginal EMG probe and visual control. 3. Usual care. 

Self reported urinary symptoms. Electromyographic outcomes 

NnbwocredaraSju

Wells, 1991520

RCT to examine the effects of pelvic muscle exercise or pharmacologic treatment of stress urinary incontinence in community-living elderly women. Duration: 6 months 

157 community-living women, ages 55 to 90 years. Exclusion criteria: nursing home residency Loss of followup: 34% in active and 15% in control group. 

1. Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds, 90-160 times/day. 2. Phenylpropanolamine hydrochloride in a dose of 50mg /day, increasing to 50mg 2 times/ day. 

Subjective improvement, self recorded frequency of wetting. 

NORacredaraSju

Aukee, 2002521

RCT to examine the effects of electromyographyassisted biofeedback training and pelvic floor muscle training on female stress urinary incontinence. Duration: 12 weeks. 

30 women with urodynamically tested stress incontinence ages 31 to 69 years without previous incontinence operations and an abdominal leak point pressure >90. Exclusion criteria: Genital protrusion beyond the vaginal hymen, an inability to understand instructions for home training, pregnancy, and any severe disease such as malignancy in the abdominal region, multiple sclerosis, and insulin-dependent diabetes. Loss of followup: 6.7% 

1. Pelvic floor muscle exercise after verbal and written instructions for home practice of 20 minutes/day 5 times/week and individual EMGassisted biofeedback device with vaginal probe and verbal control. 2. Pelvic floor muscle exercise after verbal and written instructions for home practice of 20 minutes/day 5 times/week. 

24 hour pad test, leakage index of 13 types of physical exertions that trigger urinary leakage in women with stress incontinence. 

InORratabAcredaraSju
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F418 

Study Participants Clinical Interventions Outcomes 

Berghmans, 1996522RCT to examine the effects of biofeedback and pelvic floor muscle exercise on female genuine stress incontinence. Duration: 12 weeks. 

40 women 18-70 years with mild or moderate stress incontinence (grade 1). Exclusion criteria: Use of medicine to counteract functional disabilities of the lower urinary tract, pronounced lesions of the pudendus nerve during clinical neurophysiological examination, positive sediment of urine culture, non-compliance in the diagnostic phase, neurogenic bladder function disability caused by surgery of urological and or gynecological nature, period of 6 weeks after a delivery, other forms of treatment to cure stress incontinence, stress incontinence grade 3 or 4, psychological disorders, irritable vagina, pacemaker, hip prosthesis, pathology such as spina bifida, spinal cord lesion. Loss of followup: none 

1. Pelvic floor muscle exercise 12 treatment sessions, 3 times/week with contractions 3 -30 seconds 10-30 times beginning with 4 sets of 10 (5 quick and 5 sustained) and increased by 10 per set until 30 times/set. Biofeedback with EMG vaginal probe and visual control. 2. Pelvic floor muscle exercise 12 treatment sessions, 3 times/week with contractions 3-30 seconds 10-30 times beginning with 4 sets of 10 (5 quick and 5 sustained) and increased 

by 10 per set until 30 times/set. 

Involuntary urine loss, measured with 48 hours pad test. Self completed urinary symptoms questionnaire as 10-point scale and maximum of 50 points for more serious problem: 1. At what level of bladder pressure involuntary loss of urine starts 2. Degree of wet caused by involuntary loss of urine 3. Frequency of involuntary loss of urine 4. Level of limitation of social activities because of incontinence 5. Emotional state related to involuntary loss of urine 

InSCrassina(gopAcadaraSju

LiebergallWischnitzer ,2005523

RCT to examine the effects of circular muscle exercises on female urinary stress incontinence. Duration: 12 weeks. 

59 women, mainly hospital employees with stress or mixed urinary incontinence with urine loss >1gin pad test. Exclusion criteria: Pregnancy, severe cardiac or respiratory diseases, pelvic surgery within 6 months, grade 3 and 4 cystocele, previous pelvic radiation, active mucosal lesion in vagina or perineum. Loss of followup: 13.3% 

1. Paula method of circular muscle training 15-45 minutes/day with training sessions of 45 minutes/week. 2. Pelvic floor muscle exercise 15 minutes with 30 minute lesson session/week. 

Self reported incontinence, quality of life (I-QOL), 1-hour pad test, and pelvic floor muscle strength (assessed by perineometer and digital examination). 

NSCrabacredaraS
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F419 

Study Participants Clinical Interventions Outcomes 

Sung, 2000524

RCT to examine the effects of pelvic floor muscle exercises on female genuine stress incontinence. Duration: 6 weeks 

90 married women with urinary incontinence. Exclusion criteria: not reported. Loss of followup: not reported. 

1. Functional electrical stimulationbiofeedback for 20 minutes/session with frequency 35Hz-50Hz and contractions of 32 seconds, 2 sessions/week 2. Intensive pelvic floor muscle exercises 3. Control usual care 

Jackson's Bristol female urinary symptom questionnaire with scores from 1 (not a problem) to 5 - very serious problem). Objective changes of pelvic muscle contraction force measured by perineometer. 

InORacredSju

Lagro-Janssen , 1991525RCT to examine the effects of pelvic floor exercise on urinary incontinence in women. Duration: 3 months 

66 women ages 20-65 years with genuine stress incontinence. Exclusion criteria: Previously undergone an operation for incontinence; if they suffered from underlying neurological causes for incontinence, from diabetes mellitus or from urinary tract infection; or if 

there was a temporary cause for their incontinence (for example, pregnancy or bed rest). Loss of followup: none. 

1. Instructions in pelvic floor exercises 5- 10 sessions of 10 pelvic muscle contractions for 6 seconds each day. 2. No therapy 

Self reported urinary incontinence and impact of incontinence on life. 

InsRacredaraSju

Kim, 2001526

RCT to examine the effects of continence efficacy intervention program on stress urinary incontinence in Japanese women. Duration: 3 months. 

48 women 20-75 years old with stress or mixed urinary incontinence. Exclusion criteria: Drug or surgery treatment for incontinence. Loss of followup: 15.2% 

1. Continence efficacy intervention program: common pelvic floor muscle education, audiovisual tape, calendar, counseling, schedule guideline, assessing self-care methods. 2. Conventional care. 

Self reported urinary continence and improvement in symptoms of urinary incontinence graded from 0 to 100. 

NORoccredaraSju
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F420 

Study Participants Clinical Interventions Outcomes 

Arvonen, 2001527

RCT to examine the effects of pelvic floor muscle training with and without vaginal balls on females stress urinary incontinence. Duration: 4 months 

37 women ages 25-65 with stress urinary incontinence, understanding of spoken Swedish. Exclusion criteria: Pregnancy, cysto/rectocele, prolapse, urinary tract infection, altered vaginal tissue, and medication affecting the functioning of the urinary tract or kidneys. Loss of followup: 7% 

1. Pelvic floor muscle training program with contractions/relaxations for 5 seconds 10 times twice a day. 2. Pelvic floor muscle training program with contractions/relaxations for 20/20 seconds 10 times twice a day using weighted vaginal balls 50-100g. 

Pad-test with a standardized bladder volume. The strength of the pelvic floor musculature assessed by vaginal palpation graded from 0=no contraction to 5=very strong pressure with a strong lift for 6±7 seconds. 

NORacredaraSju

Borello-France, 2006528RCT to examine the effects of exercise position during pelvic-floor muscle exercises on females stress urinary incontinence. Duration:12-weeks 

44 women 38 to 70 years old, ambulatory, with symptoms of stress urinary incontinence >1/week. Exclusion criteria: Pregnancy, symptoms of urgency or urge urinary incontinence, prior treatments for stress urinary incontinence (collagen injection, medications affecting bladder tone, pessary, or surgery), practicing pelvicfloor muscle exercises, pacemaker, use of intrauterine device, medical history of pelvic cancer, severe endometriosis, neurologic or metabolic disorders likely to impair bladder or sphincter function. Loss of followup: 18% 

1. Pelvic floor muscle exercises with EMG biofeedback in the supine position only using maximum 30-60 repetitions of 3-12 second contractions twice daily. 2. Pelvic floor muscle exercises with EMG biofeedback in both supine and upright positions,1 set (3- and 12-second contractions) in each position 

with maximum 20 repetitions (2 sets of 10) of the 3-12 second contractions twice daily. 

1-week bladder diary, 1 hour pad test, urodynamic outcomes, quality-of-life (Incontinence Impact Questionnaire ranges from 0-400 with poorer perceived quality of life). 

InOrasratacredaraSju
Table F86. Effects of behavioral interventions on risk and progression of stress urinary incontinence in females (continued) 

F421 

Study Participants Clinical Interventions Outcomes 

Mørkved, 2002529

RCT to examine the effects of individual pelvic floor muscle training with and without biofeedback in women with urodynamic stress incontinence. Duration of treatment and followup: 6 months 

103 women with symptoms of stress incontinence and >2g leakage measured by a pad test with standardized bladder volume. Exclusion criteria: involuntary detrusor contractions on cystometry, abnormal bladder function (residual urine >50ml), previous surgery for stress incontinence, neurologic or psychiatric disease, urinary tract infection, other diseases that could interfere with participation, pregnancy, use 

of concomitant treatments during the trial period, and inability to understand instructions in Norwegian. Loss of follow up: 8.7% 

1. Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) contractions per day with a biofeedback apparatus 2. Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) contractions per day without biofeedback 

Pad test with standardized bladder volume with 300ml of saline. Women wore pre-weighed pads and jumped with legs in subsequent adduction and abduction (jumping jacks/star jumps: 20 repetitions) and coughed three times. Objective cure ≤2g of 

leakage. Self-report of severity using 5-point scale (unproblematic, minor problem, moderate problem, problematic, very problematic). Subjective cure - reporting the leakage to be unproblematic after treatment. The leakage index in 5-point scale (1-never, 5-always) containing 13 types of physical activities known to trigger urinary leakage. The social activity index with nine social settings and 10cm visual analogue scale (0 - impossible to participate, 10 - no problem to participate). 

InSCcrasa svalecaBcoS
F422 

Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest)

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Pelvic floor muscle exercise (contractions for 10 seconds and relaxation for 20 seconds) via biofeedback (vaginal probe in EMG pressure mode) 3 times/week 

Cure from stress urinary incontinence in pad test 

16 0 80.0 0 17.3 

(1.1; 261.7)

Aksac, 2003516N = 50 

Pelvic floor muscle exercise (contractions for 10 sec and relaxation for 20 sec, 10 times/session, 3 sessions/day) via digital palpation at home 

Usual care 

Cure from stress urinary incontinence in pad test 

15 0 75.0 0 16.2 

(1.1; 246.5)

Bo, 2005497

N = 47 

Intensive pelvic floor exercise with 8-12 maximum contractions for 6-8 seconds 3 series/day under the supervision of physical therapist for 6 months 

Home exercise groups 

Self reported cure from incontinence 6 months followup 

13 4 60.0 17.0 4.0 

(1.5; 10.5) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F423 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

BorelloFrance, 2006528N = 44 

Pelvic floor muscle exercises with EMG biofeedback in the supine position only using maximum 30-60 repetitions of 3-12 second contractions twice daily. 

Pelvic floor muscle exercises with EMG biofeedback in both supine and upright positions, 1 set (3- and 12-second contractions) in each position with maximum 20 repetitions (2 sets of 10) of the 3-12 second contractions twice daily. 

Urinary continence (objective cure in urodynamic exam) 

13 13 59.1 59.1 1.0 (0.6; 1.6) 

Objective Cure (<2g of Leakage on the Pad Test) 

28 21 52.83 42.00 1.26 

(0.83; 1.90)

Mørkved, 2002529N = 103 100% female Followup: 6 months 

Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) contractions per day with a biofeedback apparatus 

Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) contractions per day without biofeedback 

Urinary incontinence unproblematic 

19 14 35.85 28.00 1.28 

(0.72; 2.27)
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F424 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Bo, 1999513

N = 122 

Pelvic floor exercise with 8-12 contractions 3 times/day and in groups with skilled physical therapists 1/week. 

Untreated control group offered the use of a continence guard 

Subjective cure as (number of women stating that the condition was “unproblematic” after the treatment) 

14 1 48.3 3.1 15.4 

 (2.2; 110.3)

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) and Pelvic floor electrical stimulation 

Selfadministered behavioral training administered with a selfhelp booklet 

% of women with no leakage in post treatment urodynamic testing 

32 25 47.2 37.5 1.3 (0.9; 1.9) 

Wang, 2004496N = 120 

Electrical stimulation in the management of overactive bladder with intravaginal electrode at the physiotherapy unit 

Pelvic floor muscle training 

Cured urge incontinence 

17 12 40.0 30.3 1.3 (0.7; 2.5) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F425 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Cammu, 1998514N = 30 

Weekly session of pelvic floor exercises vaginal probeEMG biofeedback using perineometer. 

Vaginal weight cones (20, 32, 45, 57, and 70g) for 15 minutes twice daily 

Negative stress test 

12 12 40.0 40.0 1.0 (0.5; 1.9) 

Wang, 2004496N = 120 

Biofeedbackassisted pelvic floor muscle training with an intravaginal electromyogram probe to contract or relax PFMs following the visual EMG signals. 

Pelvic floor muscle training 

Cured urge incontinence 

15 12 38.2 30.3 1.3 (0.7; 2.4) 

Bo, 1999513

N = 122 

Pelvic floor exercise with 8-12 contractions 3 times/day and in groups with skilled physical therapists 1/week. 

Untreated control group offered the use of a continence guard 

Objective cure as <2g leakage on the pad test with standardized bladder volume 

11 2 37.9 6.3 6.1 

(1.5; 25.1) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F426 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Kim, 2001526N = 33 

Continence Efficacy Intervention Program: common pelvic floor muscle education, audiovisual tape, calendar, counseling, schedule guideline, assessing self–care methods. 

Conventional care 

Self reported cure 

6 2 37.5 11.8 3.2 

(0.7; 13.6) 

Diokno, 2004487N = 359 

Behavioral modification program: pelvic floor muscle training, bladder training 

Usual care % of absolute 

continent 

61 55 37.0 28.0 1.3 (1.0; 1.8)

Elser, 1999498N = 204 

Pelvic floor muscle training with visual and verbal biofeedback 

Bladder training 

Cured from incontinence (self reported and urodynamic) 

25 17 36.8 25.0 1.5 (0.9; 2.5) 

Alewijnse, 2003493N = 129 

Pelvic floor muscle exercise with reminder and self-help guide 

Bladder training and pelvic floor muscle exercise 

% cured (100% dry) 1 year after intervention 

17 21 32.7 41.2 0.8 (0.5; 1.3) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F427 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Bo, 2005497

N = 47 

Intensive pelvic floor exercise with 8-12 maximum contractions for 6-8 seconds 3 series/day under the supervision of physical therapist for 6 months 

Home exercise groups 

Self reported continence 15 years followup 

6 4 28.6 15.4 1.9 (0.6; 5.7) 

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) 

Selfadministered behavioral training administered with a selfhelp booklet 

% of women with no leakage in post treatment urodynamic testing 

18 25 27.6 37.5 0.7 (0.4; 1.2) 

Wells, 1991520N = 157 

Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 90-160 times/day 

Phenylpropanolamine hydrochloride in a dose of 50mg/day, increasing to 50mg 2 times/day 

Cure from stress urinary incontinence (dry) 

22 11 27.0 14.0 1.9 (1.0; 3.6) 

Wyman, 1998491N = 204 

Combination of bladder training and pelvic muscle exercise 

Bladder training 

% cured at 3 months followup 

16 10 27.0 16.0 1.6 (0.8; 3.3) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F428 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Arvonen, 2001527N = 37 

Pelvic floor muscle training program with contractions/ relaxations for 5 seconds 10 times 2 times/day 

Pelvic floor muscle training program with contractions/ relaxations for 20/20 seconds 10 times 2 times/day using weighted vaginal balls 50-100g 

No Leakage (g) 

5 9 26.3 50.0 0.5 (0.2; 1.3) 

Berghmans, 1996522N = 40 

Pelvic floor muscle exercise with biofeedback with EMG vaginal probe and visual control. 

Pelvic floor muscle exercise 

Cure from stress urinary incontinence 

5 3 25.0 15.0 1.7 (0.5; 6.1) 

Burns, 1993517N = 135 

Biofeedback using vaginal EMG probe, contraction for 10 seconds and relaxations for 10 seconds 10 times in each weekly session 

Usual care. Cure from 

stress urinary incontinence 

9 1 23.0 3.0 8.8 

(1.2; 66.0) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F429 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Janssen, 2001508N = 530 

Individual pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 11 30 minute sessions. 

Group pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 9 2 hour sessions 

% cured (urinary continent) at 9 months 

28 57 22.0 14.0 1.6 (1.0; 2.4) 

LagroJanssen, 1991525N = 66 

Instructions in pelvic floor exercises 5-10 sessions of 10 pelvic muscle contractions for 6 seconds each day. 

No therapy Urinary 

continence 

7 1 21.2 3.0 7.0 

(0.9; 53.8) 

Wyman, 1998491N = 204 

Pelvic muscle exercise with biofeedbackassisted instruction 

Bladder training 

% cured at 3 months followup 

13 10 20.0 16.0 1.3 (0.6; 2.7) 

Janssen, 2001508N = 530 

Individual pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 11 30 minute sessions. 

Group pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 9 2 hour sessions 

% cured (urinary continent) at 3 months 

25 53 20.0 13.0 1.5 (1.0; 2.3) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F430 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

4 visits of behavioral training without biofeedback (verbal feedback based on vaginal palpation). Pelvic floor muscle exercise with 10 second contractions and 10 second relation for 45 minutes/day 

Selfadministered behavioral treatment using a selfhelp booklet to advice pelvic floor exercise and bladder control 

Burgio, % cured 15 11 20.0 15.0 1.4 (0.7; 2.8) 2002505N = 222 

Biofeedbackassisted behavioral training implemented by nurse practitioners 

Selfadministered behavioral treatment using a selfhelp booklet to advice pelvic floor exercise and bladder control 

% cured 15 11 20.0 15.0 1.4 (0.7; 2.8) 

LagroJanssen, 1992502N = 106 

Pelvic floor exercises alone (stress) or bladder training (urge) or its combination (mixed) 

Usual care Self reported 

urinary continence cured 

10 1 18.5 1.8 10.4 

(1.4; 78.3) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F431 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) 

Selfadministered behavioral training administered with a selfhelp booklet 

% of patients with 100% reduction in weekly incontinence episodes cured 

11 10 17.0 15.0 1.1 (0.5; 2.5) 

Burns, 1993517N = 135 

Pelvic muscle exercise with 4 sets of 20 increasing by 10/set until maximum 200 sets/day 

Usual care Cure from 

stress urinary incontinence 

7 1 16.0 3.0 6.3 

(0.8; 49.3) 

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) and pelvic floor electrical stimulation 

Selfadministered behavioral training administered with a selfhelp booklet 

% of patients with 100% reduction in weekly incontinence episodes cured 

10 10 15.0 15.0 1.0 (0.4; 2.2) 

Elser, 1999498N = 204 

Pelvic floor muscle training combined with bladder training 

Bladder training 

Cured from incontinence (self reported and urodynamic) 

10 17 14.7 25.0 0.6 (0.3; 1.2) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F432 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Bo, 1999513

N = 122 

The vaginal cones of 20, 40, and 70g for 20 minutes/day. 

Untreated control group offered the use of a continence guard 

Objective cure as <2g leakage on the pad test with standardized bladder volume 

4 2 13.8 6.3 2.2 

(0.4; 11.2) 

Fantl, 1991503N = 131 

Bladder training using 6 weekly visits included patient education; voiding schedule to have micturition from every 30-60minutes to every 2.5-3 hours; and positive reinforcement. 

Usual care Self reported 

urinary continence (cured) 

8 2 12.0 3.0 4.1 

 (0.9; 18.4) 

Bo, 1999513

N = 122 

The electrical stimulation using vaginal intermittent stimulation with the MS 106 Twin at 50Hz 30 minutes/day. 

Untreated control group offered the use of a continence guard 

Subjective cure as (number of women stating that the condition was “unproblematic” after the treatment) 

3 1 9.4 3.1 3.0 

(0.3; 27.3) 
Table F87. Effects of behavioral interventions on urinary continence in females (events) (tables sorted by rate of urinary contin

treatment, from highest to lowest) (continued) 

F433 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Cure 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Arvonen, 2001527N = 37 

Pelvic floor muscle training program with contractions/ relaxations for 5 seconds 10 times 2 times/day 

Pelvic floor muscle training program with contractions/ relaxations for 20/20 seconds 10 times 2 times/day using weighted vaginal balls 50-100g 

Cured from stress urinary incontinence 

0 4 0.0 22.2 0.1 (0.0; 1.8) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control –rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F434 

Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate of icontinence after active treatments, from highest to lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Wells, 1991520N = 157 

Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 90-160 times/day 

Phenylpropanolamine hydrochloride in a dose of 50mg/day, increasing to 50mg 2 times/day

Negative simple lying stress test 

77 70 94.1 93.8 1.0 (0.9; 1.1) 

Janssen, 2001508N = 530 

Individual pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 11 30 minute sessions. 

Group pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 9 2 hour sessions 

% improved for urinary incontinence at 3 months 

118 347 94.0 86.0 1.1 (1.0; 1.2) 

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) and pelvic floor electrical stimulation 

Self-administered behavioral training administered with a self-help booklet 

% of patients with >50% reduction in weekly incontinence episodes 

58 38 86.0 57.0 1.5 (1.2; 1.9) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F435 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Janssen, 2001508N = 530 

Individual pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 11 30 minute sessions. 

Group pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 9 2 hour sessions 

% improved for urinary incontinence at 9 months 

107 315 85.0 78.0 1.1 (1.0; 1.2) 

LagroJanssen, 1991525N = 66 

Instructions in pelvic floor exercises 5-10 sessions of 10 pelvic muscle contractions for 6 seconds each day. 

No therapy Improvement 

in urinary incontinence 

28 0 85.0 0 57.0 

(3.6; 896.4) 

Goode, 2002501N = 70 

Four sessions (over 8 weeks) of biofeedbackassisted behavioral training by nurse practitioners. 

Usual care Self reported 

improvement in urinary incontinence 

27 19 82.3 51.5 1.6 (1.1; 2.3) 

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) 

Self administered behavioral training administered with a self-help booklet 

% of patients with >50% reduction in weekly incontinence episodes 

53 38 80.0 57.0 1.4 (1.1; 1.8) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F436 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

LagroJanssen, 1991525N = 66 

Instructions in pelvic floor exercises 5-10 sessions of 10 pelvic muscle contractions for 6 seconds each day. 

No therapy Improvement 

in restrictions of activities 

25 2 75.0 6.0 12.5 

(3.2; 48.6) 

Fantl, 1991503N = 131 

Bladder training using 6 weekly visits included patient education; voiding schedule to have micturition from every 30-60minutes to every 2.5-3 hours; and positive reinforcement. 

Usual care Self reported 

more than 50% reduction in urinary incontinence episodes 

49 16 75.0 24.0 3.1 (2.0; 4.9) 

LagroJanssen, 1992502N = 106 

Pelvic floor exercises alone (stress) or bladder training (urge) or its combination (mixed) 

Usual care Self reported 

improvement in urinary incontinence 

40 2 74.0 3.0 20.7 

(5.3; 81.6) 

Berghmans, 1996522N = 40 

Pelvic floor muscle exercise with biofeedback with EMG vaginal probe and visual control. 

Pelvic floor muscle exercise 

Improvement in stress urinary incontinence 

14 14 70.0 70.0 1.0 (0.7; 1.5) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F437 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

LagroJanssen1991525

N = 66 

Instructions in pelvic floor exercises 5-10 sessions of 10 pelvic muscle contractions for 6 seconds each day. 

No therapy Improvement 

in psychological impact of urinary incontinence 

23 0 70.0 0.1 47.0 

(3.0; 743.0) 

Burns, 1990519N = 128 

Biofeedback with vaginal EMG probe and visual control 

Usual care. Self reported 

reduction in urine loss 

24 0 61.0 0.1 49.0 

(3.1; 779.1) 

Burns, 1993517N = 135 

Biofeedback using vaginal EMG probe, contraction for 10 seconds and relaxations for 10 seconds 10 times in each weekly session 

Usual care Improvement 

in stress urinary incontinence 

24 2 61.0 6.0 11.7 

(3.0; 46.2) 

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) and pelvic floor electrical stimulation 

Self-administered behavioral training administered with a self-help booklet 

% of patients with >75% reduction in weekly incontinence episodes 

40 30 60.0 45.0 1.3 (1.0; 1.9) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F438 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Burgio, 2002505N = 222 

4 visits of behavioral training without biofeedback (verbal feedback based on vaginal palpation). Pelvic floor muscle exercise with 10 second contractions and 10 second relation for 45 minutes/day. 

Self-administered behavioral treatment using a self-help booklet to advice pelvic floor exercise and bladder control 

Urinary incontinence does not restrict daily activities 

43 31 58.1 41.3 1.4 (1.0; 2.0) 

Arvonen, 2001527N = 37 

Pelvic floor muscle training program with contractions/ relaxations for 5 seconds 10 times 2 times/day 

Pelvic floor muscle training program with contractions/ relaxations for 20/20 seconds 10 times 2 times/day using weighted vaginal balls 50-100g 

Improvement in stress urinary incontinence 

11 7 57.9 38.9 1.5 (0.7; 3.0) 

Goode, 2003490N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) 

Self-administered behavioral training administered with a self-help booklet 

% of patients with >75% reduction in weekly incontinence episodes 

38 30 57.0 45.0 1.3 (0.9; 1.8) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F439 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Diokno, 2004487N = 359 

Behavioral modification program: pelvic floor muscle training, bladder training 

Usual care % of 

improved incontinence 

92 80 56.0 41.0 1.4 (1.1; 1.7) 

Burns, 1993517N = 135 

Pelvic muscle exercise with 4 sets of 20 increasing by 10/sets until maximum 200 sets/day 

Usual care Improvement 

in stress urinary incontinence 

23 2 54.0 6.0 10.4 

(2.6; 41.4) 

Burns, 1990519N = 128 

Kegel pelvic floor exercises 4 times/day 

Usual care Self reported 

reduction in urine loss 

21 0 54.0 0.1 45.2 

(2.8; 721.0) 

Subak, 2002500N = 152 

6 weekly 20 minute group instructional sessions on bladder training by nurse educators and followed individualized voiding schedules 

Usual care Self reported 

reduction in mean number of incontinent episodes, % 

39 11 50.0 15.0 3.4 (1.9; 6.1) 

Burgio, 2002505N = 222 

Biofeedbackassisted behavioral training implemented by nurse practitioners 

Self administered behavioral treatment using a self-help booklet to advise pelvic floor exercise and bladder control 

Urinary incontinence does not restrict daily activities 

36 31 49.3 41.3 1.2 (0.8; 1.7) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F440 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

4 visits of behavioral training without biofeedback (verbal feedback based on vaginal palpation). Pelvic floor muscle exercise with 10 second contractions and 10 second relation for 45 minutes/day. 

Self administered behavioral treatment using a self-help booklet to advise pelvic floor exercise and bladder control 

Self reported improvement in urinary incontinence as "much better" 

36 20 48.6 26.7 1.8 (1.2; 2.8) 

Biofeedbackassisted behavioral training implemented by nurse practitioners 

Self administered behavioral treatment using a self-help booklet to advise pelvic floor exercise and bladder control 

Self reported improvement in urinary incontinence as "much better" 

33 20 45.2 26.7 1.7 (1.1; 2.7) 

Bo, 1999513

N = 122 

Pelvic floor exercise with 8-12 contractions 3 times/day and in groups with skilled physical therapists 1/week. 

Untreated control group offered the use of a continence guard 

Urinary continence and almost continent 

12 1 41.4 3.1 13.2 

(1.8; 95.6) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F441 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Aksac, 2003516N = 50 

Pelvic floor muscle exercise (contractions for 10 seconds and relaxation for 20 seconds, 10 times/session, 3 sessions/day) via digital palpation at home 

Usual care Improvement 

in stress urinary incontinence in pad test 

5 2 25.0 20.0 1.3 (0.3; 5.3) 

Combination of bladder training and pelvic muscle exercise 

Bladder training % of reported 

75-99% reduction in incontinence 

Wyman, 13 9 22.0 15.0 1.5 (0.7; 3.2) 1998491N = 204 

Pelvic muscle exercise with biofeedbackassisted instruction 

Bladder training % of reported 

75-99% reduction in incontinence 

14 9 22.0 15.0 1.5 (0.7; 3.3) 

Wells, 1991520N = 157 

Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 90-160 times/day 

Phenylpropanolamine hydrochloride in a dose of 50mg/day, increasing to 50mg 2 times/day

Improvement in stress urinary incontinence 

17 29 21.0 39.0 0.5 (0.3; 0.9) 

Aksac, 2003516N = 50 

Pelvic floor muscle exercise (contractions for 10 seconds and relaxation for 20 seconds) via biofeedback (vaginal probe in EMG pressure mode) 3 times/week 

Usual care Improvement 

in stress urinary incontinence in pad test 

4 2 20.0 20.0 1.0 (0.2; 4.6) 
Table F88. Effects of behavioral interventions on improvement of urinary continence in females (events) (tables sorted by rate 

urinary continence after active treatments, from highest to lowest) (continued) 

F442 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Bo, 1999513

N = 122 

Electrical stimulation using vaginal intermittent stimulation with the MS 106 Twin at 50Hz 30 minutes/day. 

Untreated control group offered the use of a continence guard 

Urinary continence and almost continent 

3 1 9.4 3.1 3.0 (0.3; 27.3) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F443 

Table F89. Effects of bladder training and pelvic muscle floor exercises on progression of urinary incontinence in females (eve

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI)

McFall, 2000469N = 145 

Communitybased intervention :bladder training, managing the urge to urinate, and performing pelvic muscle exercises 

Usual care Self reported 

bothersomeness of urinary incontinence 

42 62 58.9 85.2 0.7 (0.6; 0.

Fantl, 1991503

N = 131 

Bladder training using 6 weekly visits included patient education; voiding schedule to have micturition from every 30-60 minutes to every 2.5-3 hours; and positive reinforcement. 

Usual care Self reported 

increase in episodes of urinary incontinence 

5 28 8.0 43.0 0.2 (0.1; 0.4

McFall, 2000469N = 145 

Communitybased intervention: bladder training, managing the urge to urinate, and performing pelvic muscle exercises 

Usual care Use absorbent 

pads for urinary incontinence 

39 56 54.0 77.0 0.7 (0.6; 0.
Table F89. Effects of bladder training and pelvic muscle floor exercises on progression of urinary incontinence in females (eve

F444 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI)

Arvonen, 2001527N = 37 

Pelvic floor muscle training program with contractions/relaxations for 5 seconds 10 times 2 times/day 

Pelvic floor muscle training program with contractions/relaxations for 20/20 seconds 10 times 2 times/day using weighted vaginal balls 50-100g 

Leakage >50g 1 1 5.3 5.6 0.9 (0.1; 14.Problem with interference with physical activity 

13 24 43.5 79.3 0.6 (0.4; 0.

Problems because of avoiding places and situations 

8 10 28.0 34.4 0.8 (0.4; 1.8

Bo, 2000512

N = 59 

Pelvic floor muscle exercise with 8-12 maximum contractions in 3 series/day and 45 min/week group sessions 

Untreated control group 

Problems with interference with social life 

1 12 3.7 40.7 0.1 (0.0; 0.

LagroJanssen, 1992502N = 106 

Pelvic floor exercises alone (stress) or bladder training (urge) or its combination (mixed) 

Usual care Self reported 

deterioration in urinary incontinence 

1 2 2.0 3.0 0.5 (0.0; 5.6
Table F89. Effects of bladder training and pelvic muscle floor exercises on progression of urinary incontinence in females (eve

F445 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI)

Bo, 2005497

N = 47 

Intensive pelvic floor exercise with 8-12 maximum contractions for 6-8 seconds 3 series/day under the supervision of physical therapist for 6 months 

Home exercise groups 

Self reported severe and very severe urinary incontinence 15 years followup 

1 7 4.8 26.9 0.2 (0.0; 1.3

LagroJanssen, 1992502N = 106 

Pelvic floor exercises alone (stress) or bladder training (urge) or its combination (mixed) 

Usual care Self reported 

severe urinary incontinence 

4 23 7.4 41.1 0.2 (0.1; 0.

Self reported urge incontinence 15 years followup 

Bo, 2005 3 10 14.3 38.5 0.4 (0.1; 1.2497N = 47 

Intensive pelvic floor exercise with 8-12 maximum contractions for 6-8 seconds 3 series/day under the supervision of physical therapist for 6 months 

Home exercise groups 

Stress urinary incontinence last month (n) 15 years followup 

19 21 90.5 80.8 1.1 (0.9; 1.4

Bo, 2000512

N = 59 

Pelvic floor muscle exercise with 8-12 maximum contractions in 3 series/day and 45 minutes/week group sessions 

Untreated control group 

Urinary incontinence with intercourse 

3 13 10.5 41.7 0.2 (0.1; 0.
Table F89. Effects of bladder training and pelvic muscle floor exercises on progression of urinary incontinence in females (eve

F446 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI)

Bo, 2005497

N = 47 

Intensive pelvic floor exercise with 8-12 maximum contractions for 6-8 seconds 3 series/day under the supervision of physical therapist for 6 months 

Home exercise groups 

Always pad use 15 years followup 

3 7 14.3 26.9 0.5 (0.2; 1.8

Aukee, 2004494N = 35 

Pelvic floor training by physiotherapist 5 times/12 weeks with home biofeedback 

Home program with given verbal and written instructions for home practice 

Gynecologic surgery at 1 year of followup. 

9 5 47.4 31.3 1.5 (0.6; 3.6

McClurg, 2006510N = 30 100% female 24 months 

Pelvic Floor 

Training and Advice and EMG Biofeedback 

Pelvic Floor Training and Advice 

Self reported urinary incontinence 

5 8 50.00 80.00 0.63 (0.31

1.25) 

UI is Minor problem 

17 18 32.08 36.00 0.89 (0.52

1.53) 

UI is Moderate problem 

8 5 15.09 10.00 1.51 (0.53

4.31) 

Mørkved, 2002529N = 103 6 months 

Pelvic floor muscle 

training with 3 sets of 10 contractions 3

times/day, individually supervised by a 

Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, 

UI is Problematic 

3 6 5.66 12.00 0.47(0.1; 

1.79 
Table F89. Effects of bladder training and pelvic muscle floor exercises on progression of urinary incontinence in females (eve

F447 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI)

physical therapist. At home, 3 sets of 10 high intensity (close to maximum)contractions per day with a biofeedback apparatus 

individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) contractions per day without biofeedback 

UI is very problematic 

1 3 1.89 6.00 0.31 

(0.03; 2.92

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F448 

Table F90. Behavioral interventions on risk and progression of stress urinary incontinence in males with prostate diseases

Study Participants Clinical Interventions Outcomes 

Wille,2003530RCT to examine the effects of pelvic muscle exercises, electrical stimulation and biofeedback on urinary incontinence after radical retropubic prostatectomy. Duration: 3 months Duration of followup: 12 months 

139 patients who underwent radical retropubic prostatectomy Exclusion criteria: Patient unwillingness to make 2 visits 3 and 12 months Postoperatively. Loss of followup: 7.9% 

1. Instructions about postoperative pelvic muscle exercises. 2. Instructions about postoperative, electrical stimulation (ES) for 15 minutes twice daily with frequency 27Hz, biphasic pulse shape with 1-second bursts, a 5-second pulse width and 2-second pulse trains. Intensity was controlled by each patient from 10% to 100%. 3. Instructions about postoperative, electrical stimulation (ES) for 15 minutes twice daily and biofeedback (BFB) 15 minutes twice daily with stimulation time of 5 seconds, and contracting and relaxing time of 5 and 15 seconds. Treatment was started immediately after catheter removal and performed for 3 months. 

Self reported urinary incontinence with symptom inventory. 20-minute pad test Subjective continence - no or 1 pad used daily. Objective continenceurine loss of less than 1gm. 

NORacredaraSju

Yokoyama, 2004531

RCT to examine the effects extracorporeal magnetic innervation and functional electrical stimulation on urinary incontinence after retropubic radical prostatectomy. Duration: 1-2 months Duration of followup: 6 months 

36 patients with urinary incontinence after retropubic radical prostatectomy. Exclusion criteria: <100g pad weight after the 24-hour pad test 1 day after removing the catheter, use of anticholinergic drugs. Loss of followup: none 

1. Extracorporeal magnetic innervation (ExMI) using neocontrol system was used with 20 minute treatment sessions, 2/week for 2 months. The frequency of the pulse field was 10Hz for 10 minutes, followed by a second treatment at 50Hz for 10 minutes. 2. Functional electrical stimulation (FES) using anal electrode and pulses of 20Hz square waves at a 300μs pulse duration were used for 15 minutes twice daily for 1 month. 3. Control group: pelvic floor muscle exercises. 

Self reported bladder diaries, 24-hour pad weight testing 

NORacredaraSju
Table F90. Behavioral interventions on risk and progression of stress urinary incontinence in males with prostate diseases (co

F449 

Study Participants Clinical Interventions Outcomes 

Filocamo,2005532

RCT to examine the effects of early pelvic floor muscle training on urinary incontinence after radical retropubic prostatectomy. Duration of followup: 12 months 

300 consecutive patients who had undergone standard radical retropubic prostatectomy for clinical stage T1 or T2 prostate cancer. Exclusion criteria: Prior bladder or prostate surgery, prior urinary or fecal incontinence, neurogenic dysfunction of the lower urinary tract, and a preoperative history of overactive bladder. Loss of followup: 1% 

1. Early pelvic floor rehabilitation program after removal of the catheter with verbal explanations, palpation, and visualization of Kegel exercises: 3 sets of 10 contractions for 5 seconds and 10 seconds of muscular relaxation under digital anal control. 2. No formal training in pelvic floor rehabilitation after catheter removal. 

Self reported urinary incontinence using International Continence Society (ICS)-male questionnaire. 1 hour and 24 hour pad test 

NORacredaraSju

Moore, 1999533

RCT to examine the effects of intensive pelvic muscle exercises and electrical stimulation on urinary incontinence after radical prostatectomy. Duration: 12 weeks. Duration of followup: 8 months 

63 patients >4 weeks after radical prostatectomy, with urinary incontinence (>2g of urine loss on pad test), within 12 hours drive of study center, not seeking other treatments, able to speak and read English and comply with the study protocol. Exclusion criteria: Demand pacemaker, previous pelvic floor stimulation, active rectal lesions or infections, known detrusor instability. Loss of followup: 7.9% 

1. Intensive pelvic muscle exercises conducted by a physiotherapist for 30 minutes 2/week: maximal contractions for 5 seconds, slow release and 10 seconds of muscular relaxation. 2. Intensive pelvic muscle exercises conducted by a physiotherapist for 30 minutes 2/week: maximal contractions for 5 seconds, slow release and 10 seconds of muscular relaxation; plus electrical stimulation : 50Hz, biphasic pulse shape with 1 second bursts, 1 second width, and 1 second pulse trains. 3. Standard treatment with verbal and written instructions about postoperative pelvic muscle exercises from urologist and from the nurses at the pre-admission clinic. 

Urine symptom inventory. Continence: a loss of <2g of urine. Socially acceptable continence: loss of <10g of urine. 24-hour pad test 

NOgraraAcadaraS

MathewsonChapman, 1997534

RCT to examine the effects of pelvic muscle exercises with biofeedback on urinary incontinence after radical prostatectomy for localized prostate cancer. Duration: 12 weeks 

53 patients after radical prostatectomy for localized prostate cancer. Exclusion criteria: not reported Loss of followup: none 

1. Education booklet and instruction for pelvic muscle exercises with biofeedback: maximal contractions for 10 seconds, slow release, and 10 seconds of muscular relaxation, 3 times/week. 2. Standard care with no pelvic muscle exercises. All patients were recommended to limit coffee, tea, chocolate, alcohol, and over counter medication for bladder control. 

Self reported in threeday bladder diaries length of time urine loss was experienced; 2) episodes and frequency of urine loss; and 3) ounces of urine lost and number of pads used. 

NORacredaraSju
Table F90. Behavioral interventions on risk and progression of stress urinary incontinence in males with prostate diseases (co

F450 

Study Participants Clinical Interventions Outcomes 

Floratos, 2002535

RCT to examine the effects of electromyographic biofeedback with verbal instructions as learning tools of pelvic muscle exercises on urinary incontinence after radical prostatectomy. Duration: 12 weeks. Duration of followup: 6 months 

42 consecutive patients with urinary incontinence after radical retropubic prostatectomy for localized prostate cancer, able to participate in a learning program, in good general condition and willingness to participate in the study. Exclusion criteria: Significant perioperative complications (ureteric or rectal injury, urine leakage from anastomosis, thrombo-embolism), history of preoperative incontinence and pelvic or lower urinary tract operations, psychiatric history. Loss of followup: 2.4% 

1. Electromyographic biofeedback as learning tools for pelvic muscle exercises immediately after catheter removal: submaximal contractions 3-5 seconds, relaxation for 6-10 seconds, 80-100 times/day and 15 sessions of 2-channel electromyographic biofeedback (three times weekly, 30 minutes each). 2. Verbal feedback as learning tools for pelvic muscle exercises immediately after catheter removal: submaximal contractions 3-5 seconds, relaxation for 6-10 seconds, 80-100 times/day. 

Self reported in 3-day bladder diaries. Continence: a loss of <1g of urine. 1 hour pad test 

NORacredaraSju

Van Kampen, 2000536RCT to examine the effects of pelvic floor re-education for patients with urinary incontinence after radical prostatectomy. Duration of followup: 1 year 

102 consecutive incontinent patients who had had radical retropubic prostatectomy for clinically localized prostate cancer, incontinent on day 15 after surgery after removal of the catheter, and who could comply with the ambulatory treatment schedule. Exclusion criteria: Continence Loss of followup: 3.9% 

1. Pelvic floor re-education program with active pelvic floor muscle exercises and biofeedback for as long as they were incontinent.. 2. .Placebo electrotherapy (a false interferential current) via four skin electrodes, two placed on the abdomen and two on the adductor muscles of the thighs 

Self reported urinary incontinence with a visual analogue scale (0=completely dry, 10=completely incontinent). 1 hour and 24 hour pad tests. 

InSCrarabcadaraS

Bales,2000537RCT to examine the effects of preoperative biofeedback training on urinary continence in men undergoing radical prostatectomy. Duration: 2-4 weeks. Duration of followup: 6 months 

100 men with Stages T1c-T2c prostate cancer who were to undergo radical retropubic prostatectomy. Exclusion criteria: Preoperative radiotherapy or neoadjuvant hormonal blockade, transurethral resection of the prostate, pre-existing neurologic disease. Loss of followup: 3% 

1. Graded pelvic muscle exercise training with biofeedback 2-4 weeks before surgery 4 times/day until surgery and to resume exercises when the urethral catheter was removed following surgery. Surface electrodes were used to assess muscle strength and contractions of 5-10 seconds, and 10-15 repetitions were performed. 2. Control group: Pelvic muscle exercises without biofeedback. 

Self reported urinary continence: one pad or less/day, either because of minimal urine leakage or for security if no leakage was present, 

NORacredSju
Table F90. Behavioral interventions on risk and progression of stress urinary incontinence in males with prostate diseases (co

F451 

Study Participants Clinical Interventions Outcomes 

Porru, 2001538RCT to examine the effects of pelvic floor muscle exercises on urinary incontinence in patients after transurethral prostatectomy. Duration: 4 weeks 

63 consecutive patients with bladder outflow obstruction and diagnosis of symptomatic benign prostatic hyperplasia after transurethral prostatectomy. Exclusion criteria: Age over 80 years old, history of urethral or pelvic surgery, neurogenic bladder, or prostatic carcinoma. Loss of followup: Not reported 

1. Verbal instruction, feedback on contractions of pelvic floor muscles, and verbal reinforcement of appropriate responses to teach selective contractions of anal sphincter muscles and relaxation of abdominal muscles for 45 times/day, divided into 3 sessions of 15 exercises each. 2 Standard care without instruction on pelvic floor muscle exercises. 

Self reported urinary incontinence using The American Urological Association Symptom Score 

InsRacredSju

Franke, 2000539

RCT to examine the effects of biofeedback and pelvic floor exercises 6 weeks after radical prostatectomy on urinary incontinence. Duration: 6 months 

30 patients who underwent radical retropubic prostatectomy. Exclusion criteria: Previous transurethral prostatic resection, neurological condition affecting the urinary tract, residual urine greater than 50ml. or a urinary tract infection. Loss of followup: Not reported 

1. Pelvic floor muscle exercises at home of 20 contractions 3 times/day, with 45 minute perineal patch, electromyography biofeedback behavioral therapy session and timed voiding schedule to decrease urgency and urge incontinence. 2. Standard care without instruction on pelvic floor muscle exercises. 

Self reported urinary incontinence and voiding diary and 48-hour pad test 

NORacredaraSju

Parekh,2003540

RCT to examine the effects of physical therapy and pelvic floor exercises before and after radical prostatectomy on urinary incontinence. Duration: 3 months Duration of followup: 6 months 

38 consecutive patients scheduled to undergo radical prostatectomy. Exclusion criteria: Prior bowel or bladder incontinence. Loss of followup: Not reported 

1. Physical therapy for a pelvic floor exercise program with 2 treatment sessions before surgery and every 3 weeks for 3 months after the catheter removal. A home exercise program was followed for 6 months or longer by patients requiring further physical therapy guidance. 2. Standard care without instruction on pelvic floor muscle exercises. 

Self reported urinary incontinence and number of pads used daily. Continence - 0 or 1 precautionary pad 

NORacredSju
Table F90. Behavioral interventions on risk and progression of stress urinary incontinence in males with prostate diseases (co

F452 

Study Participants Clinical Interventions Outcomes 

Dorey, 2004541

RCT to examine the effects of pelvic floor muscle exercises and manometric biofeedback for postmicturition dribble in men with erectile dysfunction. Duration of followup: 3 months 

55 men with erectile dysfunction. Exclusion criteria: Urological congenital abnormalities, neurological deficits, and previous urological surgery. Loss of followup: 9.1% 

1. Pelvic floor muscle exercises including a strong post-void "squeeze out" pelvic floor muscle contraction, biofeedback, and suggestions for lifestyle changes. 2. Advice on lifestyle changes 

24 hours, pad test, anal manometric outcomes. 

NSnonAcas

Burgio, 2006542

RCT to examine the effects of preoperative biofeedback assisted behavioral training on urinary incontinence after radical prostatectomy. Duration of follow up: 6 months 

125 continent men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Exclusion criteria: >2 episodes of 

urinary incontinence in the previous 6 months, documented incontinence in the bladder diary, prior prostatectomy, impaired mental status (score less than 20 on the Mini-Mental State Examination), <1 week before scheduled surgery. Loss of follow up: 18.4% 

1. Single preoperative session of biofeedback assisted behavioral training plus daily home exercise daily until the surgery and after catheter removal: 45 pelvic floor muscle exercises in various positions, divided into 3 sessions of 15 exercises to contract sphincter muscles (2 -10-second contraction, 2-10 seconds of relaxation with immediate visual feedback of rectal pressure and external anal sphincter contractions using 3 small balloons). 2. Usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. 

Self reported incontinence duration from bladder diaries, incontinence severity (the proportion with severe/continual leakage), Incontinence Impact Questionnaire, psychological distress (Hopkins Symptom Checklist) pad use, and health related quality of life (Medical Outcomes Study Short Form Health Survey). Self reported continence -3 consecutive 1-day diaries with no leakage or a 7-day diary with no leakage. 

InSRcrabsvtu(G> cadaraS
F453 

Table F91. Effects of behavioral interventions on urinary continence in males (events) (table sorted by rate of continence in the acto lowest)

Author 

Sample Active Treatment Control Treatment Definition of Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI)

Filocamo, 2005532N = 300 

Early pelvic floor rehabilitation program after removal of the catheter with verbal explanations, palpation, and visualization of Kegel exercises: 3 sets of 10 contractions for 5 seconds and 10 seconds of muscular relaxation under digital anal control. 

No formal training in pelvic floor rehabilitation after catheter removal 

Self reported urinary continence 

148 132 98.7 88.0 1.1 (1.1; 1.2) 

MathewsonChapman, 1997534N = 53 

Education booklet and instruction for pelvic muscle exercises with biofeedback: maximal contractions for 10 seconds, slow release and 10 seconds of muscular relaxation, 3 times/week. 

Standard care with no pelvic muscle exercises. All patients were recommended to limit coffee, tea, chocolate, alcohol, and over counter medication for bladder control. 

Self reported urinary continence 

26 24 96.3 100.0 1.0 (0.9; 1.1) 
Table F91. Effects of behavioral interventions on urinary continence in males (events) (table sorted by rate of continence in the ac

to lowest) (continued) 

F454 

Author 

Sample Active Treatment Control Treatment Definition of Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI)

Van Kampen, 2000536N = 102 

Pelvic floor reeducation program with active pelvic floor muscle exercises and biofeedback for as long as they were incontinent. 

Placebo electrotherapy (a false interferential current) via four skin electrodes, two placed on the abdomen and two on the adductor muscles of the thighs. 

Self reported urinary continence 

48 42 95.0 81.0 1.2 (1.0; 1.4) 

Yokoyama, 2004531N = 36 

Extracorporeal magnetic innervation (ExMI) using neocontrol system was used with 20 minute treatment sessions, 2/week for 2 months. The frequency of the pulse field was 10Hz for 10 minutes, followed by a second treatment at 50Hz for 10 minutes. 

Pelvic floor muscle exercises 

Urinary continence pad free 

11 10 91.7 83.3 1.1 (0.8; 1.5) 
Table F91. Effects of behavioral interventions on urinary continence in males (events) (table sorted by rate of continence in the ac

to lowest) (continued) 

F455 

Author 

Sample Active Treatment Control Treatment Definition of Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI)

Filocamo, 2005532N = 300 

Early pelvic floor rehabilitation program after removal of the catheter with verbal explanations, palpation, and visualization of Kegel exercises: 3 sets of 10 contractions for 5 seconds and 10 seconds of muscular relaxation under digital anal control. 

No formal training in pelvic floor rehabilitation after catheter removal. 

International Continence Society (ICS)-male questionnaire: completely dry 

134 101 89.3 67.3 1.3 (1.2; 1.5) 

Wille, 2003530N = 139 

Instructions about postoperative pelvic muscle exercises 

Instructions about postoperative, electrical stimulation (ES) for 15 minutes twice daily and biofeedback (BFB) 15 minutes twice daily with stimulation time of 5 seconds, and contracting and relaxing time of 5 and 15 seconds 

Self reported urinary continence 

41 41 88.0 88.6 1.0 (0.8; 1.1) 
Table F91. Effects of behavioral interventions on urinary continence in males (events) (table sorted by rate of continence in the ac

to lowest) (continued) 

F456 

Author 

Sample Active Treatment Control Treatment Definition of Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI)

Bales, 2000537

N = 100 

Graded pelvic muscle exercise training with biofeedback 2 to 4 weeks before surgery 4 times/day until surgery and to resume exercises when the urethral catheter was removed following surgery. 

Pelvic muscle exercises without biofeedback 

Self reported urinary continence 

44 48 88.0 96.0 0.9 (0.8; 1.0) 

Van Kampen, 2000536N = 102 

Pelvic floor reeducation program with active pelvic floor muscle exercises and biofeedback for as long as they were incontinent. 

Placebo electrotherapy (a false interferential current) via four skin electrodes, two placed on the abdomen and two on the adductor muscles of the thighs. 

Self reported urinary continence in visual analogue scale 0-1 (0 = completely dry, 10 = completely incontinent). 

44 36 88.0 70.0 1.3 (1.0; 1.6) 

Franke, 2000539N = 30 

Pelvic floor muscle exercises at home of 20 contractions 3 times/day with 45 minute perineal patch, electromyography biofeedback behavioral therapy session and timed voiding schedule to decrease urgency and urge incontinence. 

Standard care without instruction on pelvic floor muscle exercises. 

Self reported pad free condition 

13 13 86.0 88.0 1.0 (0.8; 1.3) 
Table F91. Effects of behavioral interventions on urinary continence in males (events) (table sorted by rate of continence in the ac

to lowest) (continued) 

F457 

Author 

Sample Active Treatment Control Treatment Definition of Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI)

Self reported urinary continence diary) 

Parekh, 16 14 85.0 75.0 1.1 (0.8; 1.6) 2003540N = 38 

Physical therapy for a pelvic floor exercise program with and 2 treatment sessions before surgery and every 3 weeks for 3 months after catheter removal. A home exercise program. 

Standard care without instruction on pelvic floor muscle exercises. 

Self reported urinary continence (<1 pad/day) 

16 15 84.2 78.9 1.1 (0.8; 1.4) 

Instructions about postoperative and electrical stimulation (ES) for 15 minutes twice daily with frequency 27Hz, biphasic pulse shape with 1 second bursts, a 5 second pulse width and 2 second pulse trains. 

Self reported Urinary continence 

Wille, 2003 37 41 81.0 88.6 0.9 (0.8; 1.1) 530N = 139 

Instructions about postoperative pelvic muscle exercises 

Instructions about postoperative, electrical stimulation (ES) for 15 minutes twice daily and biofeedback (BFB) 15 minutes twice daily with stimulation time of 5 seconds, and contracting and relaxing time of 5 and 15 seconds. 

Urinary continence in pad test 

36 42 76.7 90.5 0.8 (0.7; 1.0) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F458 

Table F92. Effects of behavioral interventions on progression of urinary incontinence in males (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI)

Intensive pelvic muscle exercises conducted by a physiotherapist for 30 minutes 2/week plus electrical stimulation: 50Hz, biphasic pulse shape with 1 second bursts, 1 second width, and 1 second pulse trains. 

Standard treatment with verbal and written instructions about postoperative pelvic muscle exercises from urologist and from the nurses at the pre-admission clinic 

Self reported urinary incontinence that affected life 

Moore, 6 3 31.6 14.3 2.2 (0.6; 7.6) 1999533N = 63 

Intensive pelvic muscle exercises conducted by a physiotherapist for 30 minutes 2/week: maximum contractions for 5 seconds, slow release and 10 seconds of muscular relaxation 

Standard treatment with verbal and written instructions about postoperative pelvic muscle exercises from urologist and from the nurses at the pre-admission clinic 

Self reported urinary incontinence that affected life 

3 3 16.7 14.3 1.2 (0.3; 5.1) 
Table F92. Effects of behavioral interventions on progression of urinary incontinence in males (events) (continued) 

F459 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI)

Porru, 2001538N = 58 

Verbal instruction, feedback on contractions of pelvic floor muscles, and verbal reinforcement of appropriate responses to teach selective contractions of anal sphincter muscles and relaxation of abdominal muscles, 45 times/day 

Standard care without instruction on pelvic floor muscle exercises 

Self reported urinary incontinence 

4 12 13.3 42.9 0.3 (0.1; 0.9) 

Parekh, 2003540N = 38 

Physical therapy for a pelvic floor exercise program with and 2 treatment sessions before surgery and every 3 weeks for 3 months after catheter removal. A home exercise program. 

Standard care without instruction on pelvic floor muscle exercises 

Use of >3 pads/day for urinary incontinence 

2 3 10.5 15.8 0.7 (0.1; 3.5) 
Table F92. Effects of behavioral interventions on progression of urinary incontinence in males (events) (continued) 

F460 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI)

Wille, 2003530N = 139 

Instructions about postoperative and electrical stimulation (ES) for 15 minutes twice daily with frequency 27Hz, biphasic pulse shape with 1 second bursts, a 5-second pulse width, and 2 second pulse trains. 

Instructions about postoperative, electrical stimulation (ES) for 15 minutes twice daily and biofeedback (BFB) 15 minutes twice daily with stimulation time of 5 seconds; contracting and relaxing time of 5 and 15 seconds. 

Urinary continence in pad test 

38 42 82.0 90.5 0.9 (0.8; 1.1) 

Less amount of postmicturition dribble 

2 1 7.1 3.7 1.9 (0.2; 20.1) 

Less often postmicturition dribble 

2 2 7.1 7.4 1.0 (0.1; 6.4) 

Dorey, 2004541N = 55 

Pelvic floor muscle exercises including a strong postvoid "squeeze out" pelvic floor muscle contraction, biofeedback, and suggestions for lifestyle changes. 

Advice on lifestyle changes 

No postmicturition dribble 

14 1 50.0 3.7 13.5 (1.9; 95.7) 

Filocamo, 2005532N = 300 

Early pelvic floor rehabilitation program after removal of the catheter with 

No formal training in pelvic floor rehabilitation after catheter removal 

International Continence Society (ICS)-male questionnaire: 2 pads /day 

1 11 0.7 7.3 0.1 (0.0; 0.7) 
Table F92. Effects of behavioral interventions on progression of urinary incontinence in males (events) (continued) 

F461 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI)

ICS-male questionnaire: 3 pads /day or more 

8 8 5.3 5.3 1.0 (0.4; 2.6) 

ICS male questionnaire: occasional leakage 

14 29 9.3 19.3 0.5 (0.3; 0.9) 

Self reported urinary incontinence 

2 18 1.3 12.0 0.1 (0.0; 0.5) 

verbal explanations, palpation, and visualization of Kegel exercises: 3 sets of 10 contractions for 5 seconds and 10 seconds of muscular relaxation under digital anal control. 

Severe stress urinary incontinence that required implantation of artificial sphincter 

2 3 1.3 2.0 0.7 (0.1; 3.9) 

Urine loss when coughing 

11 24 17.46 38.71 0.45 (0.24; 0.84) 

Urine loss when sneezing 

13 23 20.63 37.10 0.56 

(0.31; 1.00) 

Urine loss when Getting up from lying position 

7 15 11.11 24.19 0.46 

(0.20; 1.05) 

Urine loss when lifting 

23 26 36.51 41.94 0.87 

(0.56; 1.35) 

Urine loss when walking 

10 17 15.87 27.42 0.58 

(0.29; 1.16) 

Burgio; 

2006542

N = 125 6 months 

Single preoperative session of biofeedback assisted behavioral training plus daily home exercise. 

Usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream 

Urge to urinate on way to toilet 

13 19 20.63 30.65 0.67 

(0.37; 1.24) 
Table F92. Effects of behavioral interventions on progression of urinary incontinence in males (events) (continued) 

F462 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI)

Wearing pads 

16 24 25.40 38.71 0.66 

(0.39; 1.11) 

Resume usual activities 

28 33 44.44 53.23 0.84 

(0.58; 1.20) 

Severe and continual leakage 

4 12 5.90 19.80 0.33 

(0.11; 0.96)

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F463 

Table F93. Behavioral clinical interventions on urinary incontinence in adults 

Study Participants Clinical Interventions Outcome 

O’Brien, 1991309

RCT to examine the effects of pelvic floor exercises and bladder retraining supervised by nonspecialist nurse on urinary incontinence in adults with regular urinary incontinence. Duration: 3 months 

561 adults ages 35 years and older with regular urinary incontinence (two or more leaks in any one month). Exclusion criteria: Urinary tract infection. Loss of followup: not reported 

1. Four sessions of pelvic floor exercises and bladder retraining supervised by non-specialist nurse. 2. Usual care 

Self reported urinary incontinence and changes in incontinence. 

NSCraAcBreju

McDowell, 1999543

Cross-over RCT to examine the effects of behavioral therapies of urinary incontinence in homebound older adults. Duration: 8 weeks. 

105 adults 60 years and older, homebound (Health Care Financing Administration, cognitively intact (Folstein Mini-Mental State Examination score >24), with urinary incontinence (>2 urinary accidents/week for at least 3 months), who understand and speak English. Exclusion criteria: Folstein MMSE scores <24, severe pelvic prolapse, terminal illness, post-void residual >100ml unable to toilet independently, no caregiver willing and able to assist with toileting, <2 urinary accidents per week, unable to provide satisfactory self-report bladder diary data after three attempts. Loss of followup: 19% 

1. Biofeedback-assisted pelvic floor muscle training by NPs skilled in behavioral therapies for urinary incontinence. Behavioral therapy: 8 weekly sessions at homes with biofeedback-assisted pelvic floor muscle exercises, urge and stress strategies, and bladder retraining. Biofeedback with surface electromyography for immediate visual and/or auditory feedback of pelvic floor and abdominal muscle activity. PFM exercises 3/day, 10-15 exercises at each session to contract and relax muscles for 10 seconds. 2. Usual care with attention control (visits by the NP every 1-2 weeks to provide social interaction). 

Self reported episodes of urinary incontinence/day and changes in severity of urinary incontinence (mild: <5 accidents/week; moderate: 5-10 accidents/week; severe: >10 accidents/week). 

NSCsaaurapAcBcoSju
Table F93. Behavioral clinical interventions on urinary incontinence in adults (continued) 

F464 

Study Participants Clinical Interventions Outcome 

Engberg, 2002544, part of McDowell, 1999{McDowell, 

1999 #10200}

Cross-over RCT to examine the effects of prompted voiding in cognitively impaired homebound older adults. Duration: 8 weeks 

19 adults 60 years and older with urinary incontinence >2 episodes/week for >3 months who met Center for Medicare and Medicaid Services criteria for being homebound, residents in 2 large Medicare-approved home health agencies in a large metropolitan area who understand and speak English. Exclusion criteria: Terminal illness; postvoid residual volume >100ml; caregiver was unable or unwilling to provide toileting assistance, complete bladder diaries, or implement the PV protocol. Loss of followup: 19% 

1. Prompted voiding by caregivers to approach subjects hourly for perceived wet/dry status vs. objective wet checks, feedback and praising for correct response, toilet by request, positive feedback for appropriate toileting. 2. Usual care with attention control (visits by the NP every 1-2 weeks to provide social interaction). 

Incontinent episodes reported by subjects’ caregivers in 2-week bladder diary. 

InSCsaauraAcBcoSjure

Paterson, 1997545

RCT to examine the effects of pelvic floor exercises and urethral milking as treatments for postmicturition dribble in males. Duration: 12 weeks. 

49 men 36-83 years old who had not undergone surgery on the bladder, urethra, or prostate gland but with history of post-micturition dribble. Exclusion criteria: not reported. Loss of followup: 12.2% 

1. Pelvic muscle exercise with 1 second contractions (~5) to increase length and strengths of contractions as much as possible. 2. Urethral milking after appropriate education. 3. Counseling including drinking pattern, aperient use, toileting habits, dietary advice, and relaxation therapy. 

Objectively measure pad weight gain. 

NSRratabAcBcoSju
F465 

Table F94. Effects of behavioral interventions on urinary incontinence in adults (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI)

Self reported improved urinary incontinence 

O’Brien, 182 7 48.1 3.8 12.6 (6.0; 26.2) 1991309N = 561 76% female 

Four sessions of pelvic floor exercises and bladder retraining supervised by nonspecialist nurse 

Usual care 

Self reported cured urinary incontinence 

32 1 8.5 0.5 15.5 (2.1; 112.5) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A- avoided; E- excessive events 
F466 

Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

Urine loss per 24 hours (g) at 6 months 

38.2 ± 109.9 37.2 ± 73.4 0.0 (-0.3; 

Incontinence episodes/day at 6 months 

1.0 ± 1.9 1.8 ± 1.9 -0.4 (-0.7; 

Nocturnal voluntary at 6 months 

0.5 ± 0.8 0.9 ± 0.8 -0.5 (-0.8; 

Voiding interval (hours) at 6 months 

2.5 ± 0.7 2.4 ± 0.6 0.2 (-0.1; 

Self-rating of urine loss 6 months 

5.9 ± 0.9 4.7 ± 1.2 1.2 (0.9; 

Nocturnal voluntary micturition per night at 2 years 

0.9 ± 1.0 1.3 ± 0.9 -0.4 (-0.7; 

Voiding interval (hours) at 2 years 

2.3 ± 0.6 2.1 ± 0.6 0.3 (0.0; 

Incontinence episodes/day at 2 years 

1.0 ± 1.2 2.3 ± 3.2 -0.5 (-0.8; 

Dougherty, 2002504

N = 218 

Behavioral management for continence: selfmonitoring, bladder training, pelvic muscle exercise 

Usual care 

Self rating of urine loss at 2 years 

5.7 ± 1.3 4.9. ± 1.4 0.6 (0.3; 

Pelvic floor exercise with 8-12 contractions 3 times/day and in groups with skilled physical therapists 1/week. 

-1.2 ± 2.0 0.3 ± 2.3 -0.7 (-1.2; 

Change from baseline in episodes of leakage/day (average from 3 days) 

-0.7 ± 4.6 0.3 ± 2.3 -0.3 (-0.8; 

Change from baseline in leakage index 

-0.2 ± 0.5 0.1 ± 0.6 -0.6 (-1.1; 

Bo, 1999513

N = 122 

Electrical stimulation using vaginal intermittent stimulation with the MS 106 Twin at 50Hz 30 minutes/day. 

Untreated control group offered the use of a continence guard 

Change from baseline in social activity index 

0.6 ± 1.0 -0.2 ± 1.7 0.6 (0.1; 

LiebergallWischnitzer, 2005523N = 63 

Pelvic floor muscle exercise 15 minutes with 30 minute lesson 

Paula method of circular muscle training 15-45 

Change from baseline in quality of life-avoidance, limiting behaviors scores (8 items) 

9.5 ± 27.4 9.8 ± 17.3 0.0 (-0.5; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F467 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

session/week minutes/day 

with training sessions of 45 minutes/week 

Change from baseline in quality of life-avoidance, social embarrassment scores (5 items) 

9.3 ± 13.0 14.0 ± 23.0 -0.3 (-0.7; 

Voiding frequency totally/24 hours 

7.0 ± 1.3 9.0 ± 2.7 -1.0 (-1.8; 

Voiding frequency, nighttime/24 hours 

2.0 ± 0.0 2.0 ± 0.7 

Number of used pads/24 hours 

1.0 ± 0.0 1.0 ± 1.3 

Tibaek, 2005499

N = 26 

Intensive pelvic floor muscle training 1-2 times/day by specialized physiotherapist 

Usual care 

Number of incontinence episodes/24 hours 

0.0 ± 0.0 0.0 ± 0.7 

Diurnal incontinent episodes per week 

4.2 ± 5.5 9.6 ± 16.0 -0.5 (-0.8; 

Nocturnal incontinent episodes per week 

1.1 ± 2.0 1.4 ± 2.5 -0.1 (-0.5; 

Total incontinent episodes per week 

5.2 ± 6.8 11.0 ± 17.4 -0.4 (-0.8; 

Subak, 2002500

N = 152 

6 weekly 20-minute group instructional sessions on bladder training by nurse educators and followed individualized voiding schedules 

Usual care 

Nocturnal micturition per week 

9.5 ± 5.2 6.7 ± 4.1 0.6 (0.3; 

Self reported urinary incontinence episodes/week 

Biofeedback- 6.1 ± 10.3 6.7 ± 11.4 -0.1 (-0.4; assisted behavioral training implemented by nurse practitioners 

% reduction in self reported urinary incontinence 

63.1 ± 42.7 58.6 ± 38.8 0.1 (-0.2; 

Self reported urinary incontinence episodes/week 

17.3 ± 16.3 15.4 ± 14.2 0.1 (-0.2; 

Burgio, 2002505

N = 222 

4 visits of behavioral training without biofeedback (verbal feedback based on vaginal palpation). pelvic floor muscle exercise with 10 second contractions and 10 second relation for 45 minutes/day 

Self administered behavioral treatment using a selfhelp booklet to advice pelvic floor exercise and bladder control 

% reduction in self reported urinary incontinence 

69.4 ± 32.7 58.6 ± 38.8 0.3 (0.0; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F468 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

Wyman, 1997506

N = 131 

Bladder training: patient education, progressive scheduled voiding regimen, positive reinforcement 

Usual care Self reported quality of 

life measures (Incontinence Impact Questionnaire (IIQ) 

32.0 ± 41.0 60.0 ± 65.0 -0.5 (-0.9; 

Lagro-Janssen, 1991525N = 66 

Instructions in pelvic floor exercises 5-10 sessions of 10 pelvic muscle contractions for 6 seconds each day. 

No therapy Mean leakage 

episodes/week 

4.8 ± 1.3 25.3 ± 3.6 -7.6 (-8.9; 

Theofrastous, 2002492N = 137 

Pelvic floor muscle training: 4 office biofeedback sessions and home exercise 

Bladder training 

Self reported urinary incontinent episodes per week 

9.4 ± 14.0 10.0 ± 12.0 0.0 (-0.4; 

Fantl, 1991 Diurnal micturition/week 52.0 ± 14.0 57.0 ± 27.0 -0.2 (-0.6; 

503

N = 131 

Bladder training using 6 weekly visits included patient education; voiding schedule to have micturition from every 30-60 minutes to every 2.5-3 hours; and positive reinforcement. 

Usual care 

Nocturnal micturition/week 

5.0 ± 5.0 8.0 ± 6.0 -0.5 (-0.9; 

Change in pressure digital scores adjusted for baseline difference in this variable 

Diokno, 2004 -0.49 (-35.7

487

N = 359 

Behavioral modification program: pelvic floor muscle training, bladder training 

Usual care 

Change in displacement digital scores adjusted for baseline difference in this variable 

 -0.57 (-42.8
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F469 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

Change in 24 hour urinary frequency adjusted for baseline difference in this variable 

 -0.35 (-13.3

Change in intervoid interval adjusted for baseline difference in this variable 

 -0.39 (-14.9

Nocturia (number/night) 0.7 ± 0.8 1.5 ± 1.0 -0.9 (-1.7; Leaked urine: amount (g) 

4.6 ± 6.2 8.4 ± 9.8 -0.5 (-1.3; 

Leaked urine: amount ratio (g/ml) 

0.0 ± 0.0 0.0 ± 0.0 -0.4 (-1.2; 

Bladder training with increased interval between voluntary voids. 

Usual care 

Urinary incontinence scores 

12.1 ± 7.8 14.2 ± 3.6 -0.3 (-1.1; 

Leaked urine, amount (g) 

3.3 ± 4.5 8.4 ± 9.8 -0.7 (-1.5; 

Leaked urine, amount ratio (g/ml) 

0.0 ± 0.0 0.0 ± 0.0 -0.8 (-1.6; 

Nocturia (number/night) 1.9 ± 1.1 1.5 ± 1.0 0.4 (-0.4; 

Yoon, 2003507

N = 50 

Pelvic muscle exercise (30 contractions for 15-20 minutes/ day) with immediate and simultaneous visual feedback of pelvic muscles during a 20 minute weekly biofeedback session with electromyography. 

Usual care 

Urinary incontinence scores 

10.8 ± 6.2 14.2 ± 3.6 -0.7 (-1.5; 

Mean (SD) number of times of nocturnal loss/month at 9 months 

2.5 ± 8.7 6.1 ± 12.2 -0.3 (-0.5; 

Mean (SD) number of times of urine loss/week at 3 months 

7.3 ± 12.0 6.0 ± 9.3 0.1 (-0.1; 

Mean (SD) number of times of urine loss/week at 9 months 

8.6 ± 15.5 6.1 ± 10.5 0.2 (0.0; 

Janssen, 2001508

N = 530 

Individual pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 11 30-minute sessions. 

Group pelvic floor exercises 5 times/day and bladder training with delay voiding, training with 9 2-hour sessions Mean (SD) number of 

times of nocturnal loss/month at 3 months 

8.3 ± 17.7 7.7 ± 17.0 0.0 (-0.2; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F470 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

Self reported number of incontinence episodes/week 

Wyman, 1998 9.6 ± 10.8 10.6 ± 16.3 -0.1 (-0.4; 

491

N = 204 

The pelvic muscle exercise with biofeedbackassisted instruction 

Bladder training 

Self reported number of stress incontinence episodes/week 

8.7 ± 0.0 12.5 ± 8.3 

Self reported % reduction in incontinent episodes/week 

Goode, 2003 71.9 ± 32.8 52.5 ± 42.7 0.5 (0.2; 

490

N = 200 

Behavioral training (biofeedbackassisted pelvic floor muscle training, home exercises, bladder control strategies, and self monitoring with bladder diaries) and pelvic floor electrical stimulation 

Selfadministered behavioral training administered with a selfhelp booklet 

Self-reported number of incontinent episodes/week 

5.6 ± 13.3 7.5 ± 12.1 -0.1 (-0.5; 

Number leakages/week 5.6 ± 5.5 8.7 ± 13.0 -0.3 (-0.8; Number pads/week 6.0 ± 5.6 8.8 ± 13.0 -0.3 (-0.8; Visual analogue scale (0–10) 

2.6 ± 2.1 2.9 ± 2.4 -0.1 (-0.6; 

Cammu, 1998514

N = 30 

Weekly session of pelvic floor exercises vaginal probe EMG biofeedback using perineometer 

Vaginal weight cones (20, 32, 45, 57, and 70g) for 15 minutes, twice daily 

Visual analogue scale (0-10). Severity of incontinence 

2.1 ± 2.1 3.4 ± 3.3 -0.5 (-1.0; 

Self reported number of incontinence episodes/week 

Wyman, 1998 9.6 ± 10.8 10.6 ± 16.3 -0.1 (-0.4; 

491

N = 204 

Pelvic muscle exercise with biofeedbackassisted instruction 

Bladder training 

Self reported number of stress incontinence episodes/week 

8.7 ± 0.0 12.5 ± 8.3 

Pelvic floor muscle exercise and reminder intervention 

Bladder training and pelvic floor muscle exercise 

Alewijnse, 2003 Wet episodes/week 12.2 ± 16.6 8.8 ± 13.0 0.2 (-0.3; 

493

N = 129 

Pelvic floor muscle exercise with reminder and selfhelp guide 

Bladder training and pelvic floor muscle exercise 

Wet episodes/week 12.2 ± 16.6 8.8 ± 13.0 0.2 (-0.3; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F471 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

Pelvic floor muscle exercise with reminder, self-help guide and counseling intervention 

Bladder training and pelvic floor muscle exercise 

Wet episodes/week 12.2 ± 16.6 8.8 ± 13.0 0.2 (-0.3; 

Quality of Life Scale 90.1 ± 10.2 85.2 ± 12.0 0.4 (-0.1; Change from baseline in leakage index 

-0.9 ± 0.5 0.1 ± 0.6 -1.8 (-2.4; 

Bo, 2000512

N = 59 

Pelvic floor muscle exercise with 8-12 maximum contractions in 3 series/day and 45 minutes/week group sessions 

Untreated control group 

Change from baseline in social activity index 

0.6 ± 1.0 -0.2 ± 1.7 0.6 (0.0; 

Frequency of incontinence (5-very serious problem) 

1.8 ± 0.9 2.2 ± 0.5 -0.5 (-1.1; 

Quantity of urine leakage (5-very serious problem) 

1.8 ± 0.8 2.3 ± 0.5 -0.7 (-1.3; 

Severity of incontinence (5-very serious problem) 

1.8 ± 0.8 2.2 ± 0.6 -0.6 (-1.1; 

Discomfort due to incontinence (5-very serious problem) 

1.6 ± 1.1 1.5 ± 0.6 0.1 (-0.4; 

Wearing protection (5-very serious problem) 

1.3 ± 0.6 1.3 ± 0.5 0.0 (-0.5; 

Discomfort due to wearing protection (5-very serious problem) 

2.0 ± 0.5 2.2 ± 0.4 -0.4 (-1.0; 

Functional electrical stimulationbiofeedback for 20 minutes/ session with frequency 35Hz-50Hz and contractions of 32 seconds, 2 sessions/week 

Usual care 

Avoidance of places and situations (5-very serious problem) 

1.4 ± 0.9 1.5 ± 0.8 -0.1 (-0.6; 

Quantity of urine leakage (5-very serious problem) 

2.1 ± 0.5 2.2 ± 0.5 -0.2 ( -0.7

Severity of incontinence (5-very serious problem) 

2.1 ± 0.7 2.3 ± 0.5 -0.3 (-0.8; 

Sung, 2000524

N = 90 

Intensive pelvic floor muscle exercises 

Usual care 

Discomfort due to incontinence (5-very serious problem) 

2.0 ± 0.7 2.2 ± 0.6 -0.3 (-0.8; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F472 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

Wearing protection (5-very serious problem) 

1.4 ± 0.6 1.5 ± 0.6 -0.2 (-0.7; 

Discomfort due to wearing protection (5-very serious problem) 

1.2 ± 0.4 1.3 ± 0.5 -0.2 (-0.7; 

Frequency of incontinence (5-very serious problem) 

1.7 ± 1.0 2.2 ± 0.4 -0.7 (-1.2; 

Avoidance of places and situations (5-very serious problem) 

1.4 ± 0.7 1.5 ± 0.8 -0.1 (-0.6; 

Aukee, 2002521

N = 30 

Pelvic floor muscle exercise after verbal and written instructions for home practice of 20 minutes/day 5 times /week and individual EMGassisted biofeedback device with vaginal probe and verbal control. 

Pelvic floor muscle exercise after verbal and written instructions for home practice of 20 minutes/day 5 times/week 

Leakage index 34.9 ± 10.4 38.1 ± 10.5 -0.3 (-1.0; 

Sherman, 1997 Number of urinary leaks 2.9 ± 6.5 5.3 ± 7.2 -0.3 (-1.0; 

518

N = 39 

Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 5 times/session, 20 minutes twice/day with urethral biofeedback using vaginal EMG probe. 

Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 5 times/session 20 minutes twice/day alone 

Number of voids/night 0.3 ± 0.5 0.3 ± 0.5 0.0 (-0.6; 

Aksac, 2003516

N = 50 

Pelvic floor muscle exercise (contractions for 10 seconds and relaxation for 20 seconds, 10 

Usual care Visual analog scale 

based social activity index: 0 - cannot undertake any social activity, 10 - does not have any problem. 

7.5 ± 1.2 3.6 ± 0.6 3.7 (2.5; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F473 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

times/session, 3 sessions/day) via digital palpation at home 

Stress urinary incontinence frequency 

3.5 ± 0.5 2.4 ± 0.9 1.7 (0.8; 

Stress urinary incontinence frequency 

Pelvic floor muscle 3.6 ± 0.4 2.4 ± 0.9 2.0 (1.1; exercise (contractions for 10 seconds and relaxation for 20 seconds) via biofeedback (vaginal probe in EMG pressure mode) 3 times/ week 

Usual care 

Visual analog scale based social activity index: 0 - cannot undertake any social activity, 10 - does not have any problem. 

8.1 ± 0.8 3.6 ± 0.6 6.1 (4.3; 

Wang, 2004496

N = 120 

Biofeedbackassisted pelvic floor muscle training with an Intravaginal electromyogram probe to contract or relax PFMs following the visual EMG signals. 

Pelvic floor muscle training 

Episodes of leakage per day 

0.7 ± 1.8 0.7 ± 1.8 0.0 (-0.5; 

Change in Incontinence Impact Questionnaire score (400 with poorer perceived quality of life) 

Borello-France, 27.6 ± 32.7 24.7 ± 31.0 0.1 (-0.5; 2006528N = 44 

Pelvic-floor muscle exercises with EMG biofeedback in the supine position only using maximum 30-60 repetitions of 3-12 

Pelvic-floor muscle exercises with EMG biofeedback in both supine and 

Change from baseline in amount of urine loss in pad test, g 

3.9 ± 3.8 5.1 ± 3.9 -0.3 (-0.9; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F474 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

second contractions twice daily. 

upright positions, 1 set (3- and 12-second contractions) in each position with maximum 20 repetitions (2 sets of 10) of the 3-12 second contractions twice daily. 

Change from baseline in urine leaks/week 

4.0 ± 4.7 5.4 ± 4.8 -0.3 (-0.9; 

Kim, 2001526

N = 33 

Continence Efficacy Intervention Program: common pelvic floor muscle education, audiovisual tape, calendar, counseling, schedule guideline, assessing self care methods. 

Conventional care. 

Improved scores (from 0-100) 

37.8 ± 23.9 23.6 ± 18.9 0.7 (0.0; 

Leakage index 1.90±0.74 1.90±0.72 0.00 (-0.39; Social activity index 9.50±0.74 9.40±1.08 0.11 (-0.28; Standardized pad test 6.10±11.14 10.60±20.92 -0.27 (-0.66

Mørkved, 2003486

N – 103 6 months 

Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) contractions per day with a biofeedback apparatus 

Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) 

48-hr home pad test 6.50±15.23 6.00±10.10 0.04 (-0.35; 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F475 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

contractions per day with a biofeedback apparatus 

Incontinence Impact Questionnaire (IIQ) Scores: Total score 

62.50±44.20 101.60±46.10 -0.87 (-1.79

Incontinence Impact Questionnaire (IIQ) Scores: Physical activity 

32.90±37.10 35.60±25.70 -0.08 (-0.96

Incontinence Impact Questionnaire (IIQ) Scores: Emotional health 

28.70±39.20 28.70±26.00 0.00 (-0.88; 

Incontinence Impact Questionnaire (IIQ) Scores: Travel 

32.90±37.10 46.40±28.00 -0.41 (-1.30; 

Incontinence Impact Questionnaire (IIQ) Scores: Social relationships 

28.80±39.30 14.90±12.40 0.48 (-0.41; 

Urogenital Distress Inventory (UDI) Scores: Total score 

77.90±33.50 139.60±66.50 -1.17 

(-2.13; -0.

Urogenital Distress Inventory (UDI) Scores: Irritative symptoms 

40.00±18.12 56.60±28.80 -0.69 (-1.59

Urogenital Distress Inventory (UDI) Scores: Obstructive/discomfort 

23.70±18.20 49.10±36.10 -0.89 (-1.81

Urogenital Distress Inventory (UDI) Scores: Stress symptoms 

19.90±23.30 47.50±34.70 -0.93 (-1.86

Incontinence Impact Questionnaire (IIQ) Scores: Total score 

78.90±55.70 101.60±46.10 -0.44 (-1.33

Incontinence Impact Questionnaire (IIQ) Scores: Physical activity 

27.00±30.50 35.60±25.70 -0.30 

(-1.19; 0.

McClurg, 2006510N = 30 24 months 

Pelvic Floor Training and Advice and EMG Biofeedback 

Pelvic Floor Training and Advice 

Incontinence Impact 

28.50±29.50 28.70±26.00 -0.01 
Table F95. Effects of behavioral interventions on perceived urinary incontinence in females (severity and quality of life measur

F476 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Diffe

(95% C

Questionnaire (IIQ) Scores: Emotional health 

(-0.88; 0

Incontinence Impact Questionnaire (IIQ) Scores: Travel 

32.70±30.90 46.40±28.00 -0.46 

(-1.35; 0.

Incontinence Impact Questionnaire (IIQ) Scores: Social relationships 

25.00±30.60 14.90±12.40 0.43 (-0.46; 

Urogenital Distress Inventory (UDI) Scores: Total score 

100.50±43.10 139.60±66.50 -0.70 (-1.60

Urogenital Distress Inventory (UDI) Scores: Irritative symptoms 

47.60±12.00 56.60±28.80 -0.41 (-1.29

Urogenital Distress Inventory (UDI) Scores: Obstructive/discomfort 

31.50±22.80 49.10±36.10 -0.58 (-1.48

Urogenital Distress Inventory (UDI) Scores: Stress symptoms 

23.20±26.20 47.50±34.70 -0.79 (-1.70

Bold- significant differences in outcomes at 95% confidence level 
F477 

Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in femalemeasures) 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Mean Kegel urethral closure pressure 

19.0 ± 10.0 21.0 ± 13.0 -0.2 (-0.5; 0.2) 

Mean pressure transmission ratio, % 

91.0 ± 15.0 87.0 ± 14.0 0.3 (-0.1; 0.6) 

Urethral axis straining 44.0 ± 21.0 40.0 ± 19.0 0.2 (-0.1; 0.5) Maximum cystometric capacity 

470.0 ± 119.0 490.0 ± 139.0 -0.2 (-0.5; 0.2) 

Maximum Kegel urethral closure pressure 

32.0 ± 19.0 31.0 ± 17.0 0.1 (-0.3; 0.4) 

Difference between MCC and FSV (MCC − FSV) 

185.0 ± 141.0 217.0 ± 156.0 -0.2 (-0.6; 0.1) 

Functional urethral length 

23.0 ± 7.0 22.0 ± 7.0 0.1 (-0.2; 0.5) 

Maximum urethral closure pressure 

31.0 ± 2.0 32.0 ± 17.0 -0.1 (-0.4; 0.3) 

Mean urethral closure pressure 

19.0 ± 9.0 22.0 ± 13.0 -0.3 (-0.6; 0.1) 

Bladder training 

First sensation to void 278.0 ± 124.0 279.0 ± 133.0 0.0 (-0.3; 0.3) 

Mean Kegel urethral closure pressure 

19.0 ± 10.0 20.0 ± 11.0 -0.1 (-0.4; 0.2) 

Mean pressure transmission ratio, % 

91.0 ± 15.0 92.0 ± 17.0 -0.1 (-0.4; 0.3) 

Urethral axis straining 44.0 ± 21.0 43.0 ± 20.0 0.0 (-0.3; 0.4) Mean urethral closure pressure 

19.0 ± 9.0 19.0 ± 10.0 0.0 (-0.3; 0.3) 

Maximum Kegel urethral closure pressure 

32.0 ± 19.0 30.0 ± 16.0 0.1 (-0.2; 0.5) 

First sensation to void 278.0 ± 124.0 258.0 ± 103.0 0.2 (-0.2; 0.5) Maximum cystometric capacity 

470.0 ± 119.0 471.0 ± 141.0 0.0 (-0.3; 0.3) 

Difference between MCC and FSV (MCC − FSV) 

185.0 ± 141.0 213.0 ± 147.0 -0.2 (-0.5; 0.1) 

Elser, 1999498N = 204 

Pelvic floor muscle training combined with bladder training 

Pelvic floor muscle training 

Functional urethral length 

23.0 ± 7.0 21.0 ± 5.0 0.3 (0.0; 0.7) 
Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in female

measures) (continued) 

F478 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Maximum urethral closure pressure 

31.0 ± 2.0 35.0 ± 21.0 -0.3 (-0.6; 0.1) 

First desire to void, ml 115.9 ± 64.9 133.5 ± 59.6 -0.3 (-0.8; 0.2) Strong desire to void 228.9 ± 

106.4 

230.1 ± 78.8 0.0 (-0.5; 0.5) 

Goode, 2002501N = 70 

Four sessions (over 8 weeks) of biofeedback-assisted behavioral training by nurse practitioners. 

Usual care 

Bladder capacity 305.6 ± 117.9 323.0 ± 109.0 -0.2 (-0.6; 0.3) 

Wang, 2004496N = 120 

Biofeedback-assisted pelvic floor muscle training with an Intravaginal electromyogram probe to contract or relax PFMs following the visual EMG signals. 

Electrical stimulation in management of overactive bladder with Intravaginal electrode at physiotherapy unit 

Change from baseline in vaginal pressure 

-8.9 ± 12.8 -38.4 ± 29.6 1.3 (0.8; 1.8) 

Bo, 2005497

N = 47 

Intensive pelvic floor exercise with 8-12 maximum contractions for 6-8 seconds 3 series/day under the supervision of physical therapist for 6 months 

Home exercise groups 

Median leakage index (range) 15 years followup 

1.9 ± 0.5 1.9 ± 1.9 0.0 (-0.6; 0.6) 

Dougherty, 2002504N = 218 

Behavioral management for continence: selfmonitoring, bladder training, pelvic muscle exercise 

Usual care Urine loss per 24 

hours (g) at 2 years 

21.3 ± 36.4 130.9 ± 315.5 -0.5 (-0.8; -0.2) 

Pelvic muscle contraction: average pressure (mm/Hg) 

26.1 ± 12.5 12.2 ± 5.3 1.4 (0.5; 2.3) 

Pelvic muscle contraction: Index computed as average pressure multiplied by duration. 

392.4 ± 237.1 71.5 ± 26.4 1.9 (0.9; 2.8) 

Yoon, 2003507N = 50 

Pelvic muscle exercise (30 contractions for 15 to 20 minutes/day) with immediate and simultaneous visual feedback of pelvic muscles during a 20 minute weekly biofeedback session with electromyography. 

Usual care 

Pelvic muscle contraction: Peak pressure (mm/Hg) 

39.7 ± 20.0 19.9 ± 7.5 1.3 (0.4; 2.2) 
Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in female

measures) (continued) 

F479 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Pelvic muscle contraction: duration(seconds) 

14.5 ± 3.0 5.9 ± 1.7 3.5 (2.2; 4.8) 

Voided volume (ml) 239.7 ± 53.4 193.3 ± 37.8 1.0 (0.2; 1.8) Voided volume (ml) 271.9 ± 47.3 193.3 ± 37.8 1.8 (0.9; 2.8) Pelvic muscle contraction: Peak pressure (mm/Hg) 

30.5 ± 9.1 19.9 ± 7.5 1.3 (0.4; 2.1) 

Pelvic muscle contraction: Average pressure (mm/Hg) 

18.3 ± 6.4 12.2 ± 5.3 1.0 (0.2; 1.9) 

Pelvic muscle contraction: duration(seconds) 

11.7 ± 3.7 5.9 ± 1.7 2.0 (1.0; 3.0) 

Bladder training with increased interval between voluntary voids. 

Usual care 

Pelvic muscle contraction: Index computed as average pressure multiplied by duration. 

222.9 ± 126.7 71.5 ± 26.4 1.6 (0.7; 2.5) 

Length of postoperative bladder catheterization in days after Burch retropubic urethropexy 

Bergman, 3.3 ± 1.1 3.2 ± 1.4 0.1 (-0.3; 0.5) 1987495N = 89 

Bladder training - scheduled clamping and unclamping of the suprapubic Bonnano catheter throughout postoperative period 

Nonbladder training - continuous bladder drainage with suprapubic Bonnano catheter throughout postoperative period 

Length of postoperative bladder catheterization in days after Pereyra procedure 

3.8 ± 1.2 3.6 ± 1.7 0.1 (-0.3; 0.6) 

Vaginal pressure: mean sustained contraction 

Theofrastou 16.7 ± 12.9 13.1 ± 10.6 0.3 (0.0; 0.6) s, 2002492

N = 137 

Pelvic floor muscle training: 4 office biofeedback sessions and home exercise 

Bladder training 

Vaginal pressure: mean fast contraction 

22.3 ± 16.2 18.3 ± 14.0 0.3 (-0.1; 0.6) 
Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in female

measures) (continued) 

F480 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Fantl, 1991503N = 131 

Bladder training using 6 weekly visits included patient education; voiding schedule to have micturition from every 30-60 minutes to every 2.5-3 hours; and positive reinforcement. 

Usual care Urinary loss, g 17.0 ± 36.0 47.0 ± 87.0 -0.4 (-0.8; -0.1) 

Pelvic floor muscle activity while supine (mV) at 12 weeks 

Aukee, 15.1 ± 7.7 23.9 ± 7.9 -1.1 (-1.8; -0.4) 2004494N = 35 

Pelvic floor training by physiotherapist 5 times/12 weeks with home biofeedback 

Home program with verbal and written instructions for home practice 

Pelvic floor muscle activity while supine (mV) at 1 year 

24.7 ± 9.1 23.8 ± 8.6 0.1 (-0.6; 0.8) 

Goode, 2003490N = 200 

Behavioral training (biofeedback-assisted pelvic floor muscle training, home exercises, bladder control strategies, and self-monitoring with bladder diaries) and pelvic floor electrical stimulation 

Self administered behavioral training administered with a self-help booklet 

Bladder capacity in ml (cystometry) 

370.4 ± 143.4 355.4 ± 115.3 0.1 (-0.2; 0.5) 

Pelvic floor muscle exercise with 8-12 maximum contractions in 3 series/day and 45 minute/week group sessions 

Untreated control group 

Change in the strength of pelvic floor muscle 

19.2 ± 10.5 16.0 ± 4.2 0.4 (-0.1; 0.9) 

Change in strength of pelvic floor muscle 

18.6 ± 15.3 16.0 ± 4.2 0.2 (-0.3; 0.7) 

Change from baseline in 24 hour pad test (g) 

-0.5 ± 21.4 -7.1 ± 37.8 0.2 (-0.3; 0.7) 

Electrical stimulation using vaginal intermittent stimulation with the MS 106 Twin at 50Hz 30 minutes/day. 

Untreated control group offered the use of a continence guard Change from baseline 

in stress pad test (g) 

-7.4 ± 34.4 -12.7 ± 41.8 0.1 (-0.4; 0.6) 

Bo, 1999513

N = 122 

Pelvic floor exercise with 8-12 contractions 

Untreated control group 

Change from baseline in stress pad test (g) 

-30.2 ± 33.9 -12.7 ± 41.8 -0.5 (-1.0; 0.1) 
Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in female

measures) (continued) 

F481 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

3 times/day and in groups with skilled physical therapists 1/week. 

offered the use of a continence guard 

Change from baseline in 24 hour pad test (g) 

-6.6 ± 14.0 -7.1 ± 37.8 0.0 (-0.5; 0.5) 

Squeezing capacityfast (mV) Cammu, 10.7 ± 5.9 9.0 ± 4.1 0.3 (-0.2; 0.8) 

1998514N = 30 

Weekly session of pelvic floor exercises vaginal probe-EMG biofeedback using perineometer 

Vaginal weight cones (20, 32, 45, 57, and 70g) for 15 minutes twice daily 

Squeezing capacityslow (mV) 11.4 ± 6.2 9.7 ± 5.4 0.3 (-0.2; 0.8) 

Peak pressure, mm/Hg 

Functional electrical 41.5 ± 9.8 33 ± 7.3 1.0 (0.4; 1.5) stimulationbiofeedback for 20 minutes/session with frequency 35Hz-50Hz and contractions of 32 seconds, 2 sessions/week 

Duration of contraction, seconds 

2.3 ± 1.2 1.6 ± 0.6 0.7 (0.2; 1.3) 

Duration of contraction, seconds 

2.2 ± 0.5 1.6 ± 0.6 1.1 (0.5; 1.6) 

Sung, 2000524N = 90 

Intensive pelvic floor muscle exercises 

Usual care 

Peak pressure, mm/Hg 38.7 ± 7.8 33 ± 7.3 0.8 (0.2; 1.3) 

Berghmans, 1996522N = 40 

Pelvic floor muscle exercise with biofeedback with EMG vaginal probe and visual control. 

Pelvic floor muscle exercise 

Urine loss per 48 hour pad test 

12.2 ± 15.4 12.5 ± 12 0.0 (-0.6; 0.6) 

Urine leakage on medium cough paper towel test 

Baseline levels 0.4 ± 1.1 19.9 ± 36.7 -0.7 (-1.5; 0.0) 

Urine leakage on deep cough paper towel test 

8.0 ± 18.2 29.8 ± 36.2 -0.8 (-1.5; 0.0) 

Urine leakage on medium cough paper towel test 

0.4 ± 1.0 21.2 ± 44.8 -0.6 (-1.4; 0.1) 

Urine leakage on deep cough paper towel test from 

5.4 ± 15.3 26.8 ± 46.7 -0.6 (-1.4; 0.2) 

Miller, 1998515N = 27 

Immediate intervention group taught intentionally contracting the pelvic floor muscles before and during a cough (Knack ) Wait-listed 

control group 

Areas of wetness (cm/H2O) on paper towel test after medium cough 

0.4 ± 1.1 19.8 ± 36.7 -0.7 (-1.5; 0.0) 
Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in female

measures) (continued) 

F482 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Change from baseline in pelvic muscle strength, cm/H20 

Liebergall- 0.14 ± 3.9 -0.02 ± 7.4 0.0 (-0.5; 0.5) Wischnitzer, 2005523N = 63 

Pelvic floor muscle exercise 15 minutes with 30 minute session/week 

Paula method of circular muscle training 15-45 minutes/day with training sessions of 45 minutes/week 

Urine loss per 1 hour pad test 

2.7 ± 7.2 3.2 ± 5.8 -0.1 (-0.6; 0.4) 

Pelvic floor muscle activity (mV) Supine 

25.8 ± 10 20.1 ± 8.6 0.6 (-0.1; 1.3) 

Pelvic floor muscle activity (mV) Standing 

21.4 ± 10.3 20.9 ± 8.6 0.1 (-0.7; 0.8) 

Aukee, 2002521N = 30 

Pelvic floor muscle exercise after verbal and written instructions for home practice of 20 minutes/day 5 times/ week and individual EMG assisted biofeedback device with vaginal probe and verbal control. 

Pelvic floor muscle exercise after verbal and written instructions for home practice of 20 minutes/day 5 times/week 

24 hour pad test (g) 19 ± 19.7 22.5 ± 19.6 -0.2 (-0.9; 0.5) 

Electromyography 3.0 ± 3.4 3.5 ± 4.4 -0.1 (-0.6; 0.3) Functional urethral length, cm/H20 

20.0 ± 4.0 18.0 ± 6.0 0.4 (0.0; 0.8) 

Pelvic muscle exercise with 4 sets of 20 increasing by 10/set until maximum 200 sets/day 

Maximal urethral pressure, cm/H20 

31.0 ± 18.0 30.0 ± 19.0 0.1 (-0.4; 0.5) 

Maximal urethral pressure, cm/H20 

28.0 ± 12.0 30.0 ± 19.0 -0.1 (-0.6; 0.3) 

Functional urethral length, (cm/H20) 

21.0 ± 6.0 18.0 ± 6.0 0.5 (0.1; 0.9) 

Burns, 1993517N = 135 

Biofeedback using vaginal EMG probe, contraction for 10 seconds and relaxations for 10 seconds 10 times in each weekly session 

Usual care 

Electromyography 4.0 ± 3.1 2.0 ± 1.8 0.8 (0.3; 1.2) 

Mean urethral closure pressure 

Kegel Pelvic floor 30.2 ± 14.0 28.1 ± 11.0 0.2 (-0.3; 0.6) exercises 4 times/day 

Electromyography contractions 

3.0 ± 3.4 3.5 ± 4.4 -0.1 (-0.6; 0.3) 

Mean urethral closure pressure 

28.7 ± 12.2 28.1 ± 11.0 0.1 (-0.4; 0.5) 

Burns, 1990519N = 128 

Biofeedback with vaginal EMG probe and visual control 

Usual care 

Electromyography contractions 

6.0 ± 5.1 3.5 ± 4.4 0.5 (0.1; 1.0) 

Sherman, Pelvic muscle Pelvic muscle Bladder capacity 398.9 ± 104.6 331.9 ± 101.7 0.6 (0.0; 1.3) 
Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in female

measures) (continued) 

F483 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

1997518N = 39 

exercises with contractions for 10 seconds and relaxation for 10 seconds 5 times/session, 20minutes twice/day with urethral biofeedback using vaginal EMG probe. 

exercises with contractions for 10 seconds and relaxation for 10 seconds 5 times/session 20 minutes twice/day alone 

Maximum urethral closure pressure 

80.2 ± 27.5 77.2 ± 38.4 0.1 (-0.5; 0.7) 

1-hour pad test, g 2.1 ± 0.4 28.2 ± 3.7 -12.3 (-15.6; -

9.0) 

Perineometry, cm/H20 

37.5 ± 8.7 20.0 ± 3.9 2.3 (1.4; 3.3) 

Pelvic floor muscle exercise (contractions for 10 seconds and relaxation for 20 seconds, 10 times/session, 3 sessions/day) via digital palpation at home 

Pelvic floor muscle strength via digital palpation 

4.8 ± 0.4 3.3 ± 0.6 3.2 (2.0; 4.3) 

1-hour pad test, g 1.2 ± 0.2 28.2 ± 3.7 -12.8 (-16.3; -

9.4) 

Perineometry, cm/H20 

50.0 ± 11.5 20.0 ± 3.9 3.1 (2.0; 4.2) 

Aksac, 2003516N = 50 

Pelvic floor muscle exercise (contractions for 10 sec and relaxation for 20 sec) via biofeedback (vaginal probe in EMG pressure mode) 3 times/ week 

Usual care 

Pelvic floor muscle strength via digital palpation 

4.9 ± 0.2 3.3 ± 0.6 4.2 (2.9; 5.6) 

Arvonen, Urine Leakage (g) 5.0 ± 56.7 1.0 ± 66.0 0.1 (-0.6; 0.7) 2001527N = 37 

Pelvic floor muscle training program with contractions/ relaxations for 5 seconds 10 times 2 times/day 

Pelvic floor muscle training program with contractions/ relaxations for 20/20 seconds 10 times 2 times/day using weighted vaginal balls 50-100g 

Muscle strength 3.0 ± 1.3 4.0 ± 0.7 -0.9 (-1.6; -0.3) 
Table F96. Effects of behavioral interventions on the results of pad test and urodynamic and perineometry outcomes in female

measures) (continued) 

F484 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Wells, 1991520N = 157 

Pelvic muscle exercises with contractions for 10 seconds and relaxation for 10 seconds 90-160 times/day 

Phenylpropanolamine hydrochloride in a dose of 50mg /day, increasing to 50mg 2 times/day 

Anterior-posterior pelvic muscle strength 

1.5 ± 0.1 1.3 ± 0.1 2.9 (2.5; 3.4) 

Mørkved, 2003486N – 103 6 months 

Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist. At home, 3 sets of 10 high intensity (close to maximum) contractions per day with a biofeedback apparatus 

Pelvic floor muscle training with 3 sets of 10 contractions 3 times/day, individually supervised by a physical therapist At home, 3 sets of 10 high intensity (close to maximum) contractions per day without biofeedback 

Change in Pelvic Floor Muscle Strength Measured by Vaginal Squeeze Pressure (cm H2O) 

25.90±14.86 25.40±15.15 0.03 (-0.35; 0.42

Bold- significant differences in outcomes at 95% confidence level 
F485 

Table F97. Effects of behavioral interventions on perceived urinary incontinence in males (severity measures) 

Author Active Treatment Control Treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Self reported pad use for urinary incontinence 

Mathewson- 0.6 ± 1.6 1.8 ± 2.7 -0.5 (-1.1; 0.0) Chapman, 1997534N = 53 

Education booklet and instructions for pelvic muscle exercises with biofeedback: maximal contractions for 10 seconds, slow release and 10 seconds of muscular relaxation, 3 times/week. 

Standard care with no pelvic muscle exercises. All patients were recommended to limit coffee, tea, chocolate, alcohol, and over counter medication for bladder control. 

Self reported episodes of urinary incontinence 

0.8 ± 2.0 1.0 ± 0.3 -0.1 (-0.7; 0.4) 

Floratos, 2002535

N = 42 

2-channel electromyographic biofeedback as learning tool for pelvic muscle exercises immediately after catheter removal 

Verbal feedback as learning tool for pelvic muscle exercises immediately after catheter removal: sub maximal contractions 3-5 seconds, relaxation for 6-10 seconds, 80-100 times/day 

Pad use for urine incontinence, number/day 

0.5 ± 0.1 0.8 ± 1.4 -0.4 (-1.0; 0.3) 

Porru, 2001538N = 58 

Verbal instruction, feedback on contractions of pelvic floor muscles, and verbal reinforcement of appropriate responses to teach selective contractions of anal sphincter muscles and relaxation of abdominal muscles 45 times/day 

Standard care without instruction on pelvic floor muscle exercises 

Voiding interval, minutes 

118.5 ± 24.0 110.0 ± 23.0 0.4 (-0.2; 0.9) 
F486 

Table F98. Effects of behavioral interventions on pad test in males (severity measures) 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Floratos, 2002535

N = 42 

2-channel electromyographic biofeedback as learning tool for pelvic muscle exercises immediately after catheter removal 

Verbal feedback as learning tool for pelvic muscle exercises immediately after catheter removal: sub maximal contractions 3-5 seconds, relaxation for 6-10 seconds, 80-100 times/day. 

Urine loss in pad test (g) 

0.5 ± 10.1 0.5 ± 0.1 0.0 (-0.6; 0.6) 

Urine loss in pad test (g) 

Moore, 1999 69.9 ± 8.7 54.1 ± 6.9 2.0 (1.2; 2.8) 

533

N = 63 

Intensive pelvic muscle exercises conducted by a physiotherapist for 30 minutes 2/week: maximum contractions for 5 seconds, slow release and 10 seconds of muscular relaxation 

Standard treatment with verbal and written instructions about postoperative pelvic muscle exercises from urologist and nurses at the pre-admission clinic. 

Urine loss in pad test (g) 

98.2 ± 9.0 54.1 ± 6.9 5.6 (4.2; 7.0) 

MathewsonChapman, 1997534N = 53 

Education booklet and instructions for pelvic muscle exercises with biofeedback: maximum contractions for 10 seconds, slow release and 10 seconds of muscular relaxation 3 times/week. 

Standard care with no pelvic muscle exercises. All patients were recommended to limit coffee, tea, chocolate, alcohol, and over counter medication for bladder control. 

Urine loss in pad test (g) 

1.0 ± 1.0 14.2 ± 48.2 -0.4 (-1.0; 0.2

Urethral milking after appropriate education 

Paterson, 1997 4.0 ± 8.0 0.0 ± 4.0 0.6 (-0.1; 1.4) 545

N = 49 

Pelvic muscle exercise with 1 second contractions (~5) to increase length and strengths of contractions as much as possible. 

Counseling including drinking pattern, aperient use, toileting habits, dietary advice, and relaxation therapy. 

Improvement in pad weight gain (g) 4.3 ± 8.9 0.0 ± 4.0 0.6 (-0.1; 1.4) 

Bold- significant differences in outcomes at 95% confidence level 
F487 

Table F99. Effects of behavioral interventions on perceived urinary incontinence in males and females from the community (se

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

McDowell, 1999543N = 105 90% female 

Biofeedback-assisted pelvic floor muscle training by nurse practitioners skilled in behavioral therapies for urinary incontinence 

Usual care with attention control 

Urinary incontinence episodes/day 

1.8 ± 2.9 3.5 ± 3.0 -0.6 (-1.0; -0

Percent reduction in all incontinent episodes/day 

47.0 ± 39.2 27.2 ± 26.1 0.6 (-0.3; 1.

Percent decrease in daytime incontinent episodes/day 

50.1 ± 41.3 37.3 ± 34.3 0.3 (-0.6; 1.

Engberg, 2002544N = 19 68% female 

Prompted voiding by caregivers to approach subjects hourly for perceived wet/dry status vs. objective wet checks, feedback and praising for correct response, toilet by request, positive feedback for appropriate toileting. 

Usual care with attention control 

Reduction in day and night % wet 

40.6 ± 44.3 23.0 ± 22.7 0.5 (-0.4; 1.

Bold- significant differences in outcomes at 95% confidence level 
F488 

Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults 

Study Participants Clinical Interventions Outcomes 

Electrical stimulation of pelvic floor muscles But, 2003546

Placebo controlled RCT to examine the effects of functional magnetic stimulation in the treatment of women with urinary incontinence. Duration: 2 months 

55 women with urinary incontinence older than 18 years, not pregnant, and not physically or mentally disabled. Exclusion criteria: Implanted electronic equipment (pacemakers), urolithiasis, bladder infection, tumor, recent urethral or continence surgery, use of anticholinergic drugs, beta-blocking agents, and diuretics. Loss of followup: 7.7% 

1. Functional magnetic stimulation with Pulsegen device, which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10Hz. 2. Placebo treatment with sham not active device. 

Pad test use and paweight. Self reportenocturia. PFM contractions measuwith perineometer aperforming five maxconsecutive PFM contractions, with ainterval of 30 seconbetween every two contractions.. The power of the PFM contractions was measured as the percentage of the maximum (100% = 45mm/Hg); the time the PFM contractiowas measured in seconds. 

Spruijt, 2003547

RCT to examine the effects of intravaginal electrical stimulation of the pelvic floor for urinary incontinence in elderly women. Duration: 8 weeks 

51 women ≥65 years of age, with symptoms of stress, 

urge or mixed urinary incontinence of >3 months’ duration, and with urinary leakage >10cc /24hours. Exclusion criteria: Persistent urinary tract infection (positive urine culture after antibiotic treatment), recurrent urinary tract infection (within 4 weeks after treatment), bladder pathology or dysfunction because of fistula, tumor, pelvic irradiation, neurological or other chronic conditions (diabetes mellitus, Parkinson’s disease), genital , pacemaker, and insufficient mental condition. Loss of followup: 3.9% 

1. Intravaginal electrical stimulation of the pelvic floor using stimulator generated biphasic current pulses with duration of 1ms and a frequency of 50Hz (stress urinary incontinence) or 20Hz (urge urinary incontinence). 2. Kegel exercise program with verbal instructions on how to exercise at home. 

Urinary leakage dua pad test, pelvic muscle strength measured by a perineometer, detruinstability. Self repochange in urinary symptoms based oPRAFAB score. 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F489 

Study Participants Clinical Interventions Outcomes 

Yamanishi, 2000548Placebo controlled RCT to examine effects of electrical stimulation for urinary incontinence due to detrusor overactivity. Duration: 4 weeks 

68 patients with urinary incontinence due to detrusor overactivity urodynamically defined as involuntary detrusor contractions of more than 15cm/H2O during the filling phase. Exclusion criteria: Use of anticholinergics or tricyclic depressants, pelvic floor exercise, bladder training, or pelvic surgery before entry into the study. Loss of followup: 11.8% 

1. Electrical stimulation 15 minutes twice daily for 4 weeks (vaginal electrode in women and an anal or surface electrode in men to provide alternating pulses of 10Hz square waves of 1-ms pulse duration and a maximum output current of 60mA). 2. Sham inactive device 

Self reported urinarincontinence in frequency/volume cand urodynamic outcomes. Degree urgency scored as none, 1-slight, 2-moderate, and 3-vemuch. 

Yamanishi, 2000549RCT to examine effects of functional magnetic stimulation and functional electrical stimulation on the inhibition of detrusor overactivity. Duration: acute 

32 patients with urinary incontinence due to detrusor overactivity defined urodynamically as involuntary detrusor contractions of more than 15cm/H2O during the filling phase. Exclusion criteria: Not reported Loss of followup: No followup 

1. Functional magnetic stimulation applied continuously at 10Hz 2. Functional electrical stimulation applied continuously at 10Hz with vaginal electrode in women and a surface electrode on the dorsal part of the penis in men. 

Urodynamic outcombefore and after stimulation. 

Lappin, 2003550Crossover, placebo controlled RCT to examine effects of pulsed electromagnetic fields on bladder control in patients with multiple sclerosis. Duration: 10 weeks, 2 weeks washout period. 

145 patients 18-65 years old with clinically definite multiple sclerosis and light spasticity (>2 in 6 point scale) and bladder control problems. Exclusion criteria: Changes in medication last 2 months, pregnancy, pacemaker, chronic diseases. Loss of followup: 19% 

1. Daily simulation with low frequency pulsed electromagnetic fields 2. Sham inactive device 

The MS Quality of LInventory (MSQLI) used to assess chain bladder control fo0-none to 10-sever
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F490 

Study Participants Clinical Interventions Outcomes 

Amaro, 2006551RCT to examine the effects of intravaginal electrical stimulation in treating mixed urinary incontinence. Duration: 7 weeks, Followup: 1 month 

40 women with predominant urge urinary incontinence. Exclusion criteria: Use of anticholinergic and tricyclic antidepressants, pelvic floor exercise, bladder training, vaginal prolapse >II grade, urinary infection, metal implants, neurological diseases. Loss of followup: none 

1. Effective and sham intravaginal electrical stimulation with 3 20-minute sessions/week using Dualpex Uro 996 frequency of 4Hz. 2. Sham intravaginal electrical stimulation. 

Self reported Improvement in urgincontinence 

Berghmans, 2002552RCT to examine effects of physiotherapy in women with proven bladder overactivity. Duration: 9 weeks 

98 patients older than 18 years with proven bladder overactivity defined as Detrusor Activity Index (DAI) ≥0.50, able to understand Dutch. Exclusion criteria: Mechanical intravesical obstruction, urinary calculus, urinary tract infection, colpitis, pacemaker, pregnancy, physiotherapy within 3 months, uncontrolled diabetes mellitus. Loss of followup: 8%. 

1. Pelvic floor exercises with contractions for >20 seconds controlled by physiotherapist palpation with relaxation period of 10 seconds. Bladder training to inhibit the sensation of urgency and to postpone voiding, voiding schedule with an interval >2 hours, positive reinforcement of patient motivation by the physical therapist. 2. Office- and home-based functional electrostimulation maximum 100mA frequency 4 -10Hz. 3. Office-based functional electrostimulation, pelvic floor exercise, and bladder training. 4. No treatment. All treated subjects received 9 sessions, 1/week 

Detrusor Activity Incombined cystometoutcomes (number contractions/hour, mduration of a contraand mean amplituda contraction) and voiding diary (mean volume drunk/hour, mean number of micturitions/hour anmean volume voideper micturition. The represents a score between 0 and 1, w‘0’ represents no acof the bladder durinthe filling phase and represents severe overactivity of the bladder. 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F491 

Study Participants Clinical Interventions Outcomes 

Pages,2001553

RCT to examine the effects of intensive group physical therapy program with individual biofeedback training for female patients with urinary stress incontinence. Duration: 4 weeks 

51 women, referred by gynecologists for nonoperative treatment of genuine stress incontinence of mild-tomoderate severity. Exclusion criteria: Not reported. Loss of followup: 21% 

1. Specific physical therapy program. Group therapy 5 times/week and home pelvic floor exercise with 50 contractions for 10 minutes 2times/day. Recommendation of weight loss and aerobic sports. 2. Biofeedback training daily 90 minutes in groups and individually for 15 minutes, 5 times/week. Intra vaginal pressure sensor and visual biofeedback in computer monitor. 

Nocturnal urinary frequency and subjective improvemof incontinence, standardized examdigital contraction strength, speculum tests, and manomeoutcomes. 

Sand, 1995554

Placebo-controlled RCT to examine the effects of transvaginal electrical stimulation in treating genuine stress incontinence. Duration: 15-weeks 

52 community dwelling women with urodynamically proven genuine stress incontinence, who would comply with visits, not use/seek other treatment for incontinence. Exclusion criteria: Detrusor instability, pregnancy, pacemaker, prior pelvic floor stimulation, pelvic implanted devices, active vaginal lesions or infections, urinary tract infection, hypermenorrhea or menorrhaghia, urinary retention (>100ml), pelvic surgery in past 6 months, atrophic vaginitis, genital prolapse to introitus, pelvic irradiation, intrinsic sphincteric deficiency. Loss of followup: 15% 

1. Active pelvic floor stimulator with gradually adjusted 60-80mA from 5 seconds on/1 second off for 15 minutes to 5 seconds on/5 seconds off for 30 minutes. 2. Sham inactive device. 

Self reported urinarstress incontinence voiding in diaries, urodynamic outcompad test, and pelvic muscle strength. 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F492 

Study Participants Clinical Interventions Outcomes 

Indrekvam, 2001555Prospective cohort study to examine the effectiveness of home-managed electrical stimulation on urinary incontinence in females. Duration: 2 years 

3,198 women treated with home-managed electrical stimulation in Norway from 1992-1994. Exclusion criteria: Pregnancy, use of a pacemaker, malignancy. Loss of followup: 1.2%; 15 women did not start treatment because of severe illness or because they had died, and 24 did not complete the treatment because of pregnancy or cancer. 

Home-managed electrical stimulation with vaginal/anal stimulators (20–50Hz) for 6–8 hours/day for at least 3 months before evaluation of the effect. Before-after comparison. The stimulators Vitacon Norway AS for long-term stimulation (20–50 Hz) delivered below the sensory threshold. Devices were used for 6–8 hours/day for at least 3 months before evaluation of the effect. Max stimulation (10– 20 Hz) used a high-intensity stimulus. The companies recommended application of not more than 20 min (the machine switches off automatically) daily or at least twice weekly. Patients were advised to increase the stimulation intensity continuously using a control knob to as high as possible, but below the level of pain. The stimulator should be used at least 10–20 times before evaluation of the effect. 

Self reported frequeof incontinence episodes and amouleakage before and after treatment, numof voidings during tday and night, and number of protectivpads used (4 item ordinal scale). 

Amaro, 2006551RCT to examine the effects of intravaginal electrical stimulation in mixed urinary incontinence. Duration: 7weeks, Followup: 4 weeks. 

40 women symptoms of predominant urge incontinence not taking anticholinergics or tricyclic antidepressants. Exclusion criteria: Use of pelvic floor exercises or bladder training, vaginal prolapse >grade II, retention complaint or obstruction diagnosis during UDS, urinary infection, changes in cutaneous sensitivity, metal implants, and neurological diseases. Loss of followup: Not reported 

1. Effective intravaginal electrical stimulation using frequency of 4 Hz with 3 20-minute sessions/week 2. Sham intravaginal electrical stimulation using frequency of 4Hz with 3 20-minute sessions/week 

Self reported urge urinary incontinenc
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F493 

Study Participants Clinical Interventions Outcomes 

Smith, 1996556

RCT to examine the effects of intravaginal electrical stimulation on genuine stress urinary incontinence and detrusor instability in women. Duration: 4 months 

57 women with urinary incontinence. Exclusion criteria: Type 3 stress urinary incontinence, pregnancy, urinary retention, vaginal prolapse, cardiac pacemaker, mixed incontinence with no major and minor components. Loss of followup: 1.8%

18 women with stress urinary incontinence: 1. Electrical stimulation using frequency 12.5Hz.-50Hz and amplitude 5-10mA-80mA for 15 to 60 minutes 2/day 2. Kegel exercise 38 women with detrusor instability: 1. Anticholinergic therapy with Propantheline bromide in dose of 7.5 to 45mg 2-3 times/day 2. Electrical stimulation using frequency 12.5Hz.-50Hz and amplitude 5-25mA for 15-60 minutes 2/day.

Self reported cure furinary incontinencand no longer requpads. Reduction in episodes of urinary incontinence by >5and 10 or fewer voiper 24 hours 

Brubaker, 1997557

RCT to examine the effects of transvaginal electrical stimulation for treatment of urinary incontinence in women. Duration: 8 weeks, Followup: 2 weeks 

121 women >25 years of age with either urinary incontinence due to detrusor instability or genuine stress incontinence, or both (mixed incontinence) 

diagnosed with filling urethrocystometry. Exclusion criteria: Urinary incontinence other than genuine stress incontinence, detrusor instability, or mixed incontinence; leakage episodes <3/week, inadequate genitourinary estrogen (minimum 3 months HRT), inadequate cognitive ability (investigator judgment), urinary tract infection, anatomic defect that precluded use of device, postvoid residual >100ml, implanted electric device, genitourinary surgery, drug treatment for urinary incontinence, anticipated geographic relocation during study. Loss of followup: 18%. 

1. The transvaginal electric stimulation for 20 minutes 2 times/day using frequency of 20Hz, a 2-second-4-second work-rest cycle with a range of stimulation intensities, from 0-100mA 2. Sham inactive device 

Multichannel urodynamic testingquality-of-life scale, urinary diaries 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F494 

Study Participants Clinical Interventions Outcomes 

Amaro, 2005558RCT to examine the effect of intravaginal electrical stimulation on pelvic floor muscle strength in women with mixed urinary incontinence. Duration: 1 month 

40 women with mixed urinary incontinence and predominant urge incontinence. Exclusion criteria: Anticholinergic and tricyclic antidepressant medications, pelvic floor exercise, bladder training, vaginal prolapse more than II grade, urinary tract infection, metal implants, and neurological diseases. 

1. Intravaginal electrical stimulation with 3 20-minute sessions/week using 4Hz frequency. 2. Sham stimulation with inactive device 

Objective evaluatioperineal muscle by perineometry, vaginweight test, and urodynamic outcom

But, 2005559

RCT to examine effects of functional magnetic stimulation for treating women with mixed urinary incontinence. Duration: 2 months 

39 women with mixed urinary incontinence and predominant urge incontinence. Exclusion criteria: Not reported. Loss of followup: Not reported 

1. Functional magnetic stimulation applied continuously at 18.5Hz day and night 2. Sham inactive device 

Urodynamic diagnoof detrusor overactand patient subjectassessment of mixeurinary incontinenc

Bo, 1997560

Crossover RCT to examine the effect of voluntary pelvic floor muscle contraction and vaginal electrical stimulation on urethral pressure in women with genuine stress incontinence. Duration: 1 day experiment. 

12 women with genuine stress incontinence participated in pelvic floor exercise program with 8-12 contractions. Exclusion criteria: Not reported Loss of followup: Not applicable 

3 voluntary PFM contractions and 2 electrical stimulators 

1. Conmax 50Hz – pulse width 0.75ms, 0-90mA 2. Medicon 50Hz - pulse width 0.5ms, 0-100mA 

Urethral and bladdepressures 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F495 

Study Participants Clinical Interventions Outcomes 

Luber, 1997561

RCT to examine the effects of functional electrical stimulation for stress incontinence in women. Duration: 3 months 

57 women with stress urinary incontinence who could adequately retain the vaginal probe and cooperate with the study protocol. Exclusion criteria: Significant pelvic prolapse and detrusor instability, postvoid residual urine >100cc, extra urethral incontinence, history of vaginal intraepithelial neoplasia, urinary tract infection, a fixed, immobile urethra, and urodynamic evidence consistent with intrinsic sphincteric deficiency. Loss of followup: 18.5% 

1. Functional electrical stimulation with 15-minute treatment session/day using pulse-width of 2msec scheduled for 2 seconds with 4 seconds rest, frequency of 50Hz, and power 10-100mA. 2. Sham stimulation with inactive device. 

Self reported improvement or curfrom stress urinary incontinence and urodynamic outcomObjective cure: negstress test on repeaurodynamics. Objecfailure: positive stretest on repeat studi

Emmons, 2005562

RCT to examine the effects of acupuncture on overactive bladder in women. Duration: 4 weeks 

85 women older than 18 years, with symptoms of overactive bladder with urge incontinence,>8 voids per day, subjective urgency to void, and urge-associated incontinence at least twice during a 3-day period of time. Exclusion criteria: Pregnancy, taking medications for overactive bladder or receiving acupuncture treatments for any condition, unable to ambulate or unable to complete a 3-day voiding diary, and hematuria or untreated urinary tract infection. Loss of followup: 13% 

1. Acupuncture treatment expected to improve bladder symptoms 2. Placebo acupuncture treatment designed to promote relaxation 

Number of incontinepisodes over 3 davoiding frequency aurgency, cystometrbladder capacity, maximum voided volume, and the uridistress inventory aincontinence impacquestionnaire sympscores. 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F496 

Study Participants Clinical Interventions Outcomes 

Yamanishi, 1997563CT to examine the effects of electrical pelvic stimulation in stress incontinence. Duration: 4 weeks 

35 patients with stress incontinence. Exclusion criteria: Persistent urinary infection, uterine or rectal prolapse and cystocele, severe cardiac or cerebrovascular disorders including on-demand heart pacemakers, hepatic disorders and renal dysfunction. Anticholinergics, calcium antagonists, alpha or beta agonists or antagonists, or tricyclic depressants were discontinued medications for 1 week. Loss of followup: 5.7% 

1. Electrical pelvic stimulation with 50Hz. square waves of 1msec. pulse duration and vaginal electrode in women and an anal electrode in men for 15 minutes 2 or 3 times daily 2. Sham electrical pelvic stimulation with inactive device 

Frequency/volume chart, results of 1-hpad test and urodynamic parameSubjective data (paimpressions) rankevery good, good, fanot good. Daily frequency of pad changes was score0-no change, 1-onctwice and 3-3 times more. Degree of disturbance in daily activities was score0-not disturbed, 1-slightly disturbed, 2moderately disturbeand 3-very disturbeCured-no incontineon the frequency/volume cand leakage of <1.0in the pad test. Improved-frequency incontinence decreby >50% or if the ptest showed a decrin leakage by >50%Unchanged or aggravated-frequenof incontinence or amount of leakage pad test was unchanged or aggravated 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F497 

Study Participants Clinical Interventions Outcomes 

Barroso, 2004564

Placebo controlled RCT to examine the effects of transvaginal electrical stimulation on urinary incontinence. Duration: 12 weeks. Duration of followup: 6 months 

36 women (24 patients and 12 controls) with stress, urge, or mixed urinary incontinence. Exclusion criteria: Prolapse or first degree urogenital prolapse, intrinsic sphincter deficiency, cardiac pacemaker; pregnancy, postmenopausal climacteric with symptoms and signs of urogenital atrophy (they could be included after 3 months of treatment with hormone-replacement therapy); urinary tract infection, genitourinary surgery during the previous 6 months; previous electrical stimulation of the pelvic floor; use medication chronically (e.g., antidepressants, diuretics and others) known to possibly change voiding function, reflex urinary incontinence (clear presence of neurological lesions); paradoxical urinary incontinence (presence of intravesical obstructive factor); urinary incontinence caused by overflow, characterized by the presence of a large urinary residual volume; urge incontinence treated with medication during the last 3 months. Loss of followup: Not reported 

1. Transvaginal electrical stimulation at home twice a day (20-minute sessions) with frequency of 20 (urge) or 50Hz (stress UI), a pulse width of 300ms, with asymmetrical biphasic pulses, an adjustable current intensity (0-100mA), a 1 s rise time, sustained for 5 seconds and resting for 5 seconds. 2. Placebo (identical equipment but with no electrical current) 

Self reported urinarincontinence in voiddiary. Urodynamic outcomes 

Neurostimulation Scheepens,200256 5

Crossover RCT to examine the effects of bilateral sacral neuromodulation. Duration: 4 days 

33 patients with chronic voiding dysfunction (urge incontinence with or without urodynamic instabilities), complete urinary retention and incomplete voiding with residual of >100ml. Exclusion criteria: Stress incontinence, untreated urinary tract infection, stone disease, psychiatric disturbance, pregnancy, neurogenic voiding disorders (including diabetes mellitus, spinal cord injury, multiple sclerosis), Reiter’s syndrome, pelvic pain syndrome, cerebrovascular accident less than 6 months ago, anatomical obstructive voiding disorders, malignancy of the urinary tract, severe (grade III/IV) pelvic prolapse, 

cystocele, urethrocele, enterocele, proven interstitial 

cystitis or evident functional neurological asymmetry. Loss of followup: none 

1. Bilateral sacral stimulation with external stimulation device to deliver alternating pulses left and right programmed individually at amplitude just above sensory threshold. Patients were instructed to adjust the stimulation amplitude if necessary. 2. Unilateral sacral stimulation with external stimulation device in a side with the best response using the lowest amplitude 

Standardized voidindiaries were used trecord voiding, catheterization and leaking episodes 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F498 

Study Participants Clinical Interventions Outcomes 

Schmidt, 1999566

RCT to examine the effects of sacral nerve stimulation for treatment of refractory urinary urge incontinence. Duration: 5 months 

98 patients older than 16 years refractory to standard medical therapy, with 100ml bladder capacity and normal upper urinary tract, able to complete study documentation and return for followup evaluation. Exclusion criteria: Neurological conditions (multiple sclerosis, diabetes with peripheral nerve involvement, spinal cord injury, stroke), stress urinary incontinence, 

primary pelvic pain Loss of followup: 22% 

1. Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place. 2. Standard medical therapy 

Voiding diary resultand pad test. 

Weil, 2000567RCT to examine effects of sacral root neuromodulation refractory urinary urge incontinence. Duration: 6 months. 

44 patients >16 years with refractory urge incontinence, normal urinary tract function, muscular and sensory responsiveness, detrusor storage capacity >100ml and no sphincter anomaly. Exclusion criteria: Stress urinary incontinence, multiple sclerosis, Reiter’s syndrome, uncontrolled diabetes, pregnancy, spinal cord injury or cerebrovascular accident, active degenerative disc diseases, bleeding complications, urinary tract infection. Loss of followup: 4.5% 

1. Sacral root neuromodulation with an implantable impulse generator 2. Prior conservative management: medications, or pelvic floor exercise 

Self reported urge urinary incontinencvoiding diaries, quaof life questionnaireurodynamic testing 

Karademir, 2005568RCT to examine the effects of Stoller afferent neurostimulation with and without a low-dose anticholinergic (oxybutynin hydrochloride) in patients with detrusor overactivity. Duration: 8 weeks 

43 patients with symptoms of detrusor overactivity confirmed urodynamically. Exclusion criteria: Urinary tract obstruction, urinary retention, neurologic or metabolic disorder, other treatments for urinary incontinence. Loss of followup: Not reported 

1. Stoller afferent neurostimulation with frequency 20Hz and amplitude 0.5-10mA 2. Stoller afferent neurostimulation with frequency 20Hz and amplitude 0.5-10mA combined with 5mg of oral oxybutynin hydrochloride 

Self reported qualitlife and voiding diar
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F499 

Study Participants Clinical Interventions Outcomes 

Bower,1998569

RCT to examine the effects of surface neuromodulation on cystometric pressure and volume parameters in women with detrusor instability or sensory urgency. Duration: unclear 

48 women with proved detrusor instability or sensory urgency. Exclusion criteria: Urinary tract infection, pregnancy, cardiac pacemaker, impaired cognition, neurogenic bladder dysfunction or cystocele beyond the introitus. Loss of followup: Not reported 

1. Active transcutaneous electrical nerve stimulation with 10Hz. frequency and 200 microsecond pulse width (sacral placement). 2. Active transcutaneous electrical nerve stimulation with 150Hz. frequency and 200 microsecond pulse with (suprapubic placement) 3. Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement. 

Urodynamic outcom

Fujishiro, 2000570

RCT to examine the effects of magnetic stimulation of the sacral roots for the treatment of stress incontinence. Duration: 1 week 

62 women, 37 to 79 years old with stress incontinence, >1 episodes of urinary leakage recorded in a 3-day voiding diary, and 2gm or more urine loss on a 1-hour pad test. Exclusion criteria: Urinary infection, interstitial cystitis and large uterine myoma, and other treatments for 

stress incontinence, including pelvic floor exercises, medical treatment and electrical stimulation. Loss of followup: Not reported 

1. Magnetic stimulation of sacral roots with 15Hz. frequency, 50% intensity output for 5 seconds per minute for 30 minutes. 2. Sham stimulation with inactive device 

Self reported numbvoids daily, mean uvolume per void, annumber of leaks for days 

Fujishiro ,2002571RCT to examine the effects of magnetic stimulation of the sacral roots for treating urinary frequency and urge incontinence. Duration 1 week 

37 women 43 to 75 years old with the complaint of urinary frequency and/or urge incontinence, >8 voids daily and/or >1 episode of urge incontinence on a 3-day voiding diary, and mean of less than 250ml. urine volume per void on a 3-day voiding diary. Exclusion criteria: neurological disorders suggesting neurogenic bladder dysfunction, apparent episode of stress incontinence, urinary infection, interstitial cystitis or large uterine myoma , other treatments for urinary frequency or urge incontinence, including pelvic floor exercises, medical treatment or electrical stimulation. Loss of followup: not reported 

1. Magnetic stimulation of sacral roots with 15Hz. frequency , 50% intensity output for 5 seconds per minute for 30 minutes. 2. Sham stimulation with inactive device 

Self reported numbvoids daily, mean uvolume per void, annumber of leaks for days. 
Table F100. Electrical stimulation on risk and progression of urinary incontinence in adults (continued) 

F500 

Study Participants Clinical Interventions Outcomes 

Walsh, 2001572

RCT to examine the effects of noninvasive third sacral nerve (S3) stimulation on bladder activity during filling cystometry. Duration: Acute experiment 

146 patients with urge incontinence refractory to an average of three previous treatments, encompassing bladder retraining, anticholinergic medication, or bladder/urethral dilatation. Exclusion criteria: Not reported. Loss of followup: Not applicable 

1. Antidromic transcutaneous sacral neurostimulation during the second fill of standard urodynamic filling cystometry with 10Hz frequency, a pulse width of 200msec in continuous mode at the maximum tolerable level. 2.Control group underwent a second fill of standard urodynamic filling cystometry without neurostimulation 

Cystometric filling volumes and corresponding detrupressures at first deto void, strong desivoid, sensation of urgency, and maximcystometric capacit

Borawski, 2007573

RCT to examine the effects of percutaneous needle electrode technique or a surgical first stage lead placement on implantation of a pulse generator in older urge incontinent women. Duration: 2 weeks 

30 women >55 years with refractory urge incontinence after failure of medical, behavioral, and pelvic floor reeducation management. Exclusion criteria: Not reported. Loss of followup: 6.6% 

1. Electrical stimulation with percutaneous needle electrode (22-G spinal needle) placement 2. Electrical stimulation with surgical first stage lead placement 

Self reported urinarincontinence in bladdiary, daily pad couand a 24-hour pad weight test. Succestest stimulation perfor implantation of timpulse generator- >50% improvement daily incontinence episodes or 24-houpad weight. 
F501 

Table F101. Effects of physiotherapy on urinary continence in females (events) (table sorted by rate of continence after active trlowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition 

of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Functional magnetic stimulation with Pulsegen device, which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10Hz 

Placebo treatment with sham not active device 

Success of treatment of urge urinary incontinence 

24 5 79.0 22.0 3.5 (1.6; 7.8) 

Functional magnetic stimulation applied continuously at 18.5Hz day and night 

Sham inactive device 

Cured form Detrusor over activity 

17 11 75.0 66.6 1.1 (0.7; 1.6) 

But, 2003546

N = 52 

Functional magnetic stimulation with Pulsegen device, which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10Hz 

Placebo treatment with sham not active device 

No urge incontinence (cured) 

12 0 40.0 1.0 18.5 (1.2; 297.4) 
Table F101. Effects of physiotherapy on urinary continence in females (events) (table sorted by rate of continence after active tr

lowest) (continued) 

F502 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition 

of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Cured for incontinence 

Smith, 1996 2 1 22.0 11.0 2.0 (0.2; 18.3) 556

N = 57 

Electrical stimulation using frequency 12.5Hz. -50Hz and amplitude 5-10mA-80mA for 15 to 60 minutes 2/day 

Kegel exercise 

Improved urinary incontinence 

4 1 22.0 11.0 1.8 (0.2; 13.9) 

Pages, 2001553N = 51 

Specific physical therapy program. Group therapy 5 times/week and home pelvic floor exercise with 50 contractions for 10 minutes 2 times/day. Recommendation of weight loss and aerobic sport 

Biofeedback training 90 minutes/day in group and individually for 15 minutes, 5 times/week Intra vaginal pressure sensor and visual biofeedback in computer monitor 

No stress urinary incontinence episodes and symptoms 

6 4 22.0 28.0 0.7 (0.2; 2.1) 

Sand, 1995554

N = 52 

Active pelvic floor stimulator with gradually adjusted 60-80mA from 5 seconds on/1 sec off for 15 minutes to 5 seconds on/5 seconds off for 30 minutes 

Sham inactive device. 

Cured from stress urinary incontinence 

7 2 20.0 12.0 1.7 (0.4; 7.3) 
Table F101. Effects of physiotherapy on urinary continence in females (events) (table sorted by rate of continence after active tr

lowest) (continued) 

F503 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition 

of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Smith, 1996556

N = 57 

Anticholinergic therapy with Propantheline bromide in dose of 7.5 to 45mg 2-3 times/day 

Electrical stimulation using frequency 12.5Hz. -50Hz and amplitude 5-25mA for 15-60 minutes 2/day 

Cured for incontinence 

3 4 16.7 11.0 0.4 (0.1; 1.3) 

Objectively cured from stress urinary incontinence 

Luber, 1997 3 3 15.0 12.5 1.2 (0.3; 5.3) 561

N = 57 

Functional electrical stimulation with15 minute treatment session/day using pulse-width of 2msec scheduled for 2 seconds with 4 seconds rest, frequency of 50Hz, and power 10–100mA 

Sham stimulation with inactive device. 

Subjectively cured from stress urinary incontinence 

2 4 10.0 16.7 0.6 (0.1; 2.9) 

Fujishiro, 2000570N = 62 

Neuromodlation therapy :Magnetic stimulation of sacral roots with 15Hz frequency, 50% intensity output for 5 seconds per minute for 30 minutes. 

Sham stimulation with inactive device 

Self reported cure from stress urinary incontinence 

4 1 13.0 3.0 4.0 (0.5; 33.8) 

Bold - significant differences in outcomes at 95% confidence level; Number of attributable events = 1000*(rate of the outcome in the conin the active group); A - avoided; E - excessive events 
F504 

Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Amaro, 2006551N = 40 

Effective Intravaginal electrical stimulation with 3 20-minute sessions/week using Dualpex Uro 996 (frequency = 4Hz) 

Sham Intravaginal electrical stimulation 

Self reported reduction in urge urinary incontinence 

17 14 85.0 68.5 1.2 (0.9; 1.7) 

Fujishiro, 2000570N = 62 

Neuromodulation therapy:

Magnetic stimulation of sacral roots with 15Hz. frequency, 50% intensity output for 5 seconds each minute for 30 minutes 

Sham stimulation with inactive device 

Self reported improvement in stress urinary incontinence 

23 10 74.0 32.0 2.3 (1.3; 4.0) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F505 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Pages, 2001553N = 51 

Specific physical therapy program. Group therapy 5 times/week and home pelvic floor exercise with 50 contractions for 10 minutes 2 times/day. Recommendation of weight loss and aerobic sports 

Biofeedback training and stimulation daily 90 minutes in group and individually for 15 minutes, 5 times/week. Intra vaginal pressure sensor and visual biofeedback in computer monitor 

Fewer stress urinary incontinence episodes (-50%) and symptoms 

20 9 74.0 68.0 1.1 (0.7; 1.6) 

Spruijt, 2003547N = 51 

Intravaginal electrical stimulation of the pelvic floor using stimulator generated biphasic current pulses with a duration of ms and a frequency of 50Hz (stress urinary incontinence) or 20Hz ( urge urinary incontinence). 

Kegel exercise program with verbal instructions on how to exercise at home 

% of improved pelvic muscle strength 

18 5 70.8 44.4 1.7 (0.8; 3.5) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F506 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Bower, 1998569N = 48 

Neuromodulation therapy:Active transcutaneous electrical nerve stimulation with 150Hz. frequency and 200 microsecond pulse with (suprapubic placement) 

Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement 

Detrusor pressure at max cystometric capacity <15cm 

11 6 68.7 40.0 1.8 (0.9; 3.7) 

Smith, 1996556N = 57 

Electrical stimulation using frequency 12.5Hz -50Hz and amplitude 5-25mA for 15 to 60 minutes 2/day 

Kegel exercise 

Improved urinary incontinence 

10 3 50.0 33.0 1.5 (0.5; 4.2) 

Sand, 1995554N = 52 

Active pelvic floor stimulator with gradually adjusted 60-80mA from 5 seconds on/1 sec off for 15 minutes to 5 seconds on/5 seconds off for 30 minutes. 

Sham inactive device. 

Improved by 50% pad test 

16 3 46.0 18.0 2.6 (0.9; 7.7) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F507 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Indrekvam, 2001555N = 3,008 

Homemanaged electrical stimulation with vaginal/anal stimulators (20-50Hz) for 6 -8 hours/day for at least 3 months before evaluation of the effect. 

Baseline data Reduction in 

frequency of urine loss: every day and/or night 

1,384 1865 46.0 62.0 0.7 (0.7; 0.8) 

% with improved subjective outcome variables PRAFAB score 

Spruijt, 11 5 45.8 45.4 1.1 (0.5; 2.4) 2003547N = 51 

Intravaginal electrical stimulation of the pelvic floor using stimulator generated biphasic current pulses with duration of 1ms and a frequency of 50Hz (stress urinary incontinence) or 20Hz (urge urinary incontinence). 

Kegel exercise program with verbal instructions on how to exercise at home % with 

improved frequency of urine leakage 

11 3 45.8 27.3 1.8 (0.6; 5.2) 

Smith, 1996556N -= 57 

Electrical stimulation using frequency 12.5Hz-50Hz and amplitude 5-10mA-80mA for 15 to 60 minutes 2/day 

Kegel exercise 

Improved urinary incontinence 

4 3 44.0 33.0 1.3 (0.4; 4.3) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F508 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

But, 2005559

N = 39 

Functional magnetic stimulation applied continuously at 18.5Hz day and night 

Sham inactive device 

Improvement in mixed urinary incontinence 

11 3 41.9 22.9 1.8 (0.6; 5.4) 

Smith, 1996556N -= 57 

Anticholinergic therapy with Propantheline bromide in dose of 7.5 to 45mg 2-3 times/day 

Electrical stimulation using frequency 12.5Hz-50Hz and amplitude 5-25mA for 15-60 minutes 2/day 

Improved urinary incontinence 

7 9 38.9 33.0 0.4 (0.2; 0.7) 

Sand, 1995554N = 52 

Active pelvic floor stimulator with gradually adjusted 60-80mA from 5 seconds on/1 second off for 15 minutes to 5 seconds on/5 seconds off for 30 minutes. 

Sham inactive device. 

Improved by 50% voiding diary 

13 2 37.0 12.0 3.2 (0.8; 12.4) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F509 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Less abdominal pain related to urge urinary incontinence 

But, 2003 11 1 36.7 5.0 8.1 (1.1; 57.9) 

546

N = 52 

Functional magnetic stimulation with Pulsegen device, which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10Hz. 

Placebo treatment with sham not active device. 

Improvement in urge urinary incontinence at night 

11 4 36.7 20.0 2.0 (0.7; 5.5) 

Brubaker, 1997557N = 148 

Transvaginal electric stimulation for 20 minutes 2 times/day using frequency of 20Hz, a 2 second-4 second workrest cycle with a range of stimulation intensities, from 0 to 100mA 

Sham inactive device. 

Adequate subjective improvement 

21 10 35.0 17.0 2.1 (1.1; 4.1) 

Borawski, 2007573N = 30 

Neuromulation therapy:Electrical stimulation with percutaneous needle electrode (22-G spinal needle) placement 

Electrical stimulation with surgical first stage lead placement 

>50% 

Improvement in 24 hour pad weight for urinary incontinence 

4 13 30.8 76.5 0.4 (0.2; 0.9) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F510 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

% with reduced amount of loss urine 

Spruijt, 7 3 29.2 27.3 1.1 (0.3; 3.6) 2003547N = 51 

Intravaginal electrical stimulation of the pelvic floor using stimulator generated biphasic current pulses with duration of 1msec and a frequency of 50Hz (stress urinary incontinence) or 20Hz (urge urinary incontinence). 

Kegel exercise program with verbal instructions on how to exercise at home 

% of 

improved/cured from urinary incontinence 

7 4 29.2 36.4 0.8 (0.3; 2.3) 

But, 2003546

N = 52 

Functional magnetic stimulation with Pulsegen device, which produced a pulsating magnetic field of B = 10 microT intensity and a frequency of 10Hz. 

Placebo treatment with sham not active device. 

Improvement in urge urinary incontinence during a day 

7 1 23.0 5.0 5.1 (0.7; 

38.8) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F511 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Spruijt, 2003547N = 51 

Intravaginal electrical stimulation of the pelvic floor using stimulator generated biphasic current pulses with duration of 1ms and a frequency of 50Hz (stress urinary incontinence) or 20Hz (urge urinary incontinence) 

Kegel exercise program with verbal instructions on how to exercise at home 

% improved Detrusor instability 

6 3 22.2 28.6 1.0 (0.3; 3.2) 

Borawski, 2007573N = 30 

Neuromodualtion therapy:Electrical stimulation with percutaneous needle electrode (22-G spinal needle) placement 

Electrical stimulation with surgical first stage lead placement 

>50% Improvement in 24 hour pad usage for urinary incontinence 

2 11 15.4 64.7 0.2 (0.1; 0.9) 
Table F102 Effects of electrical stimulation and neuromodulationon improvement of urinary incontinence in females (events) (tabl

improvement after active treatment, from highest to lowest) (continued) 

F512 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Luber, 1997561N = 57 

Functional electrical stimulation with15 minute treatment session/day using pulsewidth of 2msec scheduled for 2 seconds with 4 seconds rest, frequency of 50Hz, and power 10–100mA 

Sham stimulation with inactive device. 

Subjectively improvement in stress urinary incontinence 

3 3 15.0 12.5 1.2 (0.3; 5.3) 

Borawski, 2007573N = 30 

Neuromodulation therapy:Electrical stimulation with percutaneous needle electrode (22-G spinal needle) placement 

Electrical stimulation with surgical first stage lead placement 

>50% Improvement in daily incontinence episodes 

1 14 7.7 82.4 0.1 (0.0; 0.6) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F513 

Table F103. Effects of stimulation therapy on urinary incontinence in females (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Frequency of urine loss: every day and/or night 

1,384 1,865 46.0 62.0 0.7 (0.7; 0.8) 

Pad use during 24 hours >5 

331 361 11.0 12.0 0.9 (0.8; 1.1) 

Patients’ assessment of impact: much bothered 

391 632 13.0 21.0 0.6 (0.6; 0.7) 1

Severity index: moderate 

361 90 12.0 3.0 4.0 (3.2; 5.0) 

Severity index: severe 

1053 1,444 35.0 48.0 0.7 (0.7; 0.8) 

Two or more voidings during the night 

1023 1,173 34.0 39.0 0.9 (0.8; 0.9) 2

Indrekvam, 2001555N = 3,008 

Homemanaged electrical stimulation with vaginal/anal stimulators (20-50Hz) for 6-8 hours/day for at least 3 months before evaluation of the effect 

Baseline data 

Usual amount of leakage: substantial amounts 

331 451 11.0 15.0 0.7 (0.6; 0.8) 2

Stamp, 2001574N = 1,340 

Massage and stretching of perineum during second stage of labor with a water soluble lubricant 

Usual care Urinary 

incontinence 3 months postpartum 

123 115 17.4 18.2 1.0 (0.8; 1.2) 
Table F103. Effects of stimulation therapy on urinary incontinence in females (events) (continued) 

F514 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

% with deterioration of urinary incontinence 

Spruijt, 2003 6 7 25.0 54.5 0.4 (0.2; 1.0) 

547

N = 51 

Intravaginal electrical stimulation of the pelvic floor using stimulator generated biphasic current pulses with duration of 1msec and frequency of 50Hz (stress urinary incontinence) or 20Hz (urge urinary incontinence) 

Kegel exercise program with verbal instructions on how to exercise at home 

% with unchanged urinary incontinence 

11 1 45.8 9.1 5.3 (0.8; 36.3) 

Amaro, 2005558

N = 40 

Intravaginal electrical stimulation with 3 20-minute sessions/week using 4Hz frequency. 

Sham stimulation with inactive device. 

Urge urinary incontinence at 1 month followup 

3 6 15.0 31.5 0.5 (0.1; 1.7) 

But, 2005559

N = 39 

Functional magnetic stimulation applied continuously at 18.5Hz day and night 

Sham inactive device 

Incidence of idiopathic detrusor over activity 

1 3 3.8 23.1 0.2 (0.0; 1.4) 

Emmons, 2005562N = 85 

Acupuncture treatment expected to improve bladder symptoms 

Placebo acupuncture treatment designed to promote relaxation 

Proportion of subjects with detrusor contractions during cystometry 

7 11 16.0 28.0 0.6 (0.3; 1.4) 
Table F103. Effects of stimulation therapy on urinary incontinence in females (events) (continued) 

F515 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Amaro, 2006551

N = 40 

Effective Intravaginal electrical stimulation using frequency of 4Hz with 3 20-minute sessions/week 

Sham Intravaginal electrical stimulation using frequency of 4Hz with 3 20-minute sessions/week

Self reported urge incontinence 

3 6 15.0 31.5 0.5 (0.1; 1.7) 

Brubaker, 1997557N = 148 

Transvaginal electric stimulation for 20 minutes 2 times/day using frequency of 20Hz, a 2 second-4 second workrest cycle with range of stimulation intensities, from 0-100mA 

Sham inactive device. 

Final urodynamic diagnosis of detrusor over activity 

16 25 27.0 41.0 0.6 (0.4; 1.1) 

Detrusor pressure at maximum cystometric capacity <15cm 

11 6 68.7 40.0 1.8 (0.9; 3.7) 

Maximum detrusor pressure <15cm 

7 2 43.7 13.3 3.5 (0.9; 14.3) 

Bower, 1998569

N = 48 

Neuromodulation therapy: Active transcutaneous electrical nerve stimulation with 150Hz. frequency and 200 microsecond pulse with suprapubic placement 

Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement 

Change in detrusor pressure at first desire to void 

7 2 44.0 13.0 3.5 

(0.9; 14.3) 
Table F103. Effects of stimulation therapy on urinary incontinence in females (events) (continued) 

F516 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk

(95% CI) 

N

Change in detrusor pressure at first desire to void 

7 2 44.0 13.0 3.5 

(0.9; 14.3) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F517 

Table F104. Effects of electrical stimulation or neuromodulation therapy on urinary continence in adults (events) (sorted by rate of treatment, from highest to lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition 

of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Schmidt, 1999566

N = 98 81% female 

Neuromodulation therapy: Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place. 

Standard medical therapy 

Self reported urge urinary continence (cured) 

24 0 47.0 1.0 43.5 (2.7; 695.0) 

Weil, 2000567

N = 44 91% female 

Neuromodulation therapy: Sacral root neuromodulation with an implantable impulse generator 

Prior conservative management: medications or pelvic floor exercise 

Self reported urge urinary continence (cured) 

9 1 42.9 4.3 9.9 (1.4; 71.4) 

Yamanishi, 2000548N = 68 57% female 

Electrical stimulation 15 minutes twice daily for 4 weeks (vaginal electrode in women and an anal or surface electrode in men to provide alternating pulses of 10Hz square waves 

Sham inactive device 

Urinary continence (cured) 

7 1 18.9 3.2 5.9 (0.8 (45.1) 
Table F104. Effects of electrical stimulation or neuromodulation therapy on urinary continence in adults (events) (sorted by rat

active treatment, from highest to lowest (continued) 

F518 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition 

of 

Continence 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

of 1ms pulse duration and a maximum output current of 60mA). 

Karademir, 2005568N = 43 88% female 

Neuromodulation therapy: Stoller afferent neurostimulation with frequency 20Hz and amplitude 0.5-10mA 

Stoller afferent neuronstimulation with frequency 20Hz and amplitude 0.5-10mA combined with 5mg of oral oxybutynin hydrochloride 

Cured from urge incontinence 

3 3 14.3 13.0 1.1 (0.2; 4.8) 

Yamanishi, 1997563N = 35 86% female 

Electrical pelvic stimulation with 50Hz square waves of 1msec. pulse duration and vaginal electrode in women and an anal electrode in men for 15 minutes 2 or 3 times daily 

Sham electrical pelvic stimulation with inactive device 

Cured 2 0 8.0 1.0 3.3 (0.2; 64.3) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F519 

Table F105. Effects of electrical stimulation and neuromodulation therapy on improvement of urinary incontinence (events) (ta

improvement after active treatment, from highest to lowest) 

Author 

Sample Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Schmidt, 1999566N = 98 81% female 

Neuromodulation therapy: Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place 

Standard medical therapy 

Improvement in severity: heavy urge incontinence at baseline and none at 6 months 

40 4 77.0 8.0 8.8 (3.4; 22.8) 

Karademir, 2005568N = 43 88% female 

Neuromodulation therapy: Stoller afferent neurostimulation with frequency 20Hz and amplitude 0.5-10mA 

Stoller afferent neurostimulation with frequency 20Hz and amplitude 0.5-10mA combined with 5mg of oral oxybutynin hydrochloride 

% decrease in symptoms of urge incontinence 

15 20 70.2 89.7 0.8 (0.6; 1.1) 

Schmidt, 1999566N = 98 81% female 

Neuromodulation therapy: Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place. 

Standard medical therapy 

Self reported no use of absorbent pads or diapers for urge urinary incontinence 

26 1 50.0 2.0 23.0 (3.2; 

162.9) 
Table F105. Effects of electrical stimulation and neuromodulation therapy on improvement of urinary incontinence (events) (ta

improvement after active treatment, from highest to lowest) (continued) 

F520 

Author 

Sample Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

% decrease in symptoms of urgency 

Karademir, 10 13 46.1 61.1 0.8 (0.5; 1.4) 2005568N = 43 88% female 

Neuromodulation therapy: Stoller afferent neurostimulation with frequency 20Hz and amplitude 0.5-10mA 

Stoller afferent neurostimulation with frequency 20Hz and amplitude 0.5-10mA combined with 5mg of oral oxybutynin hydrochloride 

% decrease in symptoms of frequency 

8 10 36.7 44.2 0.8 (0.4; 1.7) 

Schmidt, 1999566N = 98 81% female 

Neuromodulation therapy: Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place 

Standard medical therapy 

Significant reduction in daily urge urinary incontinence episodes (>50%) 

15 2 29.0 5.0 6.6 (1.6; 27.5) 

Yamanishi, 2000548N = 68 57% female 

Electrical stimulation 15 minutes twice daily for 4 weeks (vaginal electrode in women and an anal or surface electrode in men to provide alternating pulses of 10Hz square waves of 1ms pulse duration and a maximum output current of 60mA) 

Sham inactive device 

No Detrusor overactivity 

8 2 21.6 6.5 3.4 (0.8; 14.6) 
Table F105. Effects of electrical stimulation and neuromodulation therapy on improvement of urinary incontinence (events) (ta

improvement after active treatment, from highest to lowest) (continued) 

F521 

Author 

Sample Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Yamanishi, 2000549N = 32 54% female 

Functional magnetic stimulation applied continuously at 10Hz 

Functional electrical stimulation applied continuously at 10Hz with vaginal electrode in women and a surface electrode on the dorsal part of the penis in men. 

Abolished detrusor overactivity 

3 0 20.0 0.5 7.9 (0.4; 141.1) 

Improved: decrease >50% in pad test 

Yamanishi, 3 0 13.0 3.0 4.7 (0.3; 83.5) 1997563N = 35 86% female 

Electrical pelvic stimulation with 50Hz. square waves of 1ms. pulse duration and vaginal electrode in women and an anal electrode in men for 15 minus 2 or 3 times/day 

Sham electrical pelvic stimulation with inactive device 

Improved: decrease in urinary leakage >50% 

2 0 11.0 2.0 3.3 (0.2; 64.3) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F522 

Table F106. Effects of electrical stimulation or neuromodulation on perceived urinary incontinence in females (severity measur

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differences (95% CI) 

Brubaker, 1997557N = 148 

Transvaginal electric stimulation for 20 minutes 2 times/day using frequency of 20Hz, a 2-second, 4-second work-rest cycle with a range of stimulation intensities, from 0 to 100mA 

Sham inactive device 

Number of urinary accidents/24 hour (average) 

2.4 ± 3.1 2.2 ± 2.7 0.1 (-0.3; 0.4) 

Electrical stimulation using frequency 12.5H - 50Hz and amplitude 5-10mA80mA for 15 to 60 minutes 2/day 

Kegel exercise Leaks/24hours 2.4 ± 2.4 1.4 ± 2.4 0.4 (-0.5; 1.4) 

Anticholinergic therapy with Propantheline bromide in dose of 7.5 to 45mg 2-3 times/day 

Electrical stimulation using frequency 12.5Hz -50Hz and amplitude 5-25mA for 15 to 60 minutes 2/day 

Pads use/week 8.1 ± 5.3 6.5 ± 7.7 0.2 (-0.4; 0.9) 

Smith, 1996556

N = 57 

Electrical stimulation using frequency 12.5Hz. -50 Hz and amplitude 5-10mA80mA for 15 to 60 minutes 2/day 

Kegel exercise Pads use/week 5.4 ± 3.1 4.0 ± 4.0 0.4 (-0.5; 1.3) 

Urinary leaks/24 hours 

Sand, 1995 1.8 ± 2.5 3.8 ± 3.1 -0.7 (-1.3; -0.1) 

554

N = 52 

Active pelvic floor stimulator with gradually adjusted 60-80mA from 5 seconds on, 1 second off for 15 minutes to 5 seconds on, 5 seconds off for 30 minutes 

Sham inactive device 

Urinary leaks/week 10.0 ± 14.5 27.0 ± 53.8 -0.5 (-1.1; 0.1) 
Table F106. Effects of electrical stimulation or neuromodulation on perceived urinary incontinence in females (severity measur

F523 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differences (95% CI) 

Nocturnal urination frequency 

0.3 ± 0.5 0.4 ± 0.4 -0.1 (-0.7; 0.6) 

digital contraction strength: cough scores (1–5) 

4.0 ± 0.9 4.0 ± 0.6 0.0 (-0.7; 0.7) 

Pages, 2001553

N = 51 

Specific physical therapy program. Group therapy 5 times/week and home pelvic floor exercise with 50 contractions for 10 minutes 2 times/day. Recommendation of weight loss and aerobic sports. 

Biofeedback training daily 90 minutes in group and individually for 15 minutes, 5 times/week. Intra vaginal pressure sensor and visual biofeedback in computer monitor. 

Digital contraction strength: voluntary contraction scores (1–5) 

3.5 ± 1.0 4.0 ± 0.8 -0.5 (-1.2; 0.1) 

Sand, 1995554

N = 52 

Active pelvic floor stimulator with gradually adjusted 60-80mA from 5 seconds on, 1 second off for 15 minutes to 5 seconds on, 5 seconds off for 30 minutes 

Sham inactive device 

Pad use/week 4.1 ± 5.3 11.2 ± 16.8 -0.7 (-1.3; -0.1) 

Change from baseline in VAS (from 10 possible) 

2.5 2.0 0.0 ± 0.0 1.7 (1.0; 2.5) 

Change from baseline in Urogenital Distress Inventory (from 57 possible) 

7.0 ± 0.8 0.0 ± 5.2 1.9 (1.2; 2.6) 

Dumoulin, 2004489N = 64 

Electrical stimulation of the pelvic floor + pelvic floor muscle exercise + biofeedback 

Relaxation massage for the back and extremities 

Change from baseline in Incontinence Impact Questionnaire (from 90 possible) 

13.0 ± 9.6 0.5 ± 3.6 1.7 (1.0; 2.4) 
Table F106. Effects of electrical stimulation or neuromodulation on perceived urinary incontinence in females (severity measur

F524 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differences (95% CI) 

Change from baseline in Urogenital Distress Inventory (from 57 possible) 

4.0 ± 4.8 0.0 ± 5.2 0.8 (0.2; 1.4) 

Change from baseline in Incontinence Impact Questionnaire (from 90 possible ) 

10.0 ± 4.8 0.5 ± 3.6 2.2 (1.4; 3.0) 

Jarvis, 2005575

N = 60 

Preoperative physiotherapy 

No preoperative physiotherapy 

Self reported scores of symptoms of urinary incontinence 

-3.8 (-0.7; -6.9) 

Number of episodes of voiding urgency. 

1.5 ± 1.8 6.5 ± 2.4 -2.5 (-3.4; -1.6) 

Urinary leakage 1.3 ± 1.0 3.0 ± 0.9 -1.8 (-2.6; -0.9) 

Barroso, 2004564N = 34 

Transvaginal electrical stimulation at home twice a day (20-minute sessions) with frequency of 20 (urge) or 50Hz (stress), a pulse width of 300ms, with asymmetrical biphasic pulses, an adjustable current intensity (0–100mA). 

Placebo (identical equipment but with no electrical current) 

Number of nocturnal voids 

1.1 ± 0.5 2.3 ± 0.9 -1.8 (-2.6; -1.0) 

Incontinence impact questionnaire score 

4.3 ± 2.7 7.0 ± 3.5 -0.9 (-1.3; -0.4) 

Urinary distress inventory score 

3.6 ± 3.2 5.8 ± 4.8 -0.5 (-1.0; -0.1) 

Emmons, 2005562N = 85 

Acupuncture treatment expected to improve bladder symptoms 

Placebo acupuncture treatment designed to promote relaxation 

Number of total urinary incontinent episodes/3 days) 

2.6 ± 3.1 5.3 ± 5.9 -0.6 (-1.0; -0.1) 
Table F106. Effects of electrical stimulation or neuromodulation on perceived urinary incontinence in females (severity measur

F525 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differences (95% CI) 

Fujishiro, 2000570N = 62 

Neuromodulation therapy: Magnetic stimulation of sacral roots with 15Hz frequency, 50% intensity output for 5 seconds per minute for 30 minutes. 

Sham stimulation with inactive device 

Number of stress urinary leakage episodes/3 days 

2.2 ± 3.6 3.2 ± 2.9 -0.3 (-0.8; 0.2) 

Dumoulin, 2004489N = 64 

Electrical stimulation of the pelvic floor + pelvic floor muscle exercise + biofeedback 

Relaxation massage for the back and extremities 

Change from baseline in VAS (from 10 possible ) 

3.0 ± 0.8 0.0 ± 0.0 5.2 (3.9; 6.5) 

Emmons, 2005562N = 85 

Acupuncture treatment expected to improve bladder symptoms 

Placebo acupuncture treatment designed to promote relaxation 

Number of urge urinary episodes/3 days) 

11.4 ± 8.8 15.0 ± 9.4 -0.4 (-0.8; 0.0) 

Luber, 1997561

N =- 57 

Functional electrical stimulation with15-minute treatment sessions per day using pulse-width of 2msec scheduled for 2 seconds with4 second rest, frequency of 50Hz, and power 10-100mA 

Sham stimulation with inactive device 

Stress urinary incontinence episodes/ 24hours 

2.4 ± 4.4 2.4 ±5.7 0.0 (-0.6; 0.6) 

Number of urinary voids/daily 

Fujishiro, 9.3 ± 2.3 10.0 ± 2.0 -0.3 (-1.0; 0.3) 2002571N = 37 

Neuromodulation therapy: Magnetic stimulation of sacral roots with 15Hz. frequency, 50% intensity output for 5 seconds per minute for 30 minutes 

Sham stimulation with inactive device 

Number of urge urinary leakage episodes/3 days 

1.6 ± 3.2 1.6 ± 1.2 0.0 (-0.7; 0.7) 

Bold- significant differences in outcomes at 95% confidence level 
F526 

Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urody

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Smith, 1996556

N = 57 

Anticholinergic therapy with Propantheline bromide in dose of 7.5 to 45mg 2 - 3 times/day 

Electrical stimulation using frequency 12.5Hz. -50Hz and amplitude 5-25mA for 15 to 60 minutes 2/day 

Bladder capacity, ml 

220.0 ± 253.3 247.0 ± 235.3 -0.1 (-0.7; 0.5) 

Bower, 1998569

N = 48 

Neuromodulation therapy: Active transcutaneous electrical nerve stimulation with 10Hz. frequency and 200 microsecond pulse width (sacral placement) 

Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement 

First desire to void 

154.0 ± 61.0 186.0 ± 77.0 -0.5 (-1.2; 0.2) 

Amaro, 2005558N = 40 

Intravaginal electrical stimulation with 3 20-minute sessions/week using 4Hz frequency 

Sham stimulation with inactive device 

Vaginal cone weight test 

4.0 ± 1.3 2.0 ± 1.1 1.7 (0.9; 2.4) 

Smith, 1996556

N = 57 

Electrical stimulation using frequency 12.5Hz. -50Hz and amplitude 5-10mA-80mA for 15 to 60 minutes 2/day 

Kegel exercise Leak point 

pressure 

95.0 ± 23.3 105.0 ± 16.7 -0.5 (-1.4; 0.4) 
Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urody

(continued) 

F527 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Bower,. 1998569

N = 48 

Neuromodulation therapy: Active transcutaneous electrical nerve stimulation with 150Hz. frequency and 200 microsecond pulse with (suprapubic placement) 

Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement 

Max Detrusor pressure 

18.2 ± 10.2 26.0 ± 12.3 -0.7 (-1.4; 0.0) 

Amaro, 2005558N = 40 

Intravaginal electrical stimulation with 3 20-minute sessions/week using 4Hz frequency 

Sham stimulation with inactive device 

Perineal muscle strength 

53.8 ± 18.6 46.8 ± 12.5 0.4 (-0.2; 1.1) 

Change from baseline in max Detrusor pressure 

12.7 ± 16.9 1.4 ± 4.9 0.9 (0.2; 1.6) 

Change from baseline in max Detrusor pressure 

7.0 ± 11.0 1.4 ± 4.9 0.7 (-0.1; 1.4) 

Threshold volume 

224.0 ± 141.0 262.0 ±105.0 -0.3 (-1.0; 0.4) 

Maximum Detrusor pressure 

21.7 ± 17.2 26.0 ± 12.3 -0.3 (-1.0; 0.4) 

Detrusor pressure at maximum cystometric capacity 

15.1 ± 10.1 21.5 ± 12.2 -0.6 (-1.3; 0.1) 

Bower, 1998569

N = 48 

Neuromodulation therapy: Active transcutaneous electrical nerve stimulation with 10Hz. frequency and 200 microsecond pulse width (sacral placement) 

Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement 

Detrusor pressure at maximum cystometric capacity 

12.8 ± 8.1 21.5 ± 12.2 -0.8 (-1.6; -0.1) 
Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urody

(continued) 

F528 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Detrusor pressure at first desire to void 

11.3 ± 15.7 10.7 ± 9.5 0.0 ( -0.7; 0.7) 

Detrusor pressure at first desire to void 

7.3 ± 6.6 10.7 ± 9.5 -0.4 (-1.1; 0.3) 

Maximum cystometric capacity 

305.0 ± 146.0 313.5 ± 81.0 -0.1 (-0.8; 0.6) 

Threshold volume 

295.0 ± 162.0 262.0 ± 105.0 0.2 (-0.5; 0.9) 

Office- and homebased functional electro-stimulation maximum 100mA frequency 4-10Hz 

No treatment Detrusor Activity 

Index 

Berghmans, 0.6 ± 0.3 0.8 ± 0.3 -0.8 (-1.5; 0.0) 2002552N = 98 

Pelvic floor exercises with contractions for >20 seconds, relaxation for 10 seconds. Bladder training, voiding schedule, and positive reinforcement 

No treatment Detrusor Activity 

Index 

0.6 ± 0.3 0.8 ± 0.3 -0.6 (-1.3; 0.1) 

Vaginal muscle strength (mm/Hg) 

15.2 ± 15.1 8.9 ± 7.2 0.5 (-0.1; 1.1) 

Pad weight (g) 15.4 ± 26.0 32.3 ± 43.0 -0.5 (-1.1; 0.1) Maximum cystometric capacity (ml) 

494.6 ± 236.9 496.6 ± 225.3 0.0 (-0.6; 0.6) 

Sand, 1995554

N = 52 

Active pelvic floor stimulator with gradually adjusted 60-80mA from 5 seconds on, 1-second off for 15 minutes to 5 seconds on, 5 seconds off for 30 minutes. 

Sham inactive device. 

Residual urine (ml) 

23.8 ± 34.1 12.9 ± 18.8 0.4 (-0.2; 0.9) 

Berghmans, 2002552N = 98 

Office-based functional electro stimulation, pelvic floor exercise, and bladder training 

No treatment Detrusor Activity 

Index 

0.8 ± 0.3 0.8 ± 0.3 0.2 (-0.6; 0.9) 
Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urody

(continued) 

F529 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Maximum forced cough pressure cm/H2O 

38.0 ± 22.0 55.0 ± 12.0 -0.9 (-1.6; -0.2) 

Maximum contraction pressure cm/H2O 

38.0 ± 22.0 75.0 ± 21.0 -1.7 (-2.5; -0.9) 

Pages, 2001553

N = 51 

Specific physical therapy program. Group therapy 5 times/week and home pelvic floor exercise with 50 contractions for 10 minutes 2 times/day. Recommendation of weight loss and aerobic sports 

Biofeedback training daily for 90 minutes in group and individually for 15 minutes, 5 times/week. Intra vaginal pressure sensor and visual biofeedback in computer monitor. 

Average contraction pressure cm/H2O 

16.0 ± 10.0 50.0 ± 14.0 -3.0 (-3.9; -2.0) 

Bower, 1998569

N = 48 

Neuromodulation therapy: Active transcutaneous electrical nerve stimulation with 150Hz frequency and 200 microsecond pulse with (suprapubic placement) 

Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement 

Maximum cystometric capacity 

352.0 ± 145.0 313.5 ± 81.0 0.3 (-0.4; 1.0) 

Change from baseline in pelvic floor muscle maximum strength (N) 

Dumoulin, 0.5 ± 1.6 -0.5 ± 1.2 0.7 (0.0; 1.3) 2004489N = 64 

Electrical stimulation of the pelvic floor + pelvic floor muscle exercise + biofeedback 

Relaxation massage for the back and extremities 

Change from baseline pad test (g) 

19.0 ± 4.8 0.0 ± 7.8 3.0 (2.1; 3.8) 
Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urody

(continued) 

F530 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Bower, 1998569

N = 48 

Neuromodulation therapy: Active transcutaneous electrical nerve stimulation with 150Hz. frequency and 200 microsecond pulse with (suprapubic placement) 

Sham transcutaneous electrical nerve stimulation with sacral or suprapubic placement 

First desire to void 

208.0 ± 132.0 186.0 ± 77.0 0.2 (-0.5; 0.9) 

Change from baseline in pelvic floor muscle maximum strength (N) 

Dumoulin, 0.7 ± 1.3 -0.5 ± 1.2 0.9 (0.3; 1.6) 2004489N = 64 

Electrical stimulation of the pelvic floor + pelvic floor muscle exercise + biofeedback 

Relaxation massage for the back and extremities 

Change from baseline in maximum rate of force development (N/s) 

0.8 ± 1.7 -0.5 ± 1.0 0.9 (0.3; 1.6) 

Jarvis, 2005575

N = 60 

Preoperative physiotherapy 

No preoperative physiotherapy 

Leakage at paper towel test (cm2) 

 30 (-11; 72.3) 

Dumoulin, 2004489N = 64 

Electrical stimulation of the pelvic floor + pelvic floor muscle exercise + biofeedback 

Relaxation massage for the back and extremities 

Change from baseline in pad test (g) 

8.0 ± 13.8 0.0 ± 7.8 0.7 (0.1; 1.3) 

Barroso, 2004564

N = 34 

Transvaginal electrical 

Placebo (identical 

First desire to void, ml 

161.3 ± 43.3 150.8 ± 42.5 0.2 ( -0.5; 0.9) 
Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urody

(continued) 

F531 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

stimulation at home twice a day (20-minute sessions) with frequency of 20 (urge) or 50Hz (stress), a pulse width of 300msec, with asymmetrical biphasic pulses, an adjustable current intensity (0-100mA) 

equipment but with no electrical current) 

Maximum bladder capacity, ml 

425.0 ± 97.8 316.7 ± 71.8 1.2 ( 0.5; 1.9) 

Dumoulin, 2004489N = 64 

Electrical stimulation of the pelvic floor + pelvic floor muscle exercise + biofeedback 

Relaxation massage for the back and extremities 

Change from baseline in maximum rate of force development (N/s) 

0.3 ± 1.3 -0.5 ± 1.0 0.7 (0.0; 1.3) 

Emmons, 2005562

N = 85 

Acupuncture treatment expected to improve bladder symptoms 

Placebo acupuncture treatment designed to promote relaxation 

Functional bladder capacity 

236.0 ± 99.0 196.0 ± 85.0 0.4 (0.0; 0.9) 

Fujishiro, 2000570

N = 62 

Neuromodulation therapy: Magnetic stimulation of sacral roots with 15Hz frequency, 50% intensity output for 5 seconds per minute for 30 minutes 

Sham stimulation with inactive device 

Urine loss on pad test (gm) 

5.5 ± 7.5 8.0 ±6.8 -0.3 (-0.9; 0.2) 

Emmons, 2005562

N = 85 

Acupuncture treatment expected to improve bladder symptoms 

Placebo acupuncture treatment designed to promote relaxation 

Cystometric maximum capacity (ml) 

415.0 ± 205.0 356.0 ± 193.0 0.3 (-0.1; 0.7) 
Table F107. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in females (pad test and urody

(continued) 

F532 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Valsalva leakpoint pressure, cmH20 

86.0 ± 27.3 80.0 ± 116.7 0.1 ( -0.5; 0.7) 

Cystometrogram maximum volume, cm3 

470.0 ± 106.7 465.0 ± 116.7 0.0 (-0.5; 0.6) 

Luber, 1997561

N = 57 

Functional electrical stimulation with15-minute treatment sessions per day using pulse-width of 2msec scheduled for 2 seconds with 4 second rest , frequency of 50Hz, and power 10-100mA 

Sham stimulation with inactive device 

Postvoid residual volume 

23.0 ± 8.0 19.0 ± 11.3 0.4 (-0.2; 1.0) 

Fujishiro, 2002571

N = 37 

Neuromodulation therapy: Magnetic stimulation of sacral roots with 15 Hz frequency, 50% intensity output for 5 seconds per minute for 30 minutes 

Sham stimulation with inactive device 

Mean urine volume/void, ml 

195.2 ± 51.3 193.9 ± 47.5 0.0 (-0.6; 0.7) 

Bo, 1997560

N = 12 

Electrical stimulation with Conmax 50Hz - pulse width 0.75ms, 0-90mA 

Electrical stimulation with Medicon 50Hz - pulse width 0.5ms, 0-100mA 

Change in maximum urethral pressure during voluntary pelvic floor muscle contraction 

15.2 ± 11.5 10.4 ± 6.2 0.5 (-0.3; 1.3) 

Cystometric volume at first urge to void (ml) 

Emmons, 2005 65.0 ± 80.0 57.0 ± 75.0 0.1 (-0.3; 0.5) 

562

N = 85 

Acupuncture treatment expected to improve bladder symptoms 

Placebo acupuncture treatment designed to promote relaxation 

Cystometric volume at strong urge to void (ml) 

297.0 ± 167.0 276.0 ± 156.0 0.1 (-0.3; 0.6) 

Bold- significant differences in outcomes at 95% confidence level 
F533 

Table F108. Effects of electrical stimulation or neuromodulation therapy on self reported severity of urinary incontinence in ad

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) % Chan

Co

(95% 

Pad use for urge urinary incontinence 

0.7 ± 1.4 6.8 ± 4.2 -1.9 ( -2.7; -1.2) -28.4 (-3

Urinary leakage severity 

1.6 ± 1.9 2.1 ± 0.7 -0.4 (-1.0; 0.2) -17.1 (-4

Weil, 2000567N = 44 91% female 

Neuromodulation therapy: Sacral root neuromodulation with an implantable impulse generator 

Prior conservative management: medications or pelvic floor exercise 

Leakage episodes of urge urinary incontinence 

1.4 ± 4.2 11.2 ± 5.6 -2.0 (-2.7; -1.2) -17.5 (-2

Frequency of pad change:0-no change3->3times 

Yamanishi, 1.1 ± 1.3 2.0 ± 1.2 -0.7 (-1.4; 0.0) -35.7 (-71997563N = 35 86% female 

Electrical pelvic stimulation with 50Hz. square waves of 1ms. pulse duration and vaginal electrode in women and an anal electrode in men for 15 minutes 2 or 3 times/day 

Sham electrical pelvic stimulation with inactive device 

Disturbance in daily activities : 0-not at all, 3- very disturbed 

1.0 ± 1.2 2.1 ± 1.0 -1.0 (-1.7; -0.2) -46.5 (-8

Severity rank of urge urinary incontinence 

0.8 ± 0.9 2.0 ± 0.6 -1.6 (-2.0; -1.1) -77.5 (-10

Absorbent pads or diapers replaced daily due to urge urinary incontinence 

1.1 ± 2.0 6.3 ± 3.6 -1.8 (-2.3; -1.3) -28.8 (-3

Schmidt, 1999566

N = 98 81% female 

Neuromodulation therapy: Implantation of multiprogrammable neurostimulator subcutaneously in lower quadrant of the abdomen with lead positioned to target sacral nerve and anchored in place 

Standard medical therapy 

Self reported urge urinary Incontinent episodes/day 

2.6 ± 5.1 11.3 ± 5.9 -1.6 (-2.0; -1.1) -14.0 (-1
Table F108. Effects of electrical stimulation or neuromodulation therapy on self reported severity of urinary incontinence in ad

 (continued) 

F534 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) % Chan

Co

(95% 

Self reported scores of urinary urgency (0-none, 3-very much) 

Yamanishi, 1.7 ± 0.7 2.0 ± 0.8 -0.4 (-0.9; 0.1) -20.1 (-42000548N = 68 57% female 

Electrical stimulation 15 minutes twice daily for 4 weeks (vaginal electrode in women and an anal or surface electrode in men to provide alternating pulses of 10Hz square waves of 1msec pulse duration and a maximum output current of 60mA) 

Sham inactive device 

Daily frequency of pad changes for urinary incontinence 

0.8 ± 1.2 1.1 ± 2.0 -0.2 (-0.7; 0.3) -16.9 (-6

Bold- significant differences in outcomes at 95% confidence level 
F535 

Table F109. Effects of electrical stimulation or neuromodulation therapy on urinary incontinence in adults (urodynamic evaluat

Author 

Sample Active Control Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Differen

(95% C

Average flow rate, ml/second 

9.7 ± 6.9 7.4 ± 8.3 0.3 (-0.4; 

Bladder compliance at maximum sensation, cm 

91.9 ± 142.8 92.1 ± 107.2 0.0 (-0.7; 0

Maximum flow rate, ml/sec 

22.0 ± 10.9 20.6 ± 18.4 0.1 (-0.6; 0

Functional profile length, cm 

2.3 ± 0.8 2.1 ± 0.9 0.2 (-0.5; 0

Maximum urethral closure pressure, cm H20 

52.5 ±27.0 35.9 ± 15.8 0.7 (0.0; 1

Bladder capacity at first sensation, ml 

214.3 ± 96.0 240.0 ± 42.2 -0.3 (-1.0; 

Yamanishi, 1997563N = 35 86% female 

Electrical pelvic stimulation with 50Hz. square waves of 1ms. pulse duration and vaginal electrode in women and an anal electrode in men for 15 minutes 2 or 3 times daily 

Sham electrical pelvic stimulation with inactive device 

Bladder capacity at maximum sensation, ml 

392.6 ± 110.6 423.3 ± 100.7 -0.3 (-1.0; 

FDV, infused bladder volume (ml) at first desire to void 

167.2 ± 97.2 114.2 ± 90.8 0.6 (0.2; 0

SDV, infused bladder volume at perceived strong desire to void 

247.4 ± 110.1 193.7 ± 156.1 0.4 (0.1; 0

Urge, infused bladder volume at sensation of urgency; 

331.5 ± 136.8 255.4 ± 96.7 0.6 (0.3; 1

Walsh, 2001572N = 146 76% female 

Neuromodulation therapy: Antidromic transcutaneous sacral neurostimulation during the second fill of standard urodynamic filling cystometry with 10Hz frequency, a pulse width of 200 milliseconds in continuous mode at the maximum tolerable level. 

Control group underwent a second fill of standard urodynamic filling cystometry without neurostimulation 

CMax, maximum infused cystometric capacity. 

404.2 ± 229.7 315.9 ± 194.3 0.4 (0.1; 0

Bladder capacity at first desire to void (ml) 

174.2 ± 83.1 130.0 ± 69.9 0.6 (0.1; 1

Maximum cystometric capacity (ml) 

285.0 ± 143.4 182.9 ± 99.0 0.8 (0.3; 1

Detrusor pressure at maximum sensation (cm/H2O) 

34.6 ± 12.5 34.8 ± 13.6 0.0 (-0.5; 0

Amplitude of Detrusor overactivity (cm/H2O) 

39.1 ± 36.6 50.9 ± 29.8 -0.4 (-0.8; 

Yamanishi, 2000548N = 68 57% female 

Electrical stimulation 15 minutes twice daily for 4 weeks (vaginal electrode in women and an anal or surface electrode in men to provide alternating pulses of 10Hz square waves of 1msec pulse duration and a maximum output current of 60mA). 

Sham inactive device 

Bladder compliance at maximum sensation (ml/cm/H2O) 

27.8 ± 24.1 31.6 ± 35.7 -0.1 (-0.6; 
 (continued) 

F536 

Author 

Sample Active Control Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Differen

(95% C

Bladder capacity at first desire to void (ml) 

225.1 ± 123.7 220.4 ± 110.9 0.0 (-0.7; 0

Bladder compliance at maximum sensation (ml/cm/H2O) 

32.7 ± 25.6 24.3 ± 18.3 0.4 (-0.3; 

Amplitude of Detrusor overactive contraction (cm/H2O) 

51.5 ± 48.2 51.3 ± 36.9 0.0 (-0.7; 0

Maximum cystometric capacity (ml) 

290.5 ± 146.3 266.9 ± 151.0 0.2 (-0.5; 0

Yamanishi, 2000549N = 32 54% female 

Functional magnetic stimulation applied continuously at 10Hz 

Functional electrical stimulation applied continuously at 10 Hz with vaginal electrode in women and a surface electrode on the dorsal part of the penis in men Detrusor pressure at 

maximum capacity (cm/H2O) 

13.9 ± 15.4 15.4 ± 10.5 -0.1 (-0.8; 

Bold- significant differences in outcomes at 95% confidence level 
F537 

Table F110. Effects of devices on risk and progression of incontinence in females 

Study Participants Clinical Interventions Outcomes 

Nygaard, 1995576

Crossover RCT to examine the effects of Hodge pessary with support, a super tampon on urinary incontinence during exercise. Duration: three exercise sessions. 

20 female exercisers ages 33-73 with urinary incontinence during exercise and positive coughing test. Exclusion criteria: Prolapse of the uterus, stenotic vagina, or pelvic mass. Loss of followup:10% 

1. 40-minute standardized aerobics session wearing a Hodge pessary with support 2. 40-minute standardized aerobics sessions wearing a super tampon 3. 40-minute standardized aerobics sessions with no mechanical device 

Urine loss as chain the weight of thpad during exercising. Continence-pad weight gain <4g 

Thyssen, 2001577

Crossover RCT to examine the effects of disposable intravaginal device on stress incontinence in women. Duration: 5 weeks 

94 women with the predominant symptom of stress incontinence, 39 were recruited in Denmark, 28 in England, and 27 in Australia. Exclusion criteria: Major uterovaginal prolapse. Loss of followup: 34% 

1. Conveen Continence Guard, CCG made of hydrophilic polyurethane and requires soaking in water before being placed on a handle like applicator for insertion. 2. Contrelle Continence Tampon, CCT, coloplastis made of hydrophobic polyurethane and supplied ready-assembled within an applicator, allowing insertion directly into the vagina with no manual contact. 

24 hour pad test, uroflowmetry, postvoid residual urine volume and voiding diary 

Seo, 2004578

RCT to examine the effects of vaginal cone with conventional FESbiofeedback therapy for female urinary incontinence. Duration: 6 weeks. 

120 patients, who required a non-surgical treatment for urinary incontinence. Exclusion criteria: not reported. Loss of followup: not reported. 

1. Pelvic floor exercise (5 second contraction and 10 second relaxation, 3-5 times for >5 minutes/day) and functional electrical stimulation biofeedback (35Hz-50Hz for 24 seconds); 2 training sessions /week. 2. Vaginal cone, 150g dumbbellshaped made of fine ceramic material. 

Self reported urinincontinence. Urodynamic outcomes. 
Table F110. Effects of devices on risk and progression of incontinence in females (continued) 

F538 

Study Participants Clinical Interventions Outcomes 

Robinson, 2003579

RCT to examine the effects of new urethral device or the reliance insert on female urinary incontinence. Duration of followup: 4 months 

24 women 30-75 years old with mixed or stress urinary incontinence >2 episodes/week >2g urine loss on baseline pad weight test, with sound mental condition, willing to use >3 devices/week. Exclusion criteria: overflow incontinence or neurogenic bladder, type III incontinence, kidney inflammatory diseases, urinary tract infection, use of anticoagulants or incontinence medications, allergy to antibiotics, diabetes mellitus type II, pregnancy, urethral mucosal abnormalities, prosthetic heart valve, HRT last 3 months, collagen injections or other urethral bulking agents last 3 months, detrusor contraction >20cm/H20. Loss of followup: 33.3 % 

1. Urethral device (NEAT) –sterile urethral insert with disposable applicator packaged with device. 2. Reliance insert sterile balloon type device 

Success was defas a 50% or greareduction in urine loss using the formula 100 [(pad weight without device -pad weigwith device)/pad weight with devicPure stress incontinence-urinloss with no detrucontractions >15cm/H20 in anpoint before cystometric bladdcapacity achieveMixed urinary incontinence- urinloss with detrusocontractions at 1620cm/H20 in any point before cystometric bladdcapacity achieve
Table F110. Effects of devices on risk and progression of incontinence in females (continued) 

F539 

Study Participants Clinical Interventions Outcomes 

Bo,1999513RCT to examine the effects of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment on females’ genuine stress incontinence. Duration: 6 months 

107 women with clinically and urodynamically proved genuine stress incontinence >4g of leakage measured by pad test with standardized bladder volume. Exclusion criteria: Urinary incontinence other than genuine stress incontinence, involuntary detrusor contractions >10cm/H2O on cystometry, abnormal bladder function (residual urine >0ml and maximal uroflow <15 ml/s), previous surgery for genuine stress incontinence, neurological or psychiatric disease, ongoing urinary tract infections, other diseases that could interfere with participation, use of concomitant treatments during the trial, and inability to understand instructions given in Norwegian. Loss of followup: 12.3% 

1. Pelvic floor exercise with 8-12 contractions 3 times/day in groups with skilled physical therapists 1/week. 2. Electrical stimulation using vaginal intermittent stimulation with MS 106 Twin at 50Hz 30 minutes/day. 3. Vaginal cones of 20, 40, and 70g for 20 minutes/day. 4. Untreated control group offered use of a continence guard 

Muscle strength measured by vagsqueeze pressur1/month. Pad teswith standardized bladder volume. hour pad test. Sereported symptomof severity. Leakindex. Patients indicated on a 5 point scale (5 always, 4 often, 3 sometimes, 2 seldom, 1 never) frequency of urinleakage during sneezing, coughilaughing, walkingwalking downhill, running, jumpingand lifting. The mwas calculated aindex of leakage frequency before and after treatmeObjective cure as <2g leakage on tpad test with standardized bladvolume. Subjectivcure as (number women stating ththe condition was “unproblematic” atreatment). 
Table F110. Effects of devices on risk and progression of incontinence in females (continued) 

F540 

Study Participants Clinical Interventions Outcomes 

Nielsen, 1993580

Cross-sectional RCT to examine effects of urethral plug on female genuine urinary stress incontinence. Duration: 2 weeks 

40 women with genuine urinary stress incontinence. Exclusion criteria: not reported Loss of followup: 55% 

1. Urethral plug as oval metal plate, a soft stalk, and 1 sphere along the stalk with fixed distances between the metal plate and the spheres. Inside the stalk is a removable semi-rigid guide pin to ease insertion. 2. Urethral plug as oval metal plate, a soft stalk, and 2 spheres along the stalk with fixed distances between the metal plate and the spheres. Inside the stalk is a removable semi-rigid guide pin to ease insertion. 

Self reported urinincontinence. Paweighting test. 
F541 

Table F111. Effects of medical devices on female urinary incontinence (events rate) 

Author 

Sample Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%

After 

Contro

Treatm

Nygaard, 1995576N = 20 

40 minute standardized aerobics sessions wearing a Hodge pessary with support 

40 minute standardized aerobics sessions wearing a super tampon 

Continent during exercise 

7 12 36.0 58.0 

Cured from stress urinary incontinence 

Thyssen, 34 45 36.0 48.0 2001577N = 94 

Conveen continence disposable intravaginal device guard, CCG made of hydrophilic polyurethane requires soaking in water before being placed on a handle like applicator for insertion 

Contrelle Continence Tampon, CCT, coloplastic made of hydrophobic polyurethane and supplied readyassembled within an applicator, allowing insertion directly into the vagina with no manual contact 

Self reported Improvement in stress urinary incontinence 

38 34 40.0 36.0 

Seo, 2004578N = 120 

Pelvic floor exercise (5 second contraction and 10 second relaxation, 3-5 times for >5 minutes/day) and functional electrical stimulation biofeedback (35Hz50Hz for 24 seconds); 2 training sessions/week 

Vaginal cone ,150g dumbbell-shaped made of fine ceramic material 

Self reported improvement in urinary incontinence 

55 53 91.7 88.3 

Success as a 50% or greater reduction in urine loss 

Robinson, 9 6 67.0 58.0 2003579N = 24 

Urethral device (NEAT) sterile urethral insert with disposable applicator packaged with device 

Reliance insert sterile balloon type device 

Success as negative pad weight test 

9 7 73.0 62.0 
Table F111. Effects of medical devices on female urinary incontinence (events rate) (continued) 

F542 

Author 

Sample Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%

After 

Contro

Treatm

Objective cure as <2g leakage on pad test with standardized bladder volume 

4 2 13.8 6.3 

Subjective cure as (number of women stating that condition was “unproblematic” after treatment) 

2 1 6.9 3.1 

Bo, 1999513

N = 122 

Vaginal cones of 20, 40, and 70g for 20 minutes/day 

Untreated control group offered use of a continence guard 

Urinary continence and almost continent 

5 1 17.2 3.1 
F543 

Table F112. Effects of medical devices on self reported severity of urinary incontinence, quality of life, and objective instrumen(continuous variables) 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Self reported severity of urinary incontinenceBo, 1999513

N = 122 

Vaginal cones of 20, 40, and 70g for 20 minutes/day. 

Untreated control group offered use of a continence guard 

Change from baseline in episodes of leakage in 3 days 

0.8 ± 5.3 0.3 ± 2.3 0.1 (-0.4; 0.6) 

Changes in episodes of urine leakage 

Seo, 2004 -1.1 ± 0.2 -0.6 ± 0.2 -2.3 (-2.8; -1.9) 

578

N = 120 

Pelvic floor exercise (5 second contraction and 10 second relaxation, 3-5 times for >5 minutes/day) and functional electrical stimulation biofeedback (35Hz-50Hz for 24 seconds); 2 training sessions/ week 

Vaginal cone,150g dumbbellshaped made of fine ceramic material 

Changes in amount of urine leakage 

-0.6 ± 0.2 -0.6 ± 0.2 0.0 (-0.4; 0.4) 

Self reported quality of life

Changes in scores: restriction in exercise due to incontinence 

Seo, 2004 -0.6 ± 0.2 -0.4 ± 0.2 -1.3 (-1.7; -0.9) 

578

N = 120 

Pelvic floor exercise (5 second contraction and 10 second relaxation, 3-5 times for >5 minutes/day) and functional electrical stimulation biofeedback (35Hz-50Hz for 24 seconds); 2 training sessions/week 

Vaginal cone,150g dumbbellshaped made of fine ceramic material 

Changes in scores: avoiding places due to urinary incontinence 

-0.3 ± 0.1 -0.1 ± 0.2 -1.1 (-1.5; -0.7) 

Change from baseline in leakage index 

-0.3 ± 0.5 0.1 ± 0.6 -0.7 (-1.2; -0.2) 

Bo, 1999513

N = 122 

Vaginal cones of 20, 40, and 70g for 20 minutes/day. 

Untreated control group offered use of a continence guard 

Change from baseline in social activity index 

0.1 ± 1.1 -0.2 ± 1.7 0.2 (-0.3; 0.7) 
Table F112. Effects of medical devices on self reported severity of urinary incontinence, quality of life, and objective instrumen

(continuous variables) (continued) 

F544 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Effects of medical devices on objective measured severity of urinary incontinence

40 minute standardized aerobics sessions wearing a Hodge pessary with support 

Nygaard, 36.4 ± 67.1 45.3 ± 45.7 -0.2 (-0.8; 0.5) 1995576N = 20 

40 minute standardized aerobics sessions wearing a super tampon 

40 minute standardized aerobics sessions with no mechanical device 

Mean urine loss as change in weight of the pad during exercising. 

31.0 ± 46.2 45.3 ± 45.7 -0.3 (-0.9; 0.3) 

Conveen continence disposable intravaginal device guard, CCG made of hydrophilic polyurethane requires soaking in water before being placed on a handle like applicator for insertion 

24 hour pad test (g) 

Thyssen 20.2 ± 12.8 43.1 ± 11.0 -1.9 (-2.3; -1.6) 

577

Contrelle continence disposable intravaginal device tampon, CCT, coloplastic made of hydrophobic polyurethane and supplied readyassembled within an applicator, allowing insertion directly into the vagina with no manual contact 

No device 

24 hour pad test (g) 

10.8 ± 5.4 43.1 ± 11.0 -3.7 (-4.2; -3.3) 

Seo, 2004578

N = 120 

Pelvic floor exercise (5 second contraction and 10 second relaxation, 3-5 times for >5 minutes/day) and functional electrical stimulation biofeedback (35Hz-50Hz for 24 seconds); 2 training sessions/week 

Vaginal cone, 150g dumbbellshaped made of fine ceramic material 

Pad test 3.4 ± 5.4 3.7 ± 6.7 -0.1 (-0.4; 0.3) 
Table F112. Effects of medical devices on self reported severity of urinary incontinence, quality of life, and objective instrumen

(continuous variables) (continued) 

F545 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Nielsen, 1993580N = 40 

Urethral plug as oval metal plate, a soft stalk, and 1 sphere along the stalk with fixed distances between the metal plate and the spheres. Inside the stalk is a removable semi-rigid guide pin to ease insertion 

Urethral plug as oval metal plate, a soft stalk and 2- spheres along the stalk with fixed distances between the metal plate and the spheres. Inside the stalk is a removable semi-rigid guide pin to ease insertion. 

Urine leakage during pad weighting test. 

6.0 ± 76.7 3.0 ± 80.0 0.0 (-0.4; 0.5) 

Change from baseline in stress pad test (g) 

Bo, 1999 -14.7 ± 34.2 -12.7 ± 41.8 -0.1 (-0.6; 0.5) 

513

N = 122 

Vaginal cones of 20, 40, and 70g for 20 minutes/day 

Untreated control group offered the use of a continence guard Change from 

baseline in 24 hour pad test (g) 

-22.0 ± 89.3 -7.1 ± 37.8 -0.2 (-0.7; 0.3) 

Effects of medical devices on urodynamic outcomes

Peak flow, ml/s 

25.8 ± 22.8 25.9 ± 28.7 0.0 (-0.3; 0.3) 

Voided volume, ml 

216.0 ± 256.0 251.0 ± 263.3 -0.1 (-0.4; 0.2) 

Corrected peak flow, ml/s 

1.9 ± 2.8 1.8 ± 1.4 0.0 (-0.2; 0.3) 

Conveen continence disposable intravaginal device guard, CCG made of hydrophilic polyurethane requires soaking in water before being placed on a handle like applicator for insertion 

No device 

Residual urine, ml 

17.1 ± 74.6 18.3 ± 81.1 0.0 (-0.3; 0.3) 

Peak flow, ml/s 

24.3 ± 24.5 25.9 ± 28.7 -0.1 (-0.3; 0.2) 

Voided volume, ml 

215.0 ± 243.3 251.0 ± 263.3 -0.1 (-0.4; 0.1) 

Thyssen, 2001577N = 94 

Contrelle continence disposable Intravaginal device tampon, CCT, coloplastic made of hydrophobic polyurethane and supplied readyNo device Corrected peak flow, ml/s 2.1 ± 2.3 1.8 ± 1.4 0.2 (-0.1; 0.4) 
Table F112. Effects of medical devices on self reported severity of urinary incontinence, quality of life, and objective instrumen

(continuous variables) (continued) 

F546 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

assembled within an applicator, allowing insertion directly into the vagina with no manual contact 

Residual urine, ml 

13.2 ± 55.9 18.3 ± 81.1 -0.1 (-0.4; 0.2) 

Maximum urethral closing pressure, mm/H20 

77.9 ± 31.0 78.4 ± 18.3 0.0 (-0.4; 0.3) 

Maximum vaginal pressure, mmHg 

33.6 ± 16.7 27.2 ± 13.2 0.4 (0.1; 0.8) 

Seo, 2004578

N = 120 

Pelvic floor exercise (5 second contraction and 10 second relaxation, 3-5 times for >5 minutes/day) and functional electrical stimulation biofeedback (35Hz-50Hz for 24 seconds); 2 training sessions/week 

Vaginal cone,150g dumbbellshaped made of fine ceramic material 

Duration of PEM contractions, seconds 

10.2 ± 5.7 9.3 ± 5.4 0.2 (-0.2; 0.5) 

Bo, 1999513

N = 122 

Vaginal cones of 20, 40, and 70g for 20 minutes/day. 

Untreated control group offered use of a continence guard 

Change in strength of pelvic floor muscle 

15.4 ± 12.4 16.0 ± 4.2 -0.1 (-0.6; 0.4) 

Bold- significant differences in outcomes at 95% confidence level 
F547 

Table F113. Effects of medical devices on urinary incontinence in community-dwelling males 

Study Participants Clinical Interventions Outcomes 

Chancellor, 1999581RCT to examine effects of sphincteric stent or external sphincterotomy on urinary incontinence in spinal cord injured men. Duration of followup: 24 months 

57 men with spinal cord injury and electromyographic and manometric evidence of external detrusor-sphincter dyssynergia during involuntary detrusor contractions. Exclusion criteria: Concomitant documented bladder neck or prostatic obstruction Loss of followup: 42.5% 

1. UroLume sphincteric stent (2, 2.5,or 3cm) prosthesis inserted using a 22F cystoscopic insertion tool with distal end of the prosthesis extended at least 5mm into the bulbous urethra and well beyond the distal aspect of the external sphincter. 2. Conventional external sphincterotomy. 

Urodynamic outcomes. Self reported changes urinary incontinen

Moore, 2004582

Cross-over RCT to examine effects of penile compression devices on male urinary incontinence. Acute test. 

12 men, 6 months after radical prostatectomy with stress urinary incontinence requiring continuous incontinence pad protection, normal perineal and penile sensation, intact penile skin, and the ability to read and speak English. Exclusion criteria: Neurologic or cognitive impairment (Mini-Mental State Examination score <27), neurologic disorders that could affect sensation or peripheral circulation, sufficient manual dexterity to manage the penile compression device, previous radiotherapy, symptoms of overactive bladder. 

Penile Compression Devices: 1. C3 penile compression device with 2 styrofoam arms with a raised bottom arm applies pressure on the urethra. 2. Cunningham clamp 3. U-tex male adjustable tension nylon band with a urethral occlusion pad and nylon strap adjustable for comfort and continence. 

4 hour pad test weight gain of 2g more in one pad considered urinaincontinence 
F548 

Table F114. Clinical improvement in urinary incontinence in 57 males after inserted sphincter stent 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Rela

Risk 

C

Chancellor, 1999581N = 57 

UroLume sphincteric stent (2, 2.5, or 3cm) prosthesis inserted using a 22F cystoscopic insertion tool with distal end of prosthesis extended at least 5mm. into the bulbous urethra and well beyond the distal aspect of the external sphincter 

Conventional external sphincterotomy 

Significant improvement in bladder emptying ability 

12 6 38.7 23.1 1.7 (0.
F549 

Table F115. Effects of devices on urinary incontinence in males (severity measures) 

Author 

Sample Outcome Active Treatment Control Treatment Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Mean maximum. detrusor. Cm/H20 

71.6 ± 43.8 41.6 ± 16.3 0.9 (0.3; 1.4) 

Mean residual urine, ml 

132.0 ± 159.0 112.0 ± 106.0 0.1 (-0.4; 0.7) 

Chancellor, 1999581N = 57 

Mean cystometric capacity, ml 

UroLume sphincteric stent (2, 2.5, or 3cm) prosthesis inserted using a 22F cystoscopic insertion tool with distal end of prosthesis extended at least 5mm. into the bulbous urethra and well beyond the distal aspect of the external sphincter 

Conventional external sphincterotomy 

262.0 ± 134.0 220.0 ± 135.0 0.3 (-0.2; 0.8) 

U-tex male adjustable tension 

4 hour pad test: 53.3 ± 65.7 17.1 ± 21.3 0.7 (-0.1; 1.6) mean urine loss 

C3 penile compression device with 2 styrofoam arms with a raised bottom arm applies pressure on the urethra 

Cunningham clamp 

32.3 ± 24.3 17.1 ± 21.3 0.7 (-0.2; 1.5) 

Mean right resistance index 

0.9 ± 0.1 0.9 ± 0.1 0.2 (-0.6; 1.0) 

Mean left resistance index 

Cunningham clamp No device 

0.9 ± 0.3 0.9 ± 0.1 0.0 (-0.8; 0.8) 

Mean right resistance index 

0.9 ± 0.1 0.9 ± 0.1 0.2 (-0.6; 1.0) 

Mean left resistance index 

C3 penile compression device with 2 styrofoam arms with a raised bottom arm applies pressure on the urethra 

No device 

0.9 ± 0.1 0.9 ± 0.1 0.5 (-0.3; 1.3) 

Mean right resistance index 

0.9 ± 0.1 0.9 ± 0.1 0.3 (-0.5; 1.1) 

Moore, 2004582

N = 12 

Mean left resistance index 

U-tex male adjustable tension 

No device 

0.9 ± 0.1 0.9 ± 0.1 0.4 (-0.4; 1.2) 
F550 

Table F116. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontine

Study Participants Clinical Interventions Outcomes 

Corcos, 2005583

Noninferiority RCT to examine effects of collagen injection or surgery on female stress urinary incontinence. Duration of followup: 12 months 

133 women older than 30 years with stress urinary incontinence lasted for >6 months. Exclusion criteria: Contraindications to surgery or collagen injections (allergic reaction), associated conditions (e.g., 

severe medical disease or indication for hysterectomy) or pelvic prolapse (vault, cystocele, rectocele), neurogenic bladder or interstitial cystitis or a history of pelvic radiation or previous treatment by collagen injection. Loss of followup: 3.7% 

1. Intraurethral collagen submucosal injection 4 injections at 1-month intervals 2. Surgery (needle bladder neck suspensions, Burch, and slings). The choice of technique was left to the surgeon. 

Success as dry 2hour pad test (<2.5g). Symptomof incontinence, general QOL, disease-specific QOL 

Bano, 2005584

RCT to examine effects of porcine dermal implant (Permacol) and silicone injection (Macroplastique) on urodynamic stress incontinence in females. Duration of followup: 6 months 

50 women with urodynamically proven stress incontinence. Exclusion criteria: not reported. Loss of followup: 2% 

1. Peri or transurethral porcine dermal implant injection (Permacol) 2. Transurethral silicone injection (Macroplastique) 

International Continence Socie(ICS) standard 1 hour pad test. Sereported incontinence usinStamey scoring system and KingCollege Hospital Quality of Health Questionnaire (K

Schulz, 2004585

RCT to examine effects of periurethral and transurethral injections of bulking agents on stress urinary incontinence in females. Duration of followup: 12 months 

40 women ages 18-80 years old, with genuine stress incontinence for >12 months, or mixed incontinence with a minor and controlled urge component, who failed 3 months conservative treatments. Exclusion criteria: Other treatments for incontinence, urinary tract infection, bladder capacity <250ml or postvoid residual volume >100ml, neurogenic bladder, grade 3 cystoele, uterine prolapse or rectocele, radiation of urethra, pregnancy, life expectancy <15 months. Loss of followup: 15% 

1. Periurethral route of injection of bulking agent-dextran copolymer 2. Transurethral route of injection of bulking agent-dextran copolymer 

Urinary continencas 100% improvement in sreported symptomno leakage episoand negative pad test 
Table F116. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontine

(continued) 

F551 

Study Participants Clinical Interventions Outcomes 

Lightner, 2001586

RCT to examine effects of bulking agents on stress urinary incontinence due to intrinsic sphincter deficiency in women. Duration of followup: 12 months 

355 women diagnosed with stress urinary incontinence due to intrinsic sphincter deficiency, abdominal leak point pressure of less than 90cm/H2O, who failed prior surgical and medical treatment. Exclusion criteria: Prior injections of any urethral bulking agents, positive intradermal test injections of bovine collagen and beta-glucan Loss of followup: 38% 

1. Injection of bulking agent 1.0ml durasphere maximum 5 times with a minimum 7 day interval. 2. Injection of bulking agent bovine collagen maximum 5 times with a minimum 7 day interval. 

Self reported urinincontinence with grade 0 (dry) to grade 3 (continuourinary leakage 

Appell, 2006587

Placebo controlled RCT to examine effects of transurethral radiofrequency energy collagen micro-remodeling on female stress urinary incontinence. Duration of followup: 12 months 

173 women with stress urinary incontinence, bladder outlet hypermobility, and leak point pressure >60cm/H2O. Exclusion criteria: Evidence of detrusor overactivity on cystometrogram, post-void residual bladder volumes >50cc, significant pelvic organ prolapse (POP-QStage IV) on physical examination, history of dry or wet overactive 

bladder, previous surgical or bulking agent therapy, abnormal urinalyses, positive urine cultures, and positive pregnancy test. Loss of followup: 18% 

1. Transurethral radiofrequency energy collagen microremodeling 2. Sham treatment probes lacked needle electrodes and sham treatment of radiofrequency generator 

Self reported improvement in urinary incontinenas 25% reduction both incontinence episode frequencand stress pad weight. Impact on subject quality of as incidence of >point improvemeon the IncontinenQuality of Life (IQOL) score. A baseline I-QOL score of 0-30 poi“severe SUI,” 31- points - ‘‘moderaSUI,” and 61-90 points – “mild SUI.” 
Table F116. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontine

(continued) 

F552 

Study Participants Clinical Interventions Outcomes 

Lee, 2001588Placebo controlled RCT to examine effects of periurethral autologous fat injection on female stress urinary incontinence. Duration of followup: 24 months 

68 women with stress urinary incontinence determined by history, urinary leakage via the urethra with cough provocation. Exclusion criteria: Detrusor instability on multichannel urodynamic, co-interventions, including hormone replacement, weight reduction, or Kegel exercises, other diagnoses causing incontinence, including bladder instability. Loss of followup:19% 

1. Periurethral injections of autologous fat (30cc of fat from the anterior abdominal wall or buttock through a single 2-3mm) with 3 maximum injections depending on outcomes measures. 2. Placebo (saline). 

Cure from urinary incontinence as nleakage on the 1 hour pad test, no leakage seen frothe urethra with coughing and a continence questionnaire scoof 0. Improvemenwas defined as a decrease in the continence questionnaire scoof 5 points or greater. 

Strasser, 2007589RCT to examine the effects of ultrasonographyguided injections of autologous cells or endoscopic injections of collagen on stress urinary incontinence. Duration of follow up: 12 months 

63 females 36-84 years old with intrinsic sphincter insufficiency or stress urinary incontinence with only mild hypermobility of the urethra and the urinary bladder; good state of health who failed pelvic floor muscle exercises. Exclusion criteria: urge incontinence and pronounced hypermobility of the urethra.  Loss of follow up -none 

1. Transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts; regular training of the rhabdosphincter for 12 weeks and trans vaginal electrical stimulation for 4 weeks. 2. Conventional endoscopic injections of collagen; regular training of the rhabdosphincter for 12 weeks and trans vaginal electrical stimulation for 4 weeks

24-hour voiding dwith incontinence score (range 0–6representing continence; 6 representing complete incontinence. 24-hour pad test. Quality of life questionnaire witpossible scores f22 (severely restricted quality life) to 110 (no restrictions on quof life).
F553 

Table F117. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontine

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Ne

(

Success as dry 24 hour pad test (<2.5g) 

Corcos, 34 37 51.5 55.2 0.9 (0.7; 1.3) 2005583N = 133 

Intraurethral collagen sub mucosal injection 

Surgery (needle bladder neck suspension, Burch, and slings) 

Complete retention 

1 9 1.5 13.4 0.1 (0.0; 0.9) 8

Urinary continence (negative pad test) 

15 9 60.0 36.0 1.7 (0.9; 3.1) 

Improvement in urinary incontinence (pad test) 

15 10 60.0 40.0 1.5 (0.8; 2.7) 

Improved urinary incontinence scores (Stamey) 

14 10 56.0 40.0 1.4 (0.8; 2.5) 

Bano, 2005584N = 50 

Peri or transurethral porcine dermal implant injection (Permacol) 

Transurethral silicone injection (Macroplastique 

Improved urinary incontinence scores (Kings College Hospital Quality of Health Questionnaire) 

14 7 56.0 28.0 2.0 (1.0; 4.1) 

Objective urinary continence (dry in pad test) 

Schulz, 1 3 5.0 15.0 0.3 (0.0; 2.9) 2004585N = 40 

Periurethral route of injection of bulking agentdextran copolymer 

Transurethral route of injection of bulking agentdextran copolymer 

Subjective improvement in urinary incontinence 

6 7 30.0 35.0 0.9 (0.3; 2.1) 
Table F117. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontine

(continued) 

F554 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Ne

(

Improvement of 1 or more continence grades 

Lightner, 76 79 43.2 42.0 1.0 (0.8; 1.3) 2001586N = 355 

Injection of bulking agent 1.0ml Durasphere maximum 5 times with a minimum 7-day interval 

Injection of bulking agent bovine collagen maximum 5 times with a minimum 7-day interval 

Incidence of urgency 

43 22 24.7 11.9 2.1 (1.3; 3.3) 7

Appell, 2006587N = 173 

Transurethral radiofrequency energy collagen microremodeling 

Sham treatment 

Improvement >10 point I-QOL score 

53 28 48.0 44.0 1.1 (0.8; 1.5) 

Lee, 2001588N = 68 

Periurethral injections of autologous fat (30cc of fat from the anterior abdominal wall or buttock through a single 2-3mm) with 3 maximum injections depending on outcome measures. 

Placebo (saline) 

Cured or improved 

6 6 17.1 18.2 0.9 (0.3; 2.6) 

Continence 38 2 90.48 9.50 9.50 

(2.53; 35.63) 

Strasser, 2007589N = 63 Followup: 12 months 100% 

Transurethral ultrasonography-guided injections of autologous myoblasts and 

Conventional endoscopic injections of collagen; regular 

Substantial improvement in urinary incontinence 

3 1 7.14 4.76 1.50 

(0.17; 13.56) 
Table F117. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on urinary incontine

(continued) 

F555 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

Ne

(

Slight improvement in urinary incontinence 

1 6 2.38 28.57 0.08 

(0.01; 0.65) 

4 

female fibroblasts; 

regular training of the rhabdosphincter for 12 weeks and trans vaginal electrical stimulation for 4 weeks 

training of the rhabdosphincter for 12 weeks and trans vaginal electrical stimulation for 4 weeks 

Number of incontinent patients 

4 19 9.52 90.48 0.11 

(0.04; 0.27) 

Bold- significant differences in outcomes at 95% confidence level 
F556 

Table 118. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on severity of urinary 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Urodynamic outcomesAppell, 2006587N = 173 

Transurethral radiofrequency energy collagen micro-remodeling 

Sham treatment Change in leak 

point pressure 

13.2 ± 39.2 -2.0 ± 33.8 0.4 (0.1; 0.7) 

Mean maximum. urethral closure pressure 

Lee, 2001 37.0 ± 18.1 35.6 ± 24.2 0.1 (-0.4; 0.5) 

588

N = 68 

Periurethral injections of autologous fat (30cc of fat from the anterior abdominal wall or buttock through a single 2-3mm) with 3 maximum injections depending on outcomes measures. 

Placebo (saline). 

Mean leak point pressure (cm/H2O) 

101.4 ±27.9 76.5 ± 27.9 0.9 (0.4; 1.4) 

Pad weight testLightner, 2001586N = 355 

Injection of bulking agent 1.0ml durasphere maximum 5 times with a minimum 7 day interval 

Injection of bulking agent bovine collagen maximum 5 times with a minimum 7 day interval 

Urine loss as measured by mean change in pad weight test 

27.9 ± 43.6 26.4 ± 63.7 0.0 (-0.2; 0.2) 

Lee, 2001588N = 68 

Periurethral injections of autologous fat (30cc of fat from the anterior abdominal wall or buttock through a single 2-3mm) with 3 maximum injections depending on outcomes measures. 

Placebo (saline) Mean pad weight 

(gm) 

14.8 ± 20.1 18.5 ± 27.6 -0.2 (-0.6; 0.3) 
Table 118. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on severity of urinary 

(continued) 

F557 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Quality of life

Physical functioning 

75.7 ± 59.3 73.8 ± 75.3 0.0 (-0.3; 0.4) 

Role physical 68.1 ± 85.9 71.2 ± 119.5 0.0 (-0.4; 0.3) 

Corcos, 2005583N = 133 

Intraurethral collagen sub mucosal injection 

Surgery (needle bladder neck suspensions, Burch, and slings) 

Social functioning 79.4 ± 60.6 80.1 ± 56.5 0.0 (-0.4; 0.3) 

Lee, 2001588N = 68 

Periurethral injections of autologous fat (30cc of fat from the anterior abdominal wall or buttock through a single 2-3mm) with 3 maximum injections depending on outcomes measures 

Placebo (saline) Mean 

incontinence score 

10.9 ± 4.5 12.2 ± 4.6 -0.3 (-0.8; 0.2) 

Quality-of-life score

108.00±0.67 64.00±17.33 4.43 (3.48; 5.37) 

Maximum residual urine (ml) 

13.83±43.65 8.81±24.49 0.13 (-0.39; 0.65) 

Maximum urinary flow (ml/s) 

25.29±8.17 19.63±10.22 0.64 (0.10; 1.17) 

Maximum detrusor pressure during flow (cm/H2O) 

31.26±16.78 34.76±12.21 -0.23 (-0.75; 0.30) 

Maximum bladder capacity (ml) 

469.86±158.9

5 

404.05±104.9

4 

0.46 (-0.07; 0.99) 

Strasser, 2007589N = 63 

Transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts; regular training of the rhabdosphincter for 12 weeks and trans vaginal electrical stimulation for 4 weeks

Conventional endoscopic injections of collagen; regular training of the rhabdosphincter for 12 weeks and trans vaginal electrical stimulation for 4 weeks

Maximum closure pressure at rest (cm H2O) 

40.52±15.81 35.24±10.94 0.37 (-0.16; 0.89) 
Table 118. Effects of bulking agents and transurethral radiofrequency energy collagen micro-remodeling on severity of urinary 

(continued) 

F558 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Maximum closure pressure during voluntary contraction of rhabdosphincter (cm H2O) 

53.26±23.06 40.57±12.72 0.63 (0.09; 1.16) 1

Periurethral EMG recording at rest (μV) 

44.23±15.01 31.57±10.86 0.92 (0.37; 1.47) 

Periurethral EMG recording during voluntary contraction of rhabdosphincter (μV) 

56.47±15.36 41.62±9.98 1.07 (0.52; 1.63) 

Bold- significant differences in outcomes at 95% confidence level 
F559 

Table F119. Effects of obstetric interventions on incidence and progression of urinary incontinence in females 

Study Participants Clinical Interventions Outcomes 

Dannecke, 2005590

Followup RCT to examine the effects of restrictive use of mediolateral episiotomy vs. routine episiotomy. Duration: 18 months 

146 primiparous women with an uncomplicated singleton pregnancy >34 weeks of gestation intending a vaginal delivery. Exclusion criteria: Previous surgery at the pelvic floor and neurological disorder. Loss of followup: 45% in restrictive policy group, 32% in liberal policy group. 

1. Restrictive episiotomy - avoidance of episiotomy (for fetal indications only) 2. Liberal – in addition to fetal indications use episiotomy when a tear is judged to be imminent 

Self reported presence of urinaand fecal incontinwith standardized questionnaire. Anorectal manomand urodynamic outcomes. Pelvic muscle strength wvaginal palpationEffort to contract elevator; graded the Oxford Score strongest). 

Sartore, 2004591

Non randomized CT to examine the effect of mediolateral episiotomy on puerperal pelvic floor strength and dysfunction. Duration: 3 months after vaginal delivery 

519 consecutive primiparous women with singleton pregnancies and spontaneous vaginal delivery with fetal head in occiput anterior position, residents of Trieste. Exclusion criteria: Not delivered in lithotomy position, cesarean delivery, third and fourth-degree perineal lacerations, preterm, breech, and operative delivery, anal and urinary incontinence that pre-existed vaginal delivery, and history of vaginal or anal surgery. 

1. Mediolateral episiotomy 2. No episiotomy 

Stress urinary incontinence - observation of involuntary loss ourine synchronouwith coughing (+stest) with comfortfull bladder. Self reported urge incontinence - losurine associated strong desire to vSelf reported anaincontinence - losflatus, liquid, or sstool. Pelvic floor muscle strength scored 0-5. Vaginmanometry abnoperineometric va<12cm H20. Urinstream interruptiotest abnormal anurine stream interruption test scores >5second
Table F119. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (continued) 

F560 

Study Participants Clinical Interventions Outcomes 

Hannah, 2002592

Term Breech Trial, RCT to examine the effects of planned cesarean section on incontinence 3 months postpartum. Duration: 3 months 

1,159 women with singleton live fetus in a frank or complete breech presentation at term (37 weeks’ gestation). Exclusion criteria: Fetopelvic disproportion, fetus weight >4000g, hyperextension of the fetal head, lethal anomaly or a condition that might cause a mechanical problem at delivery, and contraindication to labor or vaginal delivery. Loss of followup: 16.5% 

1. Planned vaginal birth group, management was expectant until 

spontaneous labor began, unless an indication to induce labor 

(e.g., post term pregnancy) 2. Planned cesarean delivery 

(egg, footling breech presentation) scheduled for 38 or more weeks' gestation. If the woman was in labor at the time of randomization, the caesarean section was undertaken as soon as possible. Immediately before caesarean section, the fetal presentation was reassessed and if cephalic, a vaginal birth was planned. 

Self reported streurinary incontinenand fecal or flatuincontinence with

the previous 7 daPerception of incontinence: no problem at all, a problem, or a big problem. 

Hannah, 2004593

Followup to Term Breech Trial, RCT to examine the effects of planned cesarean section on incontinence 2 years postpartum. Duration: 2 years 

917 of 1,159 women with singleton live fetus in a frank or complete breech presentation at term (37 weeks’ gestation). Exclusion criteria: Fetopelvic disproportion, fetus weight >4000g, hyperextension of the fetal head, lethal anomaly or a condition that might cause a mechanical problem at delivery, and contraindication to labor or vaginal delivery. Loss of followup: 20.9% in planned Cesarean groups and 19.6% in vaginal birth group. 

1. Planned vaginal birth group, management was expectant until 

spontaneous labor began, unless an indication to induce labor (e.g., 

post term pregnancy) 2. Planned cesarean delivery 

(egg, footling breech presentation) scheduled for 38 or more weeks' gestation. If the woman was in labor at the time of randomization, the caesarean section was undertaken as soon as possible. Immediately before caesarean section, the fetal presentation was reassessed and if cephalic, a vaginal birth was planned. 

Self-reported streurinary incontinenand fecal or flatuincontinence with

the previous 3 to months. Perceptiof incontinence: nproblem at all, a problem, or a big problem. 
Table F119. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (continued) 

F561 

Study Participants Clinical Interventions Outcomes 

Klein, 2005594Multi center RCT to examine the urinary and sexual consequences of vaginal delivery compared with Caesarean section. Duration: 3 months postpartum 

1,044 women participated in RCT. Exclusion criteria: not reported. Loss of followup: 4.3%, from 135 women delivered by Caesarean section, only 25 were randomized to this group. Cross treatment occurred due to the decision made by attending physician. 

1. Caesarean section 2. Vaginal delivery 

Self reported non specified and streurinary incontinen3 months postpartum. Seveincontinencewearing a pad. 

Sleep, 1987595

Followup RCT to examine policies of restricted versus liberal episiotomy during spontaneous vaginal delivery on urinary incontinence. Duration: 3 years postpartum. 

1,000 women with live singleton fetus of at least 37 completed weeks' gestational age presenting cephalically and spontaneous normal vaginal delivery. Exclusion criteria: 15 participants from the original trial (8- not fluent in English; 2 refused to complete 3 month questionnaire; 3 had given the baby up for adoption; 1 baby had been taken into care; and 1 baby had died in the neonatal period). Loss of followup: 33% of contacted participants did not respond to the survey 3 years postpartum. 

Two management policies aimed to minimize perineal trauma during spontaneous vaginal delivery: 1. “Try to avoid episiotomy" : restrict episiotomy to fetal indications (fetal bradycardia, tachycardia, or meconium stained liquor) 2. "Try to prevent a tear" - use episiotomy more liberally to prevent tears. 

Self reported presence of totalstress, and urge urinary incontinenFrequency of incontinency episodes. 

Johanson, 1999596

Followup RCT to examine effects of delivery by forceps or vacuum extractor on maternal and child outcomes. Duration: 5 years postpartum. 

607 women requiring assisted vaginal delivery. Exclusion criteria: 47% of participants from the original RCT were not contacted for unclear reasons. Loss of followup: 26.2% non responders to the survey 5 years postpartum. 

1. Delivery with vacuum extractor 2. Forceps delivery. 

Self reported fecaand urinary incontinence 5 yepostpartum 
Table F119. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (continued) 

F562 

Study Participants Clinical Interventions Outcomes 

Garcia, 2005597RCT to examine effects of surgical techniques for the primary repair of obstetric anal sphincter lacerations. Duration: 4 months postpartum 

51 women with complete third- or fourth-degree anal sphincter laceration who underwent primary repair at the time of vaginal delivery. Exclusion criteria: not reported Loss of followup: 35.6% 

1. End-to-end technique to repair obstetric anal sphincter lacerations: 4 separate sutures of polyglycolic acid to reapproximate the sphincter ends directly.  2. Overlapping repair of obstetric anal sphincter lacerations used 3 sutures of 2-0 PDS to reapproximate the sphincter ends in an overlapping fashion. 

Self reported urinand anal incontingraded with the FIncontinence Sco(FIS) from 18 - toincontinence >2/week, scores incontinence of flonly. Anal incontinence was defined as a fecaincontinence sco>0. 
F563 

Table F120. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Nu

Nee

T

(95

Improvement in urinary incontinence

Hannah, 2004593N = 2,088 

Planned cesarean delivery 

Planned vaginal birth 

Stress urinary incontinence no problem at all 2 years postpartum 

31 37 38.3 37.0 0.8 (0.5; 1.3) 

Sleep, 1987595N = 1,000 

Restrictive policy for episiotomy 

Liberal policy for episiotomy 

Self reported urinary incontinence 3 months postpartum, no pads 

38 45 7.6 9.0 0.9 (0.6; 1.3) 

Risk of urinary incontinenceDannecke, 2005590N = 146 

Restrictive episiotomy 

liberal episiotomy 

Self reported urinary incontinence 18 months postpartum 

13 11 48.0 27.0 1.3 (0.6; 2.7) 

% with stress urinary incontinence (+ stress test) 

Sartore, 33 32 12.9 12.1 1.1 (0.7; 1.7) 2004591

N = 519 

Mediolateral episiotomy 

No episiotomy 

% with self reported urge urinary incontinence 

5 2 1.9 0.7 2.6 (0.5; 13.3) 

Self reported stress urinary incontinence 2 years postpartum

Hannah, 81 100 17.8 21.8 0.8 (0.6; 1.1) 2004593N = 2,088 

Planned cesarean delivery 

Planned vaginal birth 

Self reported stress urinary incontinence 3 months postpartum 

36 58 4.5 7.3 0.6 (0.4; 0.9) 36 (
Table F120. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (events) (contin

F564 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Nu

Nee

T

(95

Stress urinary incontinence 3 months postpartum is not a problem at all 

4 17 16.7 37.0 0.2 (0.1; 0.7) 5 

Self reported total incontinence of urine <1/week 

69 82 13.9 16.3 0.8 (0.6; 1.1) 

Self reported total incontinence of urine 1-2 times/week 

37 35 7.4 7.0 1.1 (0.7; 1.7) 

Self reported total incontinence of urine >3 times/week 

6 7 1.2 1.4 0.9 (0.3; 2.6) 

Self reported stress urinary incontinence 

103 105 20.7 20.9 1.0 (0.8; 1.3) 

Sleep, 1987595

N = 1,000 

Restrictive policy for episiotomy 

Liberal policy for episiotomy 

Self reported urge urinary incontinence 

41 41 8.2 8.2 1.0 (0.7; 1.5) 

Self reported stress urinary incontinence sometimes 

Johanson, 46 41 15.5 13.2 1.2 (0.8; 1.7) 1999596N = 607 

Delivery with vacuum extractor 

Forceps delivery 

Self reported urge urinary incontinence sometimes 

30 32 10.1 10.3 1.0 (0.6; 1.6) 

Garcia, 2005597N = 41 

End-to-end repair technique 

Overlapping repair technique 

Self reported urinary incontinence 4 months postpartum 

1 4 4.3 22.2 0.2 (0.0; 1.6) 
Table F120. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (events) (contin

F565 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Nu

Nee

T

(95

Hannah, 2002592N = 2,088 

Planned cesarean delivery 

Planned vaginal birth 

Stress urinary incontinence 3 months postpartum is big problem 

5 6 20.8 13.0 0.8 (0.3; 2.7) 

Self reported urinary incontinence in primiparous 

0.3 (0.1; 0.7) 

Self reported urinary incontinence in multiparous 

 0.9 (0.3; 2.8) 

Self reported urinary incontinence in primiparous without history of UI 

 0.2 (0.1; 1.0) 

Self reported urinary incontinence in primiparous with history of UI 

0.3 (0.1; 0.9) 

Self reported urinary incontinence in multiparous without history of UI 

 0.7 (0.2; 14.8) 

Self reported urinary incontinence in multiparous with history of UI 

 0.8 (0.2; 2.8) 

Klein, 2005594

N = 1,044 

Caesarean section 

Vaginal delivery 

Self reported stress urinary incontinence in primiparous 

0.3 (0.2; 0.5) 
Table F120. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (events) (contin

F566 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Nu

Nee

T

(95

Self reported stress urinary incontinence in multiparous 

 0.6 (0.3; 1.5) 

Self reported stress urinary incontinence in primiparous without history of UI 

0.3 (0.0; 0.6) 

Self reported stress urinary incontinence in primiparous with history of UI 

0.3 (0.1; 0.6) 

Self reported stress urinary incontinence in multiparous without history of UI 

 0.8 (0.2; 3.8) 

Self reported stress urinary incontinence in multiparous with history of UI 

 0.6 (0.2; 1.7) 

Self reported severe (wearing pads) incontinence in primiparous 

 1.0 (0.2; 4.6) 

Self reported severe (wearing pads) incontinence in multiparous 

 1.1 (0.2; 5.5) 
Table F120. Effects of obstetric interventions on incidence and progression of urinary incontinence in females (events) (contin

F567 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Nu

Nee

T

(95

Severity of urinary incontinence

Hannah, 2004593N = 2,088 

Planned cesarean delivery 

Planned vaginal birth 

Stress urinary incontinence is a big problem 2 years postpartum 

3 9 3.7 9.0 0.3 (0.1; 1.2) 

Self reported urinary incontinence severe to wear pads, sometimes 

26 24 5.2 4.8 1.1 (0.6; 1.9) 

Self reported urinary incontinence severe to wear pads, every day 

5 4 1.0 0.8 1.3 (0.3; 4.7) 

Sleep, 1987595

N = 1,000 

Restrictive policy for episiotomy 

Liberal policy for episiotomy 

Self reported urinary incontinence 3 months postpartum, pads

19 15 3.8 3.0 1.3 (0.7; 2.5) 

Self reported frequent stress urinary incontinence 

Johanson, 8 12 2.7 3.9 0.7 (0.3; 1.7) 1999596

N = 607 

Delivery with vacuum extractor 

Forceps delivery 

Self reported frequent urge urinary incontinence 

4 1.4 0.0 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A- avoided; E - excessive events 
F568 

Table F121. Effects of obstetric interventions on progression of urinary incontinence in females (instrumental severity measure

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

Pelvic floor contraction strength (oxford score 0-4) 

2.2 ± 1.3 2.6 ± 1.3 -0.3 (-0.6; 0.0) 

Functional urethral length (rest), mm 

34.0 ± 8.2 30.0 ± 6.4 0.5 (0.2; 0.9) 

Functional urethral length (contraction) mm 

29.0 ± 15.0 25.0 ± 8.0 0.3 (0.0; 0.7) 

Maximum urethral closure pressure (rest), mmH2O 

98.0 ± 24.0 101.0 ± 28.0 -0.1 (-0.4; 0.2) 

Dannecke, 2005590N = 146 

Restrictive episiotomy 

liberal episiotomy 

Maximum urethral closure pressure (contraction) cmH2O 

95.0 ± 30.0 103.0 ± 38.0 -0.2 (-0.6; 0.1) 

Sartore, 2004591

N = 519 

Mediolateral episiotomy 

No episiotomy 

Urine stream interruption test score(s), % abnormal 

3.9 ± 3.5 3.8 ± 2.9 0.0 (-0.1; 0.2) 

Bold- significant differences in outcomes at 95% confidence level 
F569 

Table F122. Effects of hysterectomy on incidence and progression of urinary incontinence in females 

Study Participants Clinical Interventions Outcomes 

Gimbel, 2003598

RCT to examine effects of total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases. Duration: 1 year 

319 women going to have a hysterectomy for benign diseases of the uterus able to read and write Danish. Exclusion criteria: Laparoscopic or vaginal hysterectomy, dysplasia of cervix, prolapse of uterus, former operation for a urological diseases, former or present malignancy, diabetes, neurological diseases, alcoholism, poor mental function. Loss of followup: 13.2% excluded from the intention to treat analysis 

1. Total abdominal hysterectomy 2. Subtotal abdominal hysterectomy 

Self reported urinincontinence defias ‘always’ or ‘oftusing the validateself administeredpostal questionna

Thakar, 2002599

RCT to examine effects of total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases. Duration: 1 year 

279 women referred for hysterectomy because of benign disease; most of the women were premenopausal. Exclusion criteria: Age >60 years, suspected cancer, body weight that exceeded 100kg, previous pelvic surgery, known endometriosis, abnormal cervical smears, symptomatic uterine prolapse, and symptomatic urinary incontinence for which the patient might seek expert medical advice. Loss of followup: 16% in total and 12% in subtotal abdominal hysterectomy groups. 

1. Subtotal hysterectomy 2. Total hysterectomy 

Self reported urinincontinence usinstandardized Questionnaire. Stress incontinenscores from 0-noto 4-always. Twinchannel subtractecystometrographand uroflowmetry outcomes. 
Table F122. Effects of hysterectomy on incidence and progression of urinary incontinence in females (continued) 

F570 

Study Participants Clinical Interventions Outcomes 

Lalos, 1986,600

RCT to examine effects of subtotal or total hysterectomy on urinary symptoms. Duration of followup: 6 weeks. 

22 women admitted to the hospital for hysterectomy. Exclusion criteria: pathological findings of the cervix. Loss of followup: not reported 

1. Subtotal hysterectomy 2. Total hysterectomy 

Urodynamic outcomes 

Kaya, 2004601

RCT to examine effects of extrafascial and intrafascial total abdominal hysterectomy on urinary urge incontinence. Duration of followup: 12 months 

90 women undergoing total abdominal hysterectomy. Exclusion criteria: gynecologic malignancy, stress incontinence, inflammatory bladder disorders, other gynecological surgery. Loss of followup: 11.1% 

1. Extrafascial total abdominal hysterectomy 2. Intrafascial total abdominal hysterectomy 

Surgical morbiditand presence of urge incontinence defined as urodynamically established detruoveractivity at the end of 12 months 

Learman, 2003602

RCT to examine effects of total versus supracervical abdominal hysterectomy on clinical outcomes during 2 years of followup. Duration: 2 years. 

135 premenopausal women over 30 years who had abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding refractory to hormonal treatment, or both, follicle stimulating hormone 

<30mIU/ml, and endometrial biopsy within 6 months was negative for hyperplasia or carcinoma. 

Exclusion criteria: Age >50 years at screening, positive results of pregnancy test, desire for future childbearing, known or suspected genital tract carcinoma, cervicaldysplasia or carcinoma-in-situ, complex or atypical endometrial hyperplasia, candidate for vaginal 

hysterectomy (as determined by their gynecologist), and 

unlikely to remain geographically accessible for 4 years. 

Loss of followup: 4% assigned to total and 10% assigned to supracervical abdominal hysterectomy. 

1. Total abdominal hysterectomy 

(removal of both the corpus uteri and cervix uteri) 2. Subtotal supracervical hysterectomy 

Self reported urinincontinence usinquestionnaires wchecklists and Lik

scales 

Long, 2005603RCT to examine the effects of vesicourethral function following laparoscopic 

94 women with various indications for hysterectomy but no indication of uterine myomas. Exclusion criteria: incomplete records, combined procedures (colposuspension or tension-free vaginal tape procedure). Loss of follow up: 10.5% 

1. Laparoscopic hysterectomy without vaginal cuff suspension. Patients with severe SUI underwent concomitant anti-incontinence procedures 

Q-tip test, introitaultrasonography, personal interviewusing the Bristol Female Lower Urinary Tract 
Table F122. Effects of hysterectomy on incidence and progression of urinary incontinence in females (continued) 

F571 

Study Participants Clinical Interventions Outcomes 

hysterectomy with and without vaginal cuff suspension on urinary incontinence. Duration of follow up: 6 months 

2. Laparoscopic hysterectomy with vaginal cuff suspension: the use of absorbable polyglactin sutures through the cardinaluterosacral ligament complex, anchoring bilaterally to 3cm near the angle of vaginal cuff. Patients with severe SUI underwent concomitant anti-incontinence procedures 

Symptoms Questionnaire. Stress urinary incontinence – urleakage during stress urethral pressure profilometry. Intrisphincter deficienmaximum urethraclosure pressure <20cm/H2O at maximum cystometric capaSever stress incontinence - urleakage during thpad test >10g. Thanatomic position and dynamic mobof the bladder neby introital ultrasonography Q-tip test with patients in the sesupine position. 
F572 

Table F123. Effects of hysterectomy on incidence and progression of urinary incontinence in females (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

(95% 

Recover from urge urinary incontinence (cured) 

4 14 8.89 31.11 0.29 

 (0.10; 0

Develop urge urinary incontinence (incidence) 

0 4 0.10 9.50 0.11 

(0.01; 2

Kaya, 2004601

N = 90 

Extrafascial total abdominal hysterectomy 

Intrafascial total abdominal hysterectomy 

Postoperative urge urinary incontinence 

10 8 22.22 17.78 1.25 

(0.54; 2

Self reported stress incontinence 1 year postpartum 

8 6 13.00 9.50 0.66 

(0.24; 1

Self reported stress incontinence 2 years postpartum 

8 3 13.00 4.70 2.63 

(0.73; 9

Self reported urge urinary incontinence 1 year postpartum 

5 5 8.20 7.90 0.99 

(0.30; 3

Learman, 2003602N = 135 

Subtotal supracervical hysterectomy 

Total abdominal hysterectomy 

Self reported urge urinary incontinence 2 years postpartum 

4 2 6.60 3.10 1.97 

(0.37; 1

Gimbel, 2003598N = 319 

Subtotal abdominal hysterectomy 

Total abdominal hysterectomy 

Self reported urinary incontinence, always or often 1 year post operation 

24 18 21.00 9.00 1.31 

(0.74; 2
Table F123. Effects of hysterectomy on incidence and progression of urinary incontinence in females (events) (continued) 

F573 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

(95% 

Proportion of urinary incontinence symptom relief 1 year post operation 

14 20 8.70 12.66 0.69 

(0.36; 1

Proportion of women with new symptoms of urinary incontinence 1 year post operation 

10 3 6.21 1.90 3.27 (0.92

Thakar, 2002599N = 279 

Subtotal hysterectomy 

Total hysterectomy 

Self-reported urge urinary incontinence at 12 months post operation 

13 14 9.77 9.59 1.02 

(0.50; 2

Stress incontinence 

6 6 15.79 15.79 1.00 

(0.35; 2

Severe 3 2 7.89 5.26 1.50 

(0.27; 8

Mild to moderate 

3 4 7.89 10.53 0.75 

(0.18; 3

Long603

N = 76 6 months

Laparoscopic hysterectomy without vaginal cuff suspension 

Laparoscopic hysterectomy with vaginal cuff suspension 

BN hypermobility 

17 8 44.74 21.05 2.13 

 (1.04; 4

Bold- significant differences in outcomes at 95% confidence level 
F574 

Table F124. Effects of hysterectomy on self reported and objectively measured severity of urinary incontinence 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

Scores of stress urinary incontinence at 12 months post operation (4-always) 

1.5 ± 0.9 1.5 ± 0.9 0.0 (-0.2; 0.2) 

Scores of urinary urgency at 12 months post operation (4-always) 

2.0 ± 1.4 2.0 ± 1.3 0.0 (-0.2; 0.2) 

Peak flow rate (ml/sec) 21.2 ± 14.1 21.6 ± 19.9 0.0 (-0.3; 0.2) First desire to void, ml 229.7 ± 114.3 237.3 ± 106.6 -0.1 (-0.3; 0.2) Strong desire to void, ml 303.4 ± 141.9 318.1 ± 129.3 -0.1 (-0.3; 0.1) 

Thakar, 2002599N = 279 

Subtotal hysterectomy 

Total hysterectomy 

Maximum capacity, ml 391.5 ± 124.7 394.0 ± 130.4 0.0 (-0.3; 0.2) Nightly micturition/week 2.6 ± 3.1 1.5 ± 2.2 0.4 (-0.4; 1.3) 2Bladder volume, ml 494.0 ± 132.0 541.0 ± 125.0 -0.4 (-1.2; 0.5) Bladder compliance, ml/mmHg 

70.4 ± 25.2 98.1 ± 34.0 -0.9 (-1.8; 0.0) 

Intravesical pressure at maximum urine flow, mmHg 

33.0 ± 6.0 38.0 ± 7.0 -0.8 (-1.6; 0.1) 

Maximum flow rate, ml/s 21.9 ± 6.5 19.6 ± 5.7 0.4 (-0.5; 1.2) 

Lalos, 1986600N = 22 

Subtotal hysterectomy 

Total hysterectomy 

Urethral conductance (ml2*sec2*mmHg-1) 

16.8 ± 12.7 11.7 ± 8.0 0.5 (-0.4; 1.3) 

Long, 2005603N = 76 

Laparoscopic hysterectomy without vaginal cuff suspension

Laparoscopic hysterectomy with vaginal cuff suspension

Q-tip straining angle (degrees) 

38.70 ± 10.00 33.80 ± 9.20 0.51 (0.05; .97) 

Bold- significant differences in outcomes at 95% confidence level 
F575 

Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females 

Study Participants Clinical Interventions Outcomes 

Schraffordt Koops, 2006604Prospective cohort study to examine effects of tensionfree vaginal tape in women with a history of surgery for urinary incontinence and/or prolapse. Duration: 2-36 months. 

809 women with indication for TVT who had a history of previous incontinence or prolapse surgery were recruited from the Netherlands TVT database, 28 teaching and 13 local hospitals, patients of 54 gynecologists and urologists who performed tension-free vaginal tape. Exclusion criteria: Recurrent and difficult to-treat urinary tract infections, predominant symptoms of urge urinary incontinence (defined as urge incontinence being more prevailing than the stress incontinence), detrusor overactivity at cystometry, post voiding bladder retention (>150ml), bladder capacity <200ml, or a physical/mental impairment that would make participation impossible. Loss of followup: 1.8% 

Tension-free vaginal tape (Gynecare, Ethicon Inc, Sommerville, NJ) was performed with Ulmsten’s method. 

Stress urinary incontinence as a positive response the question "Do experience urinaleakage during physical activity, coughing or sneezing?" Incontinence ImpQuestionnaire (IIand Urogenital Distress Inventor(UDI-6) ranked w4-step scale from ‘‘not at all’’ to ‘‘greatly’’ impaireThe total score wtransformed to a scale from 0 as continent to 100 

Rafii, 2004605

Case-control study to examine effects of tension-free vaginal tape alone or in conjunction with vaginal procedures on stress or mixed urinary incontinence in women. Duration of followup: 24 months 

186 females with urodynamically confirmed stress urinary incontinence undergoing TVT. Exclusion criteria: not reported. Loss of followup: none 

1. Tension-free vaginal tape with Ulmsten’s method alone 2. Tension-free vaginal tape with Ulmsten’s method and concomitant vaginal hysterectomy. 3. Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction. 

Postoperative voiding diaries, standing stress-teresults, and patiesatisfaction. Objectively cured no stress incontinence (clinstress provocatiotest and urodynaexaminations) anno urinary retenti(residual urine volume >150ml omore). Subjective Cured - improvemand failure rates based on the Contilife 28-item questionnaire. 
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F576 

Study Participants Clinical Interventions Outcomes 

Rechberger, 2003606RCT to examine effects of monofilament and multifilament tapes positioned without tension at the midurethra on urinary incontinence. Duration of followup: 13.5 months 

100 patients with stress urinary incontinence confirmed by a urodynamic profile including cystometry and urethral pressure profile. Exclusion criteria: Intrinsic sphincter deficiency, other gynecologic disease, such as uterine myoma, ovarian cyst or severe uterine or vaginal prolapse. Loss of followup: not reported. 

1. Monofilament tape inserted at the midurethra using the tensionfree vaginal tape delivery instrument 2. Multifilament tape using the intravaginal slingplasty delivery instrument 

Urinary continencno stress urinary incontinence symptoms; negatcough tests in the supine and standpositions; no neehygienic pads. “improvement”- negative cough tebut patients still experienced streurinary leakage (much less frequthan previously) athe pads were occasionally wet. 

Wadie, 2005607

RCT to examine effects of fascial sling or polypropylene tape stress urinary incontinence. Duration of followup: 6 months 

53 female patients older than 21 years with stress urinary incontinence as leading symptom, life expectancy >1 year, normal upper tract, and normal manual dexterity. Exclusion criteria: Bladder or urethral pathology, as well as those with cystocele greater than grade 2, pelvic or vaginal surgery within 6 months, predominant urge incontinence, active urinary tract infection as evidenced by positive urine culture. Loss of followup: not reported. 

1. Fascial sling with free ends of flap fixed by a 1-zero polyglactin suture and the sling is fixed to the underlying periurethral fascia using 4-zero polyglactin sutures at the 6 and 12 o’clock positions 2. Tension-free vaginal polypropylene tape 

Urinary continenc(cure) as compledryness with no usage of pads, aincontinence surgresponse score oand negative strtest, Failure – visleakage on stress test and a total scof 6. 

Lightner, 2001586

RCT to examine effects of bulking agents on stress urinary incontinence due to intrinsic sphincter deficiency in women. Duration of followup:12 months 

355 women diagnosed with stress urinary incontinence due to intrinsic sphincter deficiency, abdominal leak point pressure of less than 90cm/H2O, who failed prior surgical and medical treatment. Exclusion criteria: Prior injections of any urethral bulking agents, positive intradermal test injections of bovine collagen and beta-glucan. Loss of followup: 38% 

Injection of bulking agent 1.0ml Durasphere maximum 5 times with a minimum 7 day interval. Injection of bulking agent bovine collagen maximum 5 times with a minimum 7 day interval. 

Self reported urinincontinence with grade 0 (dry) to grade 3 (continuourinary leakage) 
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F577 

Study Participants Clinical Interventions Outcomes 

Adamiak, 2002608

RCT to examine effects of tensionfree vaginal tape using local or spinal anesthesia on female stress urinary incontinence Duration of followup: 6 months 

103 women with objectively confirmed stress urinary incontinence. Exclusion criteria: mixed urinary incontinence Loss of followup: 2.9% 

1. Tension-free vaginal tape with local analgesia (injection of 0.5-0.75% lidocaine hydrochloride in subcutaneous tissue). 2.Tension-free vaginal tape with spinal analgesia (0.5% bupivacaine hydrochloride administered at L3–L4 or L4–L5

interspace) 

Self reported urinincontinence symptoms with thgrades using Ingelman-Sundbescale 

Ward, 2002609

RCT to examine effects of tensionfree vaginal tape or colposuspension on female stress incontinence. Duration of followup: 6 months 

344 women with urodynamic stress incontinence. Exclusion criteria: Detrusor overactivity, vaginal prolapse requiring treatment, previous surgery for prolapse or incontinence, a major degree of voiding dysfunction (voiding pressure >50cm H20, maximum flow <15ml/s, and residual urine volume >100ml), neurological disease, and allergy to local anesthetic. Loss of followup: 3.5% 

1. Tension-free vaginal tape procedure performed as described by Ulmsten, under local anesthesia and sedation. 2. Colposuspension was performed according to standard technique. 

Self reported urinincontinence usinSF-36, the Bristofemale lower urintract symptoms questionnaire, th5D health questionnaire. Oweek urinary diarone hour perineatest, and cystomeoutcome. objectivcure of stress incontinence basa negative stress on urodynamic tecombined with a negative one houtest (<1g change weight). 

Valpas, 2004610

Double publication: Valpas 2003611

RCT to examine effects of tensionfree vaginal tape or laparoscopic mesh colposuspension on female stress urinary 

128 women with urodynamic stress incontinence, unequivocal indication for operation according to the clinic's standards, urodynamically confirmed stress 

incontinence (stabile bladder in cystometry), positive 

stress test result (300ml of saline in the bladder, maximum 

repetitive coughs in a supine position. Exclusion criteria: Age older than 70 years, previous incontinence surgery, more than 3 episodes of urinary tract infection within the last 2 years, coincident other gynecological surgery, body mass index more than 32 kg/m(2), urethral closure pressure less than 20cm/H2O, and residual volume more than 100ml in preoperative 

1. Tension-free vaginal tape under local anesthesia with polypropylene mesh tape placed under the midurethra. 2. Laparoscopic mesh colposuspension under general anesthesia (Hannah and Chin) 

Urinary continencas negative strestest and negative hour pad test (wegain of pads was less than 8g in 48 

hours). Urinary Incontinence

Severity Score 0or 2 (no, slight, o

marked impairmeof quality of life, 
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F578 

Study Participants Clinical Interventions Outcomes 

incontinence. Duration of followup: 12 months 

urodynamic evaluation Loss of followup: 5.4% 

respectively) 0 - inconvenience at 20 - maximal 

inconvenience. UScore: >7 indicatincreased risk of 

motor urge incontinence. KinCollege Health

Questionnaire wi21 questions in 8 domains, with separate scales, 

measure the sevof urinary symptoScores in the domains range fr

0 to 100, a highescore indicating greater quality of 

impairment. 

deTayrac, 2004612

RCT to examine effects of tensionfree vaginal tape or transobturator suburethral tape on female stress urinary incontinence. Duration of followup: 12 months 

61 women with urodynamically proved genuine stress incontinence Exclusion criteria: Predominant urge incontinence, urodynamic detrusor instability, prolapse. Loss of followup: not reported 

1. Tension-free vaginal tape. 2. Transobturator suburethral tape 

Self reported symptoms of urinincontinence in vanalog scale rangfrom 0 to 10 (0 – symptoms to 10 maximum severit‘‘objectively curednegative stress te‘‘objectively improved’’ - improvement of Sbut positive strestest 

Andonian, 2005613

RCT to examine effects of suprapubic arch sling or tensionfree vaginal tape on female stress urinary 

84 women with urodynamic stress incontinence with or without pelvic organ prolapse, stable bladder function and good flow rates without clinically significant post-void residual, who failed anti-incontinence surgeries or bulking agent treatments. Exclusion criteria: Mixed urinary incontinence with abnormal capacity, compliance and uninhibited contractions, obstructive, unstable bladder functions, or 

1. Suprapubic arch sling 2. Tension-free vaginal tape by Ulmsten. Anterior and posterior colporrhaphy, and vaginal hysterectomy were performed simultaneously in symptomatic women with pelvic organ 

Objective cure as hour pad test of ≤Incontinence ImpQuestionnaire sc<50 - good qualitlife , 50-70 - moderate QoL, a>70 – poor qualit
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F579 

Study Participants Clinical Interventions Outcomes 

incontinence. Duration of followup: 12 months 

neurogenic bladders, and urinary tract infection. Loss of followup: 1.2% 

prolapse life 

Lim, 2005614

RCT to examine effects of three types of suburethral slings on female urodynamic stress incontinence. Duration of followup: 12 months 

195 consenting patients with urodynamic stress incontinence that failed conservative management for symptomatic stress incontinence, or required prophylactic incontinence surgery during prolapse repair for occult stress incontinence (no subjective stress leakage but urodynamic incontinence). Exclusion criteria: Past history of urogenital malignancy, 

fistula or pelvic radiotherapy. Loss of followup: 6.7% 

1. Suburethral slingplasty with tension-free vaginal tape macroporous monofilament threads, inserted using ‘bottom to top’ (caudocranial) approach. 2. Suburethral slingplasty with intravaginal sling multifilament threads with much smaller pore sizes, inserted using ‘bottom to 

top’ (caudocranial) approach. 3. Suburethral slingplasty with suprapubic arc sling macroporous monofilament threads, with an absorbable tensioning suture that is designed to aid tape tension adjustment inserted with a ‘top to bottom’ (craniocaudal) approach. 

Urodynamic stresincontinence as positive cough lewith 300ml of waeither in supine oerect position. intrinsic sphinctedeficiency as maximum urethraclosure pressure <20cm water. Improvement in urinary incontinenas >50% reductiofrequency of occurrence compared to preoperative stat

Lord, 2006615

RCT to examine effects of tensionfree vaginal tape and suprapubic urethral support sling on female stress incontinence. Duration of followup: 6 weeks 

313 women with clinical diagnosis of stress urinary incontinence and a recommendation of minimally invasive sling surgery to treat their symptoms with possible previous incontinence and/or other pelvic surgery including combined treatment with other pelvic operations, e.g., vaginal hysterectomy and repair. Exclusion criteria: Age <18 years, pregnancy, major voiding dysfunction specified as an abnormal flow (i.e. maximum urinary flow rate <10ml/s) or residual urinary volume of >150ml. Loss of followup: 4.3% 

1. Tension-free vaginal tape 2. Suprapubic urethral support sling

Subjective cure fstress urinary incontinence as nuse of protectionimprovement in symptoms and a scale of improvement (1-100). The objectidefinition of cure observed absencurinary leakage in stress cough test while supine and with a comfortablfull bladder. 
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F580 

Study Participants Clinical Interventions Outcomes 

Meschia, 2006616

RCT to examine effects of tensionfree vaginal tape or intravaginal slingplasty on female stress urinary incontinence. Duration of followup: 2 years 

190 women with primary urodynamic stress incontinence and urethral hypermobility. Exclusion criteria: Previous anti-incontinence surgery, vaginal prolapse requiring treatment, coexisting pelvic pathology, known bleeding diathesis or current anticoagulant therapy, detrusor overactivity, and urethral hypomobility (difference in Q-tip % 20 degrees from horizontal with straining). Loss of followup: 15.37% 

1. Tension-free vaginal tape under local or epidural anesthesia. 2. Intravaginal slingplasty under local or epidural anesthesia. 

Objective cure as leakage of urine stress cough testwith at least 300msaline solution in bladder and as a weight gain <1g during the 1-hour test. Subjective cas no urine loss during ‘‘stress’’ afailure as any reported leakage urine during exer

Arunkalaivanan, 2003617RCT to examine effects of porcine dermal sling or tension-free vaginal tape on female stress incontinence. Duration of followup: 12 months 

142 women with urodynamic genuine stress incontinence. Exclusion criteria: Detrusor instability. Loss of followup: none. 

1. Porcine dermal sling (pelvicol implant) by Barrington 2. Tension-free vaginal tape by Ulmsten 

Cure as no leakain stress cough tepatient self reporurinary continenc“dry,” improvemein quality of life scores >90% 

David-Montefiore, 2006618RCT to examine effects of retropubic and transobturator suburethral sling procedure on female urinary stress incontinence. Duration of followup: 24 months 

88 women undergoing sub-urethral sling procedure for stress urinary incontinence. Exclusion criteria: not reported Loss of followup: none 

1. Retropubic suburethral sling procedure using I-STOP® device 

macroporous (>75-micron pore size) non-elastic monofilament polypropylene mesh 2. Transobturator suburethral sling procedure using I-STOP®

device macroporous (>75-micron pore size) non-elastic monofilament polypropylene mesh 

Self reported urincontinence (dry) improvement in symptoms. 
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F581 

Study Participants Clinical Interventions Outcomes 

Dietz, 2005619

RCT to examine effects of suburethral slings on female urinary incontinence. Duration of followup: 23 months 

195 women with urinary incontinence.  Exclusion criteria: missing data Loss of followup: 6.7% 

Two-dimensional (2D) and threedimensional (3D) pelvic floor ultrasound with a 7-4MHz volume transducer. 1. Tensionless vaginal tape 2. Intravaginal sling 3. Suprapubic arc sling 

Self reported urincontinence (cureimproved). Free flowmetry outcom

Maher, 2005620

RCT to examine effects of pubovaginal sling or transurethral macroplastique on female stress urinary incontinence and intrinsic sphincter deficiency. Duration of followup:1 year and 5 years 

45 women with stress urinary incontinence and intrinsic sphincter deficiency diagnosed by maximum urethral closure pressure <20cm/H2O who failed to respond to conservative treatments. Exclusion criteria: Required prolapse surgery, previous sling procedure, contraindications for general anesthesia. Loss of followup: 4.4% 

1. Pubovaginal 11-12cm sling by McGuire positioned suburethrally at the proximal urethra 2. Transurethral macroplastique 

Self reported urinincontinence usinvalidated questionnaires [Short Urinary Distress Inventor(SUDI) and Incontinence ImpQuestionnaire (II1-hour pad test. Objective succeswas defined as nurinary leakage dto stress urinary incontinence on repeat urodynamstudies 

Abdel-Fattah, 2004621RCT to examine effects of Pelvicol pubovaginal sling or tension-free vaginal tape on females urodynamic stress incontinence Duration of followup: 3 years 

142 women with pure stress urinary incontinence Exclusion criteria: not reported Loss of followup: 4.2% 

1. Pelvicol pubovaginal sling 2. Tension-free vaginal tape 

Self reported urincontinence (dry) improvement in urinary incontinensymptoms. Pad u
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F582 

Study Participants Clinical Interventions Outcomes 

Darai, 2007622

RCT to examine effects of suburethral sling procedure on female urinary stress incontinence Duration of followup: 10 months 

88 women older than 18 years undergoing suburethral sling procedure for urodynamic stress urinary incontinence (some had mixed incontinence). Exclusion criteria: Previous history of radio- or chemotherapy, use of anticoagulants or antipsychotic medications, and pregnancy. Loss of followup: none 

1. Suburethral sling procedure with retropubic routes by Ulmsten 2. Suburethral sling procedure with transobturator routes by Delorme 

Objective cure frostress urinary incontinence: no stress incontinenby clinical and urodynamic and during stress provocation test, no urinary retentia residual urine volume of <150mObjective improvement - no incontinence in sprovocation test. reported quality ousing Urinary DisImpact Questionn[UDI]), and the soand emotional imof SUI (IncontineImpact Questionn[IIQ]). 

Choe, 2000623

RCT to examine effects of transvaginal antimicrobial mesh and anterior vaginal wall slings on females stress urinary incontinence Duration of followup: 6 months 

40 women with stress urinary incontinence and vaginal prolapse. Exclusion criteria: not reported. Loss of followup: none 

1. Transvaginal antimicrobial mesh synthetic mesh 2. Anterior vaginal wall slings 

Subjective cure fstress urinary no involuntary loss ourine during physactivities incontinence objective curenegative stress teand no leakage in urodynamic examSelf reported urinincontinence usinstandardized Medical Epidemiologic anSocial Aspects oAging Questionnand validated visanalog scale. 
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F583 

Study Participants Clinical Interventions Outcomes 

Kuo, 2001624

RCT to examine effects of pubovaginal sling procedure using rectus fascia or polypropylene mesh on female stress urinary incontinence. Duration of followup: 6 months 

50 women with various types of stress urinary incontinence. Exclusion criteria: Stress incontinence with a large cystocele or uterine prolapse. Loss of followup: none. 

1.Pubovaginal sling procedure using rectus fascia 2. Pubovaginal sling procedure using polypropylene mesh Sling was placed at the level of the bladder neck and tied with sufficient tension to prevent urinary leakage without obstructing the bladder outlet. 

Video urodynamiType 2 stress incontinence : abdominal leak ppressure >90cm. H20 or significanurethral hypermobility. Ty3 stress incontinence: abdominal leak ppressure <60cm H20. Mixed type 3 stress incontineabdominal leak ppressure. 60 and 90cm H20. 

Cholhan, 2004625

RCT to examine effects of conventional suburethral sling or modified sling on female genuine stress urinary incontinence. Duration of followup :3 months 

48 women with genuine stress urinary incontinence diagnosed with demonstrated loss of urine with increased abdominal pressure (cough, Valsalva) in the absence of detrusor contractions on multichannel urodynamic. Exclusion criteria: not reported. Loss of followup: none 

1. Conventional suburethral sling 2. Modified sling placed at the mid-urethra without tension 

Multichannel urodynamic outcomes. Self reported urinary incontinence. 

Hilton, 1989626

RCT to examine effects of suburethral sling or Stamey endoscopic bladder neck suspension on female genuine stress incontinence. Duration of followup:3 months and 2 years. 

20 women with urodynamically proven genuine stress incontinence with or without other urinary symptoms and previous treatments. Exclusion criteria: not reported. Loss of followup: not reported. 

1. Suburethral sling 2. Stamey endoscopic bladder neck suspension 

Self reported urinincontinence and urodynamic and profilometry outcomes. 
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F584 

Study Participants Clinical Interventions Outcomes 

Tseng, 2005627

RCT to examine effects of suprapubic arc sling procedure or tension-free vaginal taping on female stress incontinence. Duration of followup: 2 years 

62 women with genuine stress incontinence (GSI) alone or combined with pelvic prolapse less than International Continence Society (ICS) stage II treated with anterior colporrhaphy with or without posterior colporrhaphy and with vaginal total hysterectomy with or without sacrospinous ligament fixation for pelvic prolapse greater than ICS stage II. Exclusion criteria: Previous anti-incontinence surgery, pelvic prolapse >stage II Loss of followup: none 

1. Suprapubic arc sling procedure 2. Tension-free vaginal taping by Ulmsten 

Objective cure as pad weight 1g or less. Improvemeas decreased >5in urine loss. Urodynamic outcomes includifree flowmetry urethral pressure profilometry, fillin(provocative) and voiding cystometand a 1-hour pad test. 

Barbalias, 1997628

RCT to examine effects of Goretex pubovaginal sling or typical indigenous material graft made of rectal fascia on female stress urinary incontinence. Duration of followup: 30 months 

48 consecutive women with type III incontinence. Exclusion criteria: not reported. Loss of followup: none 

1. Vesicourethral suspension by allogenic Goretex sling 2. Vesicourethral suspension by indigenous rectus abdominis fascia sling 

Cure as complete freedom from urinstress incontinenUrodynamic outcomes. 

Laurikainen, 2007629RCT to examine effects of retropubic tensionfree vaginal tape procedure or transobturator tension-free vaginal tape procedure on female urinary stress incontinence. Duration of followup: 2 months 

273 women with history of stress urinary incontinence, 

indication for surgical treatment of stress incontinence, positive cough stress test, detrusor Instability Score 7 or less. Exclusion criteria: Previous incontinence surgery, postvoid residual urine volume >100ml, lower urinary tract anomaly, current urinary tract infection or >3 urinary tract infection episodes within the past year, urogenital prolapse of more than second degree, body mass index >35kg/m2, previous radiation therapy of the pelvis, active malignancy, anticoagulant therapy, hemophilia, neurogenic disease which can be associated with bladder disorders, use of antiholinergic medication or duloxetine, patient immobilization. Loss of followup: 3.7% 

1. Retropubic tension-free vaginal polypropylene tape procedure by Ulmsten 2. Transobturator tension-free vaginal polypropylene tape procedure by de Leval 

Objective cure as negative stress teSelf reported symptoms using Urinary IncontineSeverity Score, Detrusor InstabiliScore, a visual analog scale (VA100), IncontinencImpact Questionnaire–SForm, and UrogeDistress InventorShort Form (UDI-
Table F125. Effects of vaginal tapes and sling procedures on risk and progression of incontinence in females (continued) 

F585 

Study Participants Clinical Interventions Outcomes 

Ward, 200 630

RCT to examine the effects of tension-free vaginal tape or colposuspension on stress urinary incontinence. Duration of follow up: 2 years 

344 women with urodynamic stress incontinence unresponsive to pelvic floor muscle exercise, who had completed their family. Exclusion criteria: vaginal prolapse requiring treatment, previous surgery for incontinence or prolapse, neurologic disease, known bleeding diathesis or current anticoagulant therapy, allergy to local anesthetic, detrusor over-activity, and voiding difficulty (maximum flow <15ml/sec or voiding pressure >50cm/H2O or residual volume >100ml). Loss of follow up: 15.7% 

1. Tension Free Tape procedure using the Gynecare TVT device by Ulmsten 2. Colposuspension using either two or three sutures to support paravaginal fascia from the ileopectineal ligament on each side. 

Objective cure of stress incontinenas negative 1-hopad test (<1g change in weightSubjective cure using Short Formhealth status questionnaire, thBristol Female LoUrinary Tract Symptoms questionnaire. The responses wcombined and transformed to generate eight hedimensions; with potential score of to 100 - higher scores indicate better perceived health. 
F586 

Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of uactive treatment, from highest to lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Rafi, 2004605* N = 186 

Tension-free vaginal tape with Ulmsten’s method and concomitant vaginal hysterectomy 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

Objective assessment: cured at 24 months 

39 43 97.5 93.1 1.0 (1.0; 1.1) 

Lord, 2006615N = 313 

Tension-free vaginal tape 

Suprapubic urethral support sling 

Stress incontinence: objective cure 

150 155 97.3 97.4 1.0 (1.0; 1.0) 

Kuo, 2001624N = 50 

Pubovaginal sling procedure using rectus fascia 

Pubovaginal sling procedure using polypropylene mesh 

Urinary continence: cured 

23 26 95.8 100.0 1.0 (0.9; 1.1) 

Choe, 2000623N = 40 

Transvaginal antimicrobial mesh synthetic mesh 

Anterior vaginal wall slings 

Objective cure from stress urinary incontinence 

19 14 95.0 70.0 1.4 (1.0; 1.8) 4 

Adamiak, 2002608N = 103 

Tension-free vaginal tape with local analgesia (injection of 0.5–0.75% lidocaine hydrochloride in subcutaneous tissue). 

Tension-free vaginal tape with spinal analgesia ( 0.5% bupivacaine hydrochloride administered at L3–L4 or L4–L5 interspace) 

Urinary continence (complete cure) 

61 34 93.8 97.1 1.0 (0.9; 1.1) 

Rafii, 2004605N = 186 

Tension-free vaginal tape with Ulmsten’s method alone 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

Objective assessment: cured at 24 months 

93 43 93.0 93.1 1.0 (0.9; 1.1) 
Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

F587 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

DavidMontefiore, 2006618N = 88 

Retropubic sub urethral sling procedure 

Transobturator sub urethral sling procedure 

Dry 39 43 92.9 93.5 1.0 (0.9; 1.1) 

Cholhan, 2004625N = 48 

Conventional sub urethral sling 

Modified sling placed at the mid-urethra without tension 

Cure from urinary stress incontinence 

19 24 92.0 89.0 1.0 (0.8; 1.2) 

Meshcia, 2004631N = 50 

Tension-free vaginal tape 

Application of the endopelvic fascia 

Stress continent during the postoperative cough provocation test 

23 14 92.0 56.0 1.6 (1.1; 2.4) 

Wadie, 2005607N = 53 

Fascial sling with free ends of flap fixed by a 1-zero polyglactin suture and the sling is fixed to the underlying periurethral fascia using 4-zero polyglactin sutures at the 6 and 12 o’clock positions 

Tension-free vaginal polypropylene tape 

Urinary continence (cure) as complete dryness with no usage of pads, antiincontinence surgery response score of 0 and negative stress test 

23 26 92.0 92.9 1.0 (0.8; 1.2) 

deTayrac, 2004612N = 61 

Tension-free vaginal tape 

Transobturator sub urethral tape 

Objective cure: negative stress test 

27 26 90.0 86.7 1.0 (0.9; 1.2) 

Arunkalaivanan, 2003617N = 142 

Porcine dermal sling (pelvicol implant) by Barrington 

Tension-free vaginal tape by Ulmsten 

Self reported urinary continence (dry) 

66 58 89.2 85.3 1.0 (0.9; 1.2) 
Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

F588 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Darai, 2007622N = 88 

Suburethral sling procedure with retropubic routes by Ulmsten 

Suburethral sling procedure with transobturator routes by Delorme 

Objective cure 37 40 88.1 87.0 1.0 (0.9; 1.2) 

Rechberger, 2003606N = 100 

Monofilament tape inserted at the midurethra using the tension-free vaginal tape delivery instrument 

Multifilament tape using the Intravaginal slingplasty delivery instrument 

Urinary continence (cured) 

44 40 88.0 80.0 1.1 (0.9; 1.3) 

Lim, 2005614N = 195 

Suburethral slingplasty with tension-free vaginal tape macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Urinary continence: (cured) 

51 44 87.9 81.5 1.1 (0.9; 1.3) 

Lord, 2006615N = 313 

Tension-free vaginal tape 

Suprapubic urethral support sling 

Stress incontinence: subjective cure 

134 122 87.1 76.5 1.1 (1.0; 1.3) 

Valpas, 2004610N = 128 

Tension-free vaginal tape under local anesthesia with polypropylene mesh tape placed under the midurethra. 

Laparoscopic mesh colposuspension under general anesthesia (Hannah and Chin) 

Negative stress test 

60 29 85.7 56.9 1.5 (1.2; 2.0) 
Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

F589 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Subjects cure from stress urinary incontinence: no urine loss during ‘‘stress’’ and failure as any reported leakage of urine during exertion 

Meschia, 80 68 84.2 71.6 1.2 (1.0; 1.4) 2006616N = 190 

Tension-free vaginal tape under local or epidural anesthesia 

Intravaginal slingplasty under local or epidural anesthesia 

Negative stress test 

79 65 83.2 68.4 1.2 (1.0; 1.4) 

Andonian, 2005613N = 84 

Suprapubic arch sling 

Tension-free vaginal tape by Ulmsten 

Objective cure (1-hour pad test <2g) 

34 41 83.0 95.0 0.9 (0.7; 1.0) 

Lim, 2005614N = 195 

Suburethral slingplasty with the tensionfree vaginal tape macroporous monofilament threads 

Suburethral slingplasty with the Intravaginal sling multifilament threads 

Stress urinary incontinence (cured) 

48 47 82.8 87.0 1.0 (0.8; 1.1) 

Meschia, 2006616N = 190 

Tension-free vaginal tape under local or epidural anesthesia 

Intravaginal slingplasty under local or epidural anesthesia 

Negative pad test pad test 

78 63 82.1 66.3 1.2 (1.0; 1.5) 

Tseng, 2005627N = 62 

Suprapubic arc sling procedure 

Tension-free vaginal taping by Ulmsten 

Objective cure from stress urinary incontinence: pad weight 1g or less 

25 27 80.6 87.1 0.9 (0.7; 1.2) 
Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

F590 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Lim, 2005614N = 195 

Suburethral slingplasty with the suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with the intravaginal sling multifilament threads 

Stress urinary incontinence: (cured) 

45 47 77.6 87.0 0.9 (0.8; 1.1) 

Maher, 2005620N = 45 

Pubovaginal sling 

Transurethral macroplastique 

Subjectively cured 

17 19 77.3 82.6 0.9 (0.7; 1.3) 

AbdelFattah, 2004621N = 142 

Pelvicol pubovaginal sling 

Tension-free vaginal tape 

Dry 56 53 75.7 77.9 1.0 (0.8; 1.2) 

Rafii, 2004605N = 186 

Tension-free vaginal tape with Ulmsten’s method and concomitant vaginal hysterectomy 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

Subjective assessment: cured at 24 months 

29 31 72.5 67.3 1.1 (0.8; 1.4) 

Lim, 2005614N = 195 

Suburethral slingplasty with suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with Intravaginal sling multifilament threads 

Urinary continence: (cured) 

42 44 72.4 81.5 0.9 (0.7; 1.1) 

Rafii, 2004605N = 186 

Tension-free vaginal tape with Ulmsten’s method alone 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

Subjective assessment: cured at 24 months 

72 31 72.0 67.3 1.1 (0.8; 1.4) 

Ward, 2004630N = 344 

Tension Free Tape procedure 

Colposuspension Objective cure 

as negative 1-hour pad test 

111 86 63.43 50.89 1.25 

(1.03; 1.50) 
Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

F591 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Subjective cure : no leakage under any circumstance 

44 34 25.14 20.12 1.25 

(0.84; 1.85) 

100% female Followup: 24 months 

Subjective cure from stress leakage 

75 63 42.86 37.28 1.15 

(0.89; 1.49) 

Urge incontinence (cured) 

Suburethral 24 18 41.4 33.3 1.2 (0.8; 2.0) slingplasty with suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Urinary urgency (cured) 

20 20 34.5 37.0 0.9 (0.6; 1.5) 

Urge incontinence (cured) 

Suburethral 19 18 32.8 33.3 1.0 (0.6; 1.7) slingplasty with tension-free vaginal tape macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Dysfunctional voiding (cured) 

8 8 13.8 14.8 0.9 (0.4; 2.3) 

Lim, 2005614N = 195 

Suburethral slingplasty with suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Cured from intrinsic sphincter deficiency as maximum urethral closure pressure <20cm/H2O 

6 9 10.3 16.7 0.6 (0.2; 1.6) 

Maher, 2005620N = 45 

Pubovaginal sling 

Transurethral macroplastique 

Objectively (cured) 

2 17 9.1 73.9 0.1 (0.0; 0.5) 
Table F126. Effects of vaginal tapes and sling procedures on urinary continence in women (events) (table is sorted by rate of u

active treatment, from highest to lowest) (continued) 

F592 

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Definition of 

Continence 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Lim, 2005614N = 195 

Suburethral slingplasty with tension-free vaginal tape macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Cured from intrinsic sphincter deficiency as maximum urethral closure pressure <20cm/H2O 

3 9 5.2 16.7 0.3 (0.1; 1.1) 

*Case control study; Bold - significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or exce

= 1/(rate of the outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outco

the outcome in the active group); A - avoided; E - excessive events 
F593 

Table F127. Effects of vaginal tapes and sling procedures on improvement of urinary incontinence in women (events) (table is sorafter active treatment, from highest to lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI) 

Choe, 2000623

N = 40 

Transvaginal antimicrobial mesh synthetic mesh 

Anterior vaginal wall slings 

Improvement in symptoms of stress urinary incontinence 

20 16 100.0 80.0 1.2 (1.0; 1.6) 

Barbalias, 1997628N = 48 

Vesicourethral suspension by allogenic Goretex sling 

Vesicourethral suspension by indigenous rectus abdominis fascia sling 

Cure or improvement in stress urinary incontinence 

16 26 100.0 81.3 1.2 (1.0; 1.5) 

Cured/improved for stress incontinence (%) 

Suprapubic 42 35 95.5 77.8 1.2 (1.0; 1.5) arc sling 

Intravaginal sling 

Overall cure/improvement (%) 

41 37 93.2 82.2 1.1 (1.0; 1.3) 

Cured/improved for stress incontinence (%) 

39 35 83.0 77.8 1.1 (0.9; 1.3) 

Dietz, 2005619

N = 195 

Tensionless vaginal tape 

Intravaginal sling 

Overall cure/improvement (%) 

37 37 78.7 82.2 1.0 (0.8; 1.2) 

Arunkalaivanan, 2003617N = 142 

Porcine dermal sling (pelvicol implant) by Barrington 

Tension-free vaginal tape by Ulmsten 

Improvement in urinary stress incontinence by 90-100% 

56 51 75.7 75.0 1.0 (0.8; 1.2) 

Suprapubic arc sling 

Intravaginal sling 

Cured/improved for urge incontinence (%) 

Dietz, 2005 30 32 68.2 71.1 1.0 (0.7; 1.3) 619

N = 195 

Tensionless vaginal tape 

Intravaginal sling 

Cured/improved for urge incontinence (%) 

30 32 63.8 71.1 0.9 (0.7; 1.2) 
Table F127. Effects of vaginal tapes and sling procedures on improvement of urinary incontinence in women (events) (table is sor

after active treatment, from highest to lowest) (continued) 

F594 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI) 

Urge incontinence pre and post symptom free 

23 32 39.7 59.3 0.7 (0.5; 1.0) 

Urge incontinence improved but not cured 

23 8 39.7 14.8 2.7 (1.3; 5.5) 

Lim, 2005614

N = 195 

Suburethral slingplasty with suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with Intravaginal sling multifilament threads 

Urinary urgency pre and post symptom free 

17 22 29.3 40.7 0.7 (0.4; 1.2) 

Rafii, 2004605

N = 186 

Tension-free vaginal tape with Ulmsten’s method and concomitant vaginal hysterectomy 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

Subjective assessment: improved at 24 months 

10 10 25.0 21.7 1.2 (0.5; 2.5) 

Lim, 2005614

N = 195 

Suburethral slingplasty with suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Urinary urgency Improved but not cured 

12 9 20.7 16.7 1.2 (0.6; 2.7) 

Rafii, 2004605

N = 186 

Tension-free vaginal tape with Ulmsten’s method alone 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

Subjective assessment: improved at 24 months 

20 10 20.0 21.7 0.9 (0.5; 1.8) 

Tseng, 2005627

N = 62 

Suprapubic arc sling procedure 

Tension-free vaginal taping by Ulmsten 

Objective improvement in stress urinary incontinence: decrease >50% in urine loss 

6 4 19.4 12.9 1.5 (0.5; 4.8) 
Table F127. Effects of vaginal tapes and sling procedures on improvement of urinary incontinence in women (events) (table is sor

after active treatment, from highest to lowest) (continued) 

F595 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI) 

Suburethral slingplasty with suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Stress urinary incontinence: Improved but not cured 

10 7 17.2 13.0 1.3 (0.5; 3.2) 

Urge incontinence Improved but not cured 

10 8 17.2 14.8 1.2 (0.5; 2.7) 

Lim, 2005614

N = 195 

Suburethral slingplasty with tension-free vaginal tape macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Stress urinary incontinence: Improved but not cured 

10 7 17.2 13.0 1.3 (0.5; 3.2) 

Arunkalaivanan, 2003617N = 142 

Porcine dermal sling (pelvicol implant) by Barrington 

Tension-free vaginal tape by Ulmsten 

Improvement in urinary stress incontinence by 75-90% 

10 7 13.5 10.3 1.3 (0.5; 3.3) 

Darai, 2007622N = 88 

Suburethral sling procedure with retropubic routes by Ulmsten 

Suburethral sling procedure with transobturator routes by Delorme 

Improvement in stress urinary incontinence 

5 6 11.9 13.0 0.9 (0.3; 2.8) 

Arunkalaivanan, 2003617N = 142 

Porcine dermal sling (pelvicol implant) by Barrington 

Tension-free vaginal tape by Ulmsten 

Improvement in urinary stress incontinence <75% 

8 10 10.8 14.7 0.7 (0.3; 1.8) 

Rechberger, 2003606N = 100 

Monofilament tape inserted at the midurethra using tensionfree vaginal tape delivery instrument 

Multifilament tape using intravaginal slingplasty delivery instrument 

Significant improvement in urinary incontinence 

5 9 10.0 18.0 0.6 (0.2; 1.5) 
Table F127. Effects of vaginal tapes and sling procedures on improvement of urinary incontinence in women (events) (table is sor

after active treatment, from highest to lowest) (continued) 

F596 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk (95% 

CI) 

Abdel-Fattah, 2004621N = 142 

Pelvicol pubovaginal sling 

Tension-free vaginal tape 

Improved incontinence 

7 3 9.5 4.4 2.1 (0.6; 8.0) 

DavidMontefiore, 2006618N = 88 

Retropubic suburethral sling procedure 

Transobturator suburethral sling procedure 

Improved incontinence 

2 1 4.8 2.2 2.2 

(0.2; 23.3) 

Adamiak, 2002608N = 103 

Tension-free vaginal tape with local analgesia (injection of 0.5-0.75% lidocaine hydrochloride in subcutaneous tissue) 

Tension-free vaginal tape with spinal analgesia (0.5% bupivacaine hydrochloride administered at L3-L4 or L4-L5 interspace) 

Improvement in urinary incontinence 

3 1 4.6 2.9 1.6 

(0.2; 15.0) 

deTayrac, 2004612N = 61 

Tension-free vaginal tape 

Transobturator suburethral tape 

Objective improvement:- improvement of stress urinary incontinence but positive stress test 

1 3 3.3 10.0 0.3 (0.0; 3.0) 

Arunkalaivanan, 2003617N = 142 

Porcine dermal sling (pelvicol implant) by Barrington 

Tension-free vaginal tape by Ulmsten 

Self reported improved urinary continence 

2 6 2.7 8.8 0.3 (0.1; 1.5) 

Bold - significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pat

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the control the active group); A - avoided; E - excessive events 
F597 

Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Incidence of overactive bladder symptoms 

8 10 8.4 10.5 0.8 (0.3; 1.9) 

Incomplete emptying 

5 4 5.3 4.2 1.3 (0.3; 4.5) 

Meschia, 2006616N = 190 

Tension-free vaginal tape under local or epidural anesthesia 

Intravaginal slingplasty under local or epidural anesthesia 

Overactive bladder symptoms 

24 27 25.3 28.4 0.9 (0.6; 1.4) 

Incidence of positive stress test 

1 1 0.6 0.6 1.0 (0.1; 16.4) 

Incidence of urge urinary incontinence 

12 17 7.8 10.7 0.7 (0.4; 1.5) 

Objective leakage in stress test 

4 4 2.6 2.5 1.0 (0.3; 4.1) 

Persistent subjective symptoms of stress urinary incontinence 

19 36 12.3 22.6 0.5 (0.3; 0.9) 

Protection use for stress urinary incontinence 

33 32 21.4 20.1 1.1 (0.7; 1.6) 

Stress incontinence: objective failure

4 4 2.7 2.6 1.0 (0.3; 4.1) 

Subjective treatment failure 

20 37 12.9 23.5 0.6 (0.3; 0.9) 

Lord, 2006615N = 313 

Tension-free vaginal tape 

Suprapubic urethral support sling 

Urgency symptoms (overall) 

80 84 51.9 52.8 1.0 (0.8; 1.2) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F598 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Urgency symptoms (persistent) 

65 70 42.2 44.0 1.0 (0.7; 1.2) 

Urge urinary incontinence (persistent) 

33 37 21.4 23.3 0.9 (0.6; 1.4) 

Urge urinary incontinence (overall) 

45 54 29.2 34.0 0.9 (0.6; 1.2) 

Incidence of urge urinary incontinence 

2 2 6.7 6.7 1.0 (0.2; 6.6) 

Incidence of voiding difficulties 

5 7 16.7 23.3 0.7 (0.3; 2.0) 

No obstruction in uroflow 

19 17 63.3 56.7 1.1 (0.7; 1.7) 

deTayrac, 2004612N = 61 

Tension-free vaginal tape 

Transobturator sub urethral tape 

Free Qmax 15 ml/s 

3 4 10.0 13.3 0.8 (0.2; 3.1) 

Incidence of urge urinary incontinence 

Adamiak, 4 2 6.2 5.7 1.1 (0.2; 5.6) 2002608N = 103 

Tension-free vaginal tape with local analgesia (injection of 0.5-0.75% lidocaine hydrochloride in subcutaneous tissue) 

Tension-free vaginal tape with spinal analgesia (0.5% bupivacaine hydrochloride administered at L3-L4 or L4-L5 interspace) 

Urinary retention 

8 5 12.3 14.3 0.9 (0.3; 2.4) 

Incidence of urge urinary incontinence 

Tseng, 5 2 16.1 6.5 2.5 (0.5; 11.9) 2005627N = 62 

Suprapubic arc sling procedure 

Tension-free vaginal taping by Ulmsten 

Incidence of urinary urgency 

5 3 16.1 9.7 1.7 (0.4; 6.4) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F599 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Cholhan, 2004625N = 48 

Conventional suburethral sling 

Modified sling placed at the mid-urethra without tension 

Incidence of urge urinary incontinence 

2 1 8.0 4.0 2.6 (0.2; 26.5) 

Darai, 2007622N = 88 

Suburethral sling procedure with retropubic routes by Ulmsten 

Suburethral sling procedure with transobturator routes by Delorme 

Incidence of urinary urgency 

6 4 15.1 7.7 1.6 (0.5; 5.4) 

Choe, 2000623N = 40 

Transvaginal antimicrobial mesh synthetic mesh 

Anterior vaginal wall slings 

Incidence of urinary urgency 

1 1 5.0 5.0 1.0 (0.1; 14.9) 

AbdelFattah, 2004621N = 142 

Pelvicol pubovaginal sling 

Tension-free vaginal tape 

Incidence of urinary urgency 

12 9 16.2 13.2 1.2 (0.6; 2.7) 

Kuo, 2001624N = 50 

Pubovaginal sling procedure using rectus fascia 

Pubovaginal sling procedure using polypropylene mesh 

Incidence of urinary urgency and mild urge incontinence 

2 1 8.3 3.8 2.2 (0.2; 22.4) 

Increased bladder sensation (cured) 

9 4 15.5 7.4 2.1 (0.7; 6.4) 

Stress urinary incontinence: pre and post symptom free 

3 4 5.2 7.4 0.7 (0.2; 3.0) 

Incontinence still present 

7 10 12.1 18.5 0.7 (0.3; 1.6) 

Lim, 2005614N = 195 

Suburethral slingplasty with tensionfree vaginal tape macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Urinary urgency (cured) 

20 20 34.5 37.0 0.9 (0.6; 1.5) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F600 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Urinary urgency Improved but not cured 

22 9 37.9 16.7 2.3 (1.2; 4.5) 

Urinary urgency pre and post symptom free 

15 22 25.9 40.7 0.6 (0.4; 1.1) 

Urge incontinence pre and post symptom free 

28 32 48.3 59.3 0.8 (0.6; 1.2) 

Acquired (de novo) 

4 5 6.9 9.3 0.7 (0.2; 2.6) 

Stress urinary incontinence: acquired (de novo) 

0 0 0.0 0.0 

Acquired (de novo) detrusor over activity 

2 2 3.4 3.7 0.9 (0.1; 6.4) 

Acquired (de novo) dysfunctional voiding 

3 2 5.2 3.7 1.4 (0.2; 8.0) 

Acquired (de novo) increased bladder sensation 

3 1 5.2 1.9 2.8 (0.3; 26.0) 

Acquired (de novo) intrinsic sphincter deficiency as maximum urethral closure pressure <20 cm/H2O 

10 4 17.2 7.4 2.3 (0.8; 7.0) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F601 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Detrusor over activity (cured) 

0 4 0.0 7.4 0.1 (0.0; 1.9) 

Increased bladder sensation (cured) 

7 4 12.1 7.4 1.6 (0.5; 5.3) 

Stress urinary incontinence: pre and post symptom free 

3 4 5.2 7.4 0.7 (0.2; 3.0) 

Incontinence still present 

16 10 27.6 18.5 1.5 (0.7; 3.0) 

Acquired (de novo) 

3 5 5.2 9.3 0.6 (0.1; 2.2) 

Stress urinary incontinence: acquired (de novo) 

0 0 

Acquired (de novo) detrusor over activity 

1 2 1.7 3.7 0.5 (0.0; 5.0) 

Acquired (de novo) dysfunctional voiding 

4 2 6.9 3.7 1.9 (0.4; 9.8) 

Acquired (de novo) increased bladder sensation 

2 1 3.4 1.9 1.9 (0.2; 20.0) 

Suburethral slingplasty with suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Acquired (de novo) intrinsic sphincter deficiency as maximum urethral closure pressure <20cm/H2O 

3 4 5.2 7.4 0.7 (0.2; 3.0) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F602 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Detrusor over activity (cured) 

3 4 5.2 7.4 0.7 (0.2; 3.0) 

Dysfunctional voiding (cured) 

4 8 6.9 14.8 0.5 (0.1; 1.5) 

Interfering with life overall 

48 28 27.4 16.6 1.7 (1.1; 2.5) 

Interfering with physical activity 

32 22 18.3 13.0 1.4 (0.9; 2.3) 

Interfering with social relationships 

19 17 10.9 10.1 1.1 (0.6; 2.0) 

Night time frequency (>0) 

99 83 56.6 49.1 1.2 (0.9; 1.4) 

Nocturnal enuresis 

14 11 8.0 6.5 1.2 (0.6; 2.6) 

Number with voiding disorder 

11 8 6.3 4.7 1.3 (0.5; 3.2) 

Number with genuine stress incontinence 

17 20 9.7 11.8 0.8 (0.4; 1.5) 

Number with unstable detrusor contractions 

12 13 6.9 7.7 0.9 (0.4; 1.9) 

Quantity of urine loss (>none) 

70 55 40.0 32.5 1.2 (0.9; 1.6) 

Straining 25 25 14.3 14.8 1.0 (0.6; 1.6) Stress incontinence 

54 37 30.9 21.9 1.4 (1.0; 2.0) 

Unexplained incontinence 

27 17 15.4 10.1 1.5 (0.9; 2.7) 

Urge incontinence 

84 69 48.0 40.8 1.2 (0.9; 1.5) 

Urgency 116 100 66.3 59.2 1.1 (1.0; 1.3) 

Ward, 2002609N = 344 

Tensionfree vaginal tape procedure 

Colposuspension 

Wearing protection 

45 30 25.7 17.8 1.4 (1.0; 2.2) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F603 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Ability to perform daily task 

25 19 14.3 11.2 1.3 (0.7; 2.2) 

Avoiding places or situations 

52 41 29.7 24.3 1.2 (0.9; 1.7) 

Bladder pain 49 36 28.0 21.3 1.3 (0.9; 1.9) Changing outer clothing 

35 37 20.0 21.9 0.9 (0.6; 1.4) 

Dysuria 38 29 21.7 17.2 1.3 (0.8; 2.0) Frequency of incontinent episodes (>never) 

72 66 41.1 39.1 1.1 (0.8; 1.4) 

Hesitancy 75 70 42.9 41.4 1.0 (0.8; 1.3) History of retention 

8 6 4.6 3.6 1.3 (0.5; 3.6) 

Choe, 2000623N = 40 

Transvaginal antimicrobial mesh synthetic mesh 

Anterior vaginal wall slings 

Mixed urinary incontinence 

1 4 5.0 20.0 0.3 (0.0; 2.0) 

Negative 48 hour pad test 

Valpas, 51 30 72.9 58.8 1.2 (0.9; 1.6) 2004610N = 128 

Tension-free vaginal tape under local anesthesia with polypropylene mesh tape placed under the midurethra 

Laparoscopic mesh colposuspension under general anesthesia (Hannah and Chin) 

Using pads 0 6 0.0 11.7 0.1 (0.0; 1.0) Nocturia 0 1 0.0 4.0 0.3 (0.0; 7.8) Urgency of incontinence 

1 8 4.0 29.0 0.1 (0.0; 0.9) 

Zullo, 2005632N = 59 

Tension-free vaginal tape procedure plus postoperative vaginal 

Tension-free vaginal tape procedure alone Detrusor over 

activity symptoms 

1 1 4.0 4.0 1.0 (0.1; 15.2) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F604 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

estrogen: 1 estriol ovule (1mg) once daily for 1 month, then 2 ovules once weekly for 5 months 

Frequency of incontinence episodes 

2 5 7.0 18.0 0.4 (0.1; 1.9) 

Postoperative urinary leakage 

Tension-free 8 6 8.0 13.0 0.6 (0.2; 1.7) vaginal tape with Ulmsten’s method alone 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

De novo urinary urge symptoms at 1 month followup 

34 14 34.0 30.4 1.1 (0.7; 1.9) 

Postoperative urinary leakage 

4 6 10.0 13.0 0.8 (0.2; 2.5) 

Rafii, 2004605N = 186 

Tension-free vaginal tape with Ulmsten’s method and concomitant vaginal hysterectomy 

Tension-free vaginal tape with Ulmsten’s method and pelvic floor reconstruction 

De novo urinary urge symptoms at 1 month followup 

6 14 15.0 30.4 0.5 (0.2; 1.2) 

Meshcia, 2004631N = 50 

Tension-free vaginal tape 

Plication of the endopelvic fascia 

Self reported stress urinary incontinence 

1 9 4.0 36.0 0.1 (0.0; 0.8) 

Hilton, 1989626N = 20 

Suburethral sling 

Stamey endoscopic bladder neck suspension 

Stress incontinence 

1 2 10.0 20.0 0.5 (0.1; 4.7) 

Stress incontinence 

4 0 18.2 0.0 9.4 (0.5; 164.8) 

Urge incontinence 

7 4 31.8 17.4 1.8 (0.6; 5.4) 

Urgency in urination 

7 4 31.8 17.4 1.8 (0.6; 5.4) 

Maher, 2005620N = 45 

Pubovaginal sling 

Transurethral Macroplastique 

Voiding difficulty 

1 2 4.5 8.7 0.5 (0.1; 5.4) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F605 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Wadie, 2005607N = 53 

Fascial sling with free ends of flap fixed by a 1-zero polyglactin suture and the sling is fixed to the underlying periurethral fascia using 4-zero polyglactin sutures at the 6 and 12 o’clock positions 

Tension-free vaginal polypropylene tape 

Treatment failure – visible leakage on stress test and a total score of 6. 

2 2 8.0 7.1 1.1 (0.2; 7.4) 

Rechberger, 2003606N = 100 

Monofilament tape inserted at the midurethra using tensionfree vaginal tape delivery instrument 

Multifilament tape using intravaginal slingplasty delivery instrument 

Urgency de novo 

8 4 16.0 8.0 2.0 (0.6; 6.2) 

Suprapubic arc sling 

Voiding dysfunction (%) 

Dietz, 15 19 34.1 42.2 0.8 (0.5; 1.4) 2005619N = 195 Tensionless 

vaginal tape 

Intravaginal sling 

Voiding dysfunction (%) 

22 19 46.8 42.2 1.1 (0.7; 1.8) 

Urgency 76 79 43.43 46.75 0.93 (0.74; 1.17) Urge incontinence 

52 61 29.71 36.09 0.82 (0.61; 1.12) 

Stress incontinence 

40 38 22.86 22.49 1.02 (0.69; 1.50) 

Ward, 2002609N = 344 24 months 

Tension Free Tape procedure 

Colposuspension 

Unexplained incontinence 

21 27 12.00 15.98 0.75 (0.44; 1.28) 
Table F128. Effects of vaginal tape and sling procedures on risk and progression of urinary incontinence in females (events) (cont

F606 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number 

of Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95% CI) 

Num

Frequency incontinent episodes (>never) 

52 59 29.71 34.91 0.85 (0.63; 1.16) 

Quantity of urine loss (>none) 

52 54 29.71 31.95 0.93 (0.68; .28) 

Wearing protection 

32 36 18.29 21.30 0.86 (0.56; 1.32) 

Changing outer clothing 

32 33 18.29 19.53 0.94 (0.60; 1.45) 

History of retention 

4 4 2.29 2.37 0.97 (0.25; 3.80) 

Ability to perform daily tasks 

13 19 7.43 11.24 0.66 (0.34; 1.30) 

Avoiding places/situations 

25 26 14.29 15.38 0.93 (0.56; 1.54) 

Interfering with physical activity 

14 19 8.00 11.24 0.71 (0.37; 1.37) 

Interfering with social relationships 

9 12 5.14 7.10 0.72 (0.31; 1.67) 

Interfering with life overall 

20 25 11.43 14.79 0.77 (0.45; 1.34) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F607 

Table F129. Effects of vaginal tapes and sling procedures on perceived urinary incontinence in females (severity measures) 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differ

(95% CI

Voided volume per 24 hours (ml) 

1824.0 ± 206.0 1696.0 ± 234.7 0.6 (0.4; 0

Episodes of nocturia 1.0 ± 0.0 1.0 ± 0.0 

Ward, 2002609

N = 344 

The tension free vaginal tape procedure 

Colposuspension 

Leaks over 24 hours 0.0 ± 0.0 0.0 ± 0.0 King’s College Health Questionnaire Scores Incontinence Impact 

 -46.7 (4.35; 2

King’s College Health Questionnaire Scores Physical Limitations 

 -49.5 (1.06; 

King’s College Health Questionnaire Scores Social Limitations 

 -25.2 (1.04; 

Urinary Incontinence Severity Score (0–20) 

1.6 (0.27; 2

Valpas, 2004610N = 128 

Tension-free vaginal tape under local anesthesia with polypropylene mesh tape placed under the midurethra 

Laparoscopic mesh colposuspension under general anesthesia (Hannah and Chin) 

Urge score (0–20) 0.4 (-0.51; Daily activities (from 10 possible) 

8.9 ± 1.9 7.9 ± 3.0 0.4 (-0.1; 0

Self reported symptoms of urinary incontinence in visual analog scale ranging from 0 to 10 (0 - complete continence) 

2.7 ± 2.5 1.4 ± 2.8 0.5 (0.0; 1

deTayrac, 2004612N = 61 

Tension-free vaginal tape 

Transobturator suburethral tape 

Visual Analog Scale (1–10) 

1.3 (0.65; 2

Andonian, 2005613N = 84 

Suprapubic arch sling 

Tension-free vaginal tape by Ulmsten 

Subjective cure (IIQ scores) 

49.9 ± 25.6 45.3 ± 18.4 0.2 (-0.2; 0

Zullo, 2005632N = 59 

Tension-free vaginal tape procedure plus postoperative vaginal estrogen: 1 estriol ovule (1mg) once daily for 1 month, then 2 ovules once weekly for the 5 months 

Tension-free vaginal tape procedure alone 

Self reported micturitions during 24 hours 

4.9 ± 2.0 6.0 ± 3.7 -0.4 (-0.9; 0
Table F129. Effects of vaginal tapes and sling procedures on perceived urinary incontinence in females (severity measures) (co

F608 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differ

(95% CI

Wadie, 2005607

N = 53 

Fascial sling with free ends of flap fixed by a 1-zero polyglactin suture and the sling is fixed to the underlying periurethral fascia using 4-zero polyglactin sutures at the 6 and 12 o’clock positions 

Tension-free vaginal polypropylene tape 

Urinary incontinence scores 

0.5 ± 3.0 0.5 ± 2.3 0.0 (-0.5; 0

Abdel-Fattah, 2004621N = 142 

Pelvicol pubovaginal sling 

Tension-free vaginal tape 

Incontinence pads use/day 

2.6 ± 3.6 2.9 ± 2.0 -0.1 (-0.4; 0

Urinary Distress Impact Questionnaire, total score 

4.7 ± 10.0 1.2 ± 5.0 0.4 (0.0; 0

Urinary Distress Impact Questionnaire: global discomfort 

1.2 ± 1.9 0.5 ± 0.9 0.5 (0.1; 0

Incontinence Impact Questionnaire, total score 

2.6 ± 16.0 0.0 ± 0.0 

Darai, 2007622

N = 88 

Suburethral sling procedure with retropubic routes by Ulmsten 

Suburethral sling procedure with transobturator routes by Delorme 

Urinary Distress Impact Questionnaire: Emotional and social discomfort 

1.0 ± 1.7 0.5 ± 0.8 0.4 (0.0; 0

Quality of life scores (UDI scale) 

David- 5.4 ± 20.3 5.7 ± 25.2 0.0 (-0.4; 0Montefiore, 2006618N = 88 

Retropubic suburethral sling procedure 

Transobturator suburethral sling procedure Social and emotional 

status (IIQ scale) 

0.6 ± 3.2 6.1 ± 24.6 -0.3 (-0.7; 0

Median Short Urinary Distress Inventory score 

Maher, 2005 14.0 ± 57.3 11.0 ± 22.0 0.1 (-0.5; 0

620

N = 45 

Pubovaginal sling Transurethral 

macroplastique 

Median Incontinence Impact Questionnaire score 

5.0 ± 53.3 9.0 ± 50.7 -0.1 (-0.7; 0

Arunkalaivanan, 2003617N = 142 

Porcine dermal sling (pelvicol implant) by Barrington 

Tension-free vaginal tape by Ulmsten 

Incontinence pad use 0.0 ± 5.3 0.0 ± 2.7 0.0 (-0.3; 0

Bold- significant differences in outcomes at 95% confidence level 
F609 

Table F130. Effects of vaginal tapes and sling procedures on urinary incontinence in females (severity measures) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

Pressure transmission ratio (%):4th quarter 

29.0 ± 9.3 38.0 ± 4.0 -1.2 (-1.5; -1.0

Post micturition residual (ml) 0.0 ± 33.3 0.0 ± 23.3 0.0 (-0.2 ; 0.2 Functional urethral length at rest (mm) 

30.0 ± 2.7 34.0 ± 2.0 -1.7 (-1.9; -1.4

Maximum urethral closure pressure at rest (mm) 

37.0 ± 10.0 46.0 ± 0.7 -1.3 (-1.5; -1.0

Maximum flow rate (ml/s) 20.0 ± 3.3 20.0 ± 4.0 0.0 (-0.2; 0.2Maximum urethral closure pressure at cough (mm) 

45.0 ± 10.0 52.0 ± 23.3 -0.4 (-0.6; -0.2

Cystometric capacity (ml) 450.0 ± 33.3 443.0 ± 39.3 0.2 (0.0; 0.4Change in pad weight (g) 0.0 ± 0.1 0.0 ± 0.2 0.0 (-0.2; 0.2Functional urethral length at cough (mm) 

20.0 ± 4.0 25.0 ± 2.7 -1.5 (-1.7; -1.2

Maximum voiding pressure (cm/H2O) 

30.0 ± 5.3 30.0 ± 6.7 0.0 (-0.2; 0.2

Ward, 2002609

N = 344 

Tension-free vaginal tape procedure 

Colposuspension 

Volume at first desire to void (ml) 

236.0 ± 41.3 217.0 ± 48.0 0.4 (0.2; 0.6

Maximum flow rate 11.4 ± 1.7 10.5 ± 1.8 0.5 (-0.1; 1.1Maximum closure pressure 43.5 ± 4.5 42.4 ± 3.9 0.3 (-0.3; 0.9First sensation of bladder filling 

180.4 ± 10.3 177.2 ± 9.4 0.3 (-0.3; 0.9

Bladder capacity 520.0 ± 58.1 490.0 ± 52.4 0.6 (-0.1; 1.2Detrusor pressure at maximum flow 

35.7 ± 5.0 37.6 ± 5.9 -0.3 (-0.9; 0.3

Maximum detrusor pressure 38.2 ± 4.2 37.9 ± 4.1 0.1 (-0.5; 0.7Residual urine 82.0 ± 35.0 90.0 ± 45.0 -0.2 (-0.8; 0.4

Barbalias, 1997628N = 48 

Vesicourethral suspension by allogenic Goretex sling 

Vesicourethral suspension by indigenous rectus abdominis fascia sling. 

Urethral functional length 2.5 ± 0.1 2.3 ± 0.1 1.9 (1.2; 2.6

deTayrac, 2004612N = 61 

Tension-free vaginal tape 

Transobturator suburethral tape 

Free Qmax (ml/s) 24.4 ± 7.7 23.3 ± 8.0 0.1 (-0.4; 0.6

Maximum cystometric capacity (ml) 

445.0 ± 43.4 439.0 ± 46.8 0.1 (-0.4; 0.7

Peak flow (ml/s) 22.7 ± 3.2 23.6 ± 2.9 -0.3 (-0.8; 0.2Flow time (ml/s) 27.8 ± 4.1 27.9 ± 4.4 0.0 (-0.5; 0.5First voiding desire (ml) 174.0 ± 21.4 148.0 ± 32.8 0.9 (0.4; 1.5

Zullo, 2005632N = 59 

Tension-free vaginal tape procedure plus postoperative vaginal estrogen: 1 

Tension-free vaginal tape procedure alone 

Detrusor pressure at peak flow (cm/H2O) 

18.6 ± 2.1 17.8 ± 1.9 0.4 (-0.1; 0.9
Table F130. Effects of vaginal tapes and sling procedures on urinary incontinence in females (severity measures) (continued) 

F610 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

Maximum urethral closure pressure (cm/H2O) 

73.6 

3.5 

75.9 

6.3 

-0.5 (-1.0; 0.1

Urethral functional length (mm) 

25.0 ± 1.5 25.1 ± 1.7 -0.1 (-0.6; 0.5

estriol ovule (1mg) once daily for 1 month, then 2 ovules once weekly for the 5 months 

Post void residual (ml) 1.1 ± 4.2 1.3 ± 3.9 0.0 (-0.6; 0.5

First desire (minutes) 175.0 ± 51.0 183.0 ± 59.0 -0.1 (-0.7; 0.4Very strong desire (ml) 347.0 ± 67.0 343.0 ± 45.0 0.1 (-0.5; 0.6Average flow rate (ml/second) 

11.0 ± 6.0 14.0 ± 5.0 -0.5 (-1.1; 0.0

Voiding time (seconds) 48.0 ± 178.0 31.0 ± 12.0 0.1 (-0.4; 0.7

Meshcia, 2004631N = 50 

Tension-free vaginal tape 

Plication of the endopelvic fascia 

Functional length (mm) 22.0 ± 6.0 25.0 ± 6.0 -0.5 (-1.1; 0.1

Rest: functional length, mm 28.0 ± 5.5 26.0 ± 6.3 0.3 (-0.5; 1.2Residual volume, ml 3.0 ± 4.0 1.0 ± 3.0 0.6 (-0.3; 1.5First sensations, ml 266.0 ± 147.0 301.0 ± 143.0 -0.2 (-1.1; 0.6 Cystometric capacity, ml 584.0 ± 247.0 599.0 ± 132.0 -0.1 (-1.0; 0.8Maximum voiding pressure, cm H20 

28.0 ± 10.0 22.0 ± 16.0 0.4 (-0.4; 1.3

Rest: total profile length, mm 35.0 ± 9.2 35.0 ± 7.8 0.0 (-0.9; 0.9Rest: length to peak pressure, mm 

17.0 ± 7.3 17.0 ± 6.1 0.0 (-0.9; 0.9

Rest: maximum urethral pressure, cm H20 

47.0 ± 12.7 39.0 ± 18.9 0.5 (-0.4; 1.4

Rest: maximum urethral closure pressure, cm H20 

26.0 ± 14.4 26.0 ± 17.8 0.0 (-0.9; 0.9

Stress: functional length, mm 18.0 ± 5.2 14.0 ± 11.8 0.4 (-0.4; 1.3Stress: maximum urethral closure pressure, cm H20 

26.0 ± 23.6 19.0 ± 15.9 0.3 (-0.5; 1.2

Stress: length to peak pressure, mm 

9.0 ± 6.5 12.0 ± 8.4 -0.4 (-1.3; 0.5

Pressure transmission ratio, Q4,% 

57.0 ± 27.5 33.0 ±18.7 1.0 (0.1; 2.0

Hilton, 1989626

N = 20 

Suburethral sling 

Stamey endoscopic bladder neck suspension 

Peak flow rate, ml/s 17.0 ± 8.0 30.0 ± 13.0 -1.2 (-2.2; -0.2

Mean ml capacity 389.4 ± 124.4 382.1 ± 75.9 0.1 (-0.5; 0.6Detrusor pressure at maximum flow 

24.8 ± 14.2 30.6 ± 13.8 -0.4 (-1.0; 0.1

Maximum flow, ml/second 19.4 ± 11.7 17.8 ± 8.3 0.2 (-0.4; 0.7

Wadie, 2005607

N = 53 

Fascial sling with free ends of flap fixed by a 1-zero polyglactin suture and the 

Tension-free vaginal polypropylene tape 

Mean ml/cm/H2O compliance 

55.8 ± 31.7 69.2 ± 37.7 -0.4 (-0.9; 0.2
Table F130. Effects of vaginal tapes and sling procedures on urinary incontinence in females (severity measures) (continued) 

F611 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

sling is fixed to the underlying periurethral fascia using 4-zero polyglactin sutures at the 6 and 12 o’clock positions 

Post-void residual urine, ml 8.8 ± 35.9 8.0 ± 22.1 0.0 (-0.5; 0.6

Maximum urine flow rate 4.0 ± 8.7 15.0 ± 22.0 -0.7 (-1.0; -0.3Average urine flow rate 2.0 ± 6.7 8.0 ± 15.3 -0.5 (-0.9; -0.Average urine flow rate 2.0 ± 6.7 12.0 ± 12.0 -1.0 (-1.4; -0.6

Lim, 2005614

N = 195 

Suburethral slingplasty with the suprapubic arc sling macroporous monofilament threads 

Suburethral slingplasty with the Intravaginal sling multifilament threads 

Maximum urine flow rate 4.0 ± 8.7 9.0 ± 18.0 -0.4 (-0.7; 0.0

Peak CMG urinary flow rate, ml/second 

16.1 ± 11.2 18.1 ± 8.0 -0.2 (-0.8; 0.4

Free urinary flow rate, ml/sec 

8.6 ± 5.3 9.8 ± 3.8 -0.3 (-0.8; 0.3

Cystometric bladder capacity, ml 

466.0 ± 185.0 429.0 ± 113.0 0.2 (-0.3; 0.8

Voiding volume, ml 341.0 ± 192.0 381.0 ± 120.0 -0.3 (-0.8; 0.3Peak detrusor pressure, cmH20 

55.2 ± 18.0 54.5 ± 15.0 0.0 (-0.5; 0.6

Urethral resistance cmH20ml-2s2 

1.9 ± 2.6 0.7 ± 0.3 0.7 (0.1; 1.2

Functional urethral length, cm; sitting 

1.9 ± 0.6 2.1 ± 0.6 -0.3 (-0.9; 0.2

Cotton swab test (degrees), strain 

12.0 ± 13.0 18.0 ± 19.0 -0.4 (-0.9; 0.2

Cotton swab test (degrees), rest 

4.0 ± 12.0 9.0 ± 15.0 -0.4 (-0.9; 0.2

Maximum urethral closure pressure (cm/H2O), supine 

37.0 ± 17.0 36.0 ± 14.0 0.1 (-0.5; 0.6

Maximum urethral closure pressure (cm/H2O), sitting 

39.0 ± 20.0 32.0 ± 15.0 0.4 (-0.2; 1.0

Cholhan, 2004625N = 48 

Conventional sub urethral sling 

Modified sling placed at the mid-urethra without tension 

Functional urethral length, cm; Supine 

2.3 ± 0.8 2.7 ± 0.6 -0.6 (-1.2; 0.0
Table F130. Effects of vaginal tapes and sling procedures on urinary incontinence in females (severity measures) (continued) 

F612 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

Maximum flow rate, (ml/second) 

18.7 ± 6.8 19.9 ± 7.9 -0.2 (-0.7; 0.3

Average flow rate (ml/second) 

7.8 ± 3.0 9.0 ± 5.7 -0.3 (-0.8; 0.2

First desire to void (ml) 114.8 ± 60.8 99.3 ± 63.1 0.3 (-0.2; 0.8Maximum cystometric capacity (ml) 

370.6 ± 133.3 341.4 ± 136.0 0.2 (-0.3; 0.7

Maximum urethral closure pressure (resting)(cmH2O) 

51.5 ± 23.7 50.4 ± 16.9 0.1 (-0.4; 0.5

Maximum urethral closure pressure (coughing) (cmH2O) 

46.7 ± 36.8 51.7 ± 54.7 -0.1 (-0.6; 0.4

Pressure transmission ratio 72.9 ± 27.1 78.3 ± 27.6 -0.2 (-0.7; 0.3Functional urethral length (resting) (mm) 

21.8 ± 5.2 17.6 ± 6.0 0.7 (0.2; 1.3

Tseng, 2004627

N = 62 

Suprapubic arc sling procedure 

Tension-free vaginal taping by Ulmsten 

Functional urethral length (coughing) (mm) 

20.0 ± 7.6 19.3 ± 9.0 0.1 (-0.4; 0.6

Post-void (ml) 16.9 ± 26.7 29.6 ± 37.5 -0.4 (-0.9; 0.2Maximum urinary flow (ml/second) 

19.2 ± 10.6 16.2 ± 8.1 0.3 (-0.2; 0.9

Capacity (ml) 327.0 ± 101.0 253.0 ± 96.7 0.7 (0.2; 1.3Bladder neck open time (second) 

9.1 ± 6.1 13.0 ± 11.3 -0.4 (-1.0; 0.1

Kuo, 2001624

N = 50 

Pubovaginal sling procedure using rectus fascia 

Pubovaginal sling procedure using polypropylene mesh 

Detrusor pressure (cm/H2O) 18.4 ± 10.4 20.7 ± 9.0 -0.2 (-0.8; 0.3

Voiding volume, ml 65.9 ± 139.7 2.0 ± 164.3 0.4 (0.2; 0.6Decrease in voiding volume 25.0 ± 10.0 26.0 ± 9.3 -0.1 (-0.3; 0.1Maximum flow rate, ml/s 9.0 ± 6.7 6.0 ± 6.0 0.5 (0.2; 0.7Decrease in maximum flow rate, ml/s 

9.0 ± 3.3 10.0 ± 4.0 -0.3 (-0.5; 0.0

Decrease in average flow rate, ml/s 

9.0 ± 21.3 4.0 ± 22.7 0.2 (0.0; 0.4

Lord, 2006615

N = 313 

Tension-free vaginal tape 

Suprapubic urethral support sling 

Average flow rate, ml/s 4.0 ± 3.3 4.0 ± 3.3 0.0 (-0.2; 0.2

Average urine flow rate 2.0 ± 6.7 12.0 ± 12.0 -1.0 (-1.4; -0.6Maximum urine flow rate 4.0 ± 8.7 9.0 ± 18.0 -0.4 (-0.7; 0.0Average urine flow rate 2.0 ± 6.7 8.0 ± 15.3 -0.5 (-0.9; -0.

Lim, 2005614

N = 195 

Suburethral slingplasty with tensionfree vaginal tape macroporous monofilament threads 

Suburethral slingplasty with intravaginal sling multifilament threads 

Maximum urine flow rate 4.0 ± 8.7 15.0 ± 22.0 -0.7 (-1.0; -0.3
Table F130. Effects of vaginal tapes and sling procedures on urinary incontinence in females (severity measures) (continued) 

F613 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

Maher, 2005 1-hour pad test (g) 5.0 ± 34.7 2.0 ± 12.0 0.1 (-0.5; 0.7

620

N = 45 

Pubovaginal sling 

Transurethral macroplastique Maximum urethral closure 

pressure (cm/H2O) 

20.0 ± 17.3 26.0 ± 20.7 -0.3 (-0.9; 0.3

Bold- significant differences in outcomes at 95% confidence level 
F614 

Table F131. Surgical interventions on risk and progression of incontinence in women 

Study Participants Clinical Interventions Outcomes (Incidence) 

Colombo, 1996 633

RCT to examine effects of cystopexy alone versus cystopexy with posterior pubourethral ligaments placation on prevention of urinary incontinence in women with genitourinary prolapse. Duration of followup: 6 months, 1 and 2 years 

107 continent women admitted for surgical correction of severe urethrocystocele grade 2 or greater, a negative stress test with repositioning, and a positive cotton swab test. Exclusion criteria: urethrocystocele <grade 2, positive stress test with repositioning (potential stress incontinence), maximum urethral closure pressure less than 30cm/H2O, uninhibited detrusor contraction of any size during bladder filling, and previous retropubic antiincontinence surgery. Loss of followup: 3.7%, one patient (cystopexy alone) died on day 2 of a hemorrhagic complication due to a chronic hepatic dysfunction 

1. Cystopexy alone 2. Cystopexy with posterior pubourethral ligaments plication 

Urinary incontineas occurrence bosubjectively (patient’s history) and objectively (positive stress teStress incontinenat any time after surgery. Urethral Functional Lengtand Maximum Urethral Closure Pressure 

Brubaker, 2006634

RCT to examine the effect of standardized Burch colposuspension in addition to abdominal sacrocolpopexy for the treatment of pelvic-organ prolapse on postoperative stress urinary incontinence in women without preoperative symptoms of stress incontinence. Duration of followup: 3 months after surgery 

322 women who did not report symptoms of stress incontinence and who chose to undergo sacrocolpopexy to treat prolapse. 22 women had prior surgery for incontinence, 60 women at baseline had stress incontinence and 89 had urge incontinence. Exclusion criteria: unable to undergo the Burch colposuspension on the basis of the assessment of the mobility of the urethrovesical junction. 

Loss of followup: none 

1. Sacrocolpopexy with Burch colposuspensions. 2. Sacrocolpopexy alone 

Self reported streincontinence and urge incontinenceMaximum cystometric capa
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F615 

Study Participants Clinical Interventions Outcomes (Incidence) 

Bump, 1996 635

RCT to examine the effect of needle colposuspension or bladder neck endopelvic fascia plication as part of vaginal reconstructive surgery on urinary symptoms. Duration of followup: 6 weeks and 6 months 

32 women with bladder neck hypermobility and stage III or IV pelvic organ prolapse. Exclusion criteria: not reported. Loss of followup: 12.5% 

1. Needle colposuspension. 2. Bladder neck endopelvic fascia plication as part of vaginal reconstructive surgery 

Stress incontinendiagnosed based self reported symptoms and positive stress teabnormal urethrapressure profilomor a positive direcvisualization test immediately after catheters were removed in total absence of detruinstability during urethrocystometr

Meshcia, 2004 631

RCT to examine the effect of tension-free vaginal tape or plication of the endopelvic fascia in women with severe genital prolapse. Duration: 6 months after surgery 

50 patients with ≥ stage II anterior defect and a positive 

stress test result with prolapse reduction. Exclusion criteria: age >75 years, obesity (body mass index, >30kg/ml), diabetes mellitus, previous pelvic and anti-incontinence surgery, symptoms of SUI, cotton swab test <30 degrees, and uninhibited detrusor contraction of any size during bladder filling. Loss of followup: none 

Vaginal hysterectomy, McCall culdoplasty, and cystocele repair for pelvic floor defects and 1. Tension-free vaginal tape 2. Plication of the endopelvic fascia 

Self reported streurinary incontinenstress test, cotton swab test, and urodynamic outcomes. 

Colombo, 1997,636

RCT to examine effects of posterior pubourethral ligament plication or Pereyra suspension in patients with severe genitourinary prolapse and coexisting clinical or potential stress incontinence. Duration: 6 months 

109 patients with urethrocystocele of ≥grade 2 and a 

positive stress test result with prolapse reduction. Exclusion criteria: urethrocystocele <2, negative stress test results with repositioning, maximum urethral closure pressure <30cm/H20, occurrence of uninhibited detrusor 

contraction of any size during bladder filling, or previous retropubic anti-incontinence surgery. Loss of followup: none 

Cystopexy and 1. Posterior pubourethral ligament placation. 2. Pereyra suspension 

Self reported and clinical stress incontinence -positive stress teresult with repositioning 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F616 

Study Participants Clinical Interventions Outcomes (Incidence) 

Jarvis, 2005 575

RCT to examine the effect of perioperative physiotherapy in women undergoing corrective surgery for pelvic organ prolapse and/or incontinence Duration: 12 weeks 

60 women undergoing corrective surgery for pelvic organ prolapse and/or incontinence, able to follow verbal and written instructions in English. Exclusion criteria: neuromuscular disorders or other significant medical problems, pelvic floor muscle intervention, tension-free vaginal tape. Loss of followup: 6.6% 

Incontinence and/or prolapse surgeries and 1. Preoperative physiotherapy 2. No preoperative physiotherapy 

Paper towel test, urinary symptom specific health anquality of life questionnaire, frequency/volume chart and pelvic fmuscle manometUrinary symptom(frequency, noctuurgency, urge, stincontinence, coiincontinence, nocturnal enuresfrequent urinary tinfections, bladdepain and difficulty passing urine) weestimated with sereported scores, score of 33 indicahigh negative impact. 

Roovers, 2004 637

RCT to examine effects of vaginal hysterectomy and abdominal sacrocolpopexy on urogenital function in women undergoing surgical correction of uterine prolapse stages II-IV. Duration: one year. 

82 women undergoing surgical correction of uterine prolapse stages II-IV. Exclusion criteria: the presence of adnexal mass, history of two or more abdominal pelvic surgical procedures, BMI>35kg/ml, inflammatory bowel or pelvic diseases, fecal incontinence. Loss of followup: 4.9% 

1. Vaginal hysterectomy (combined with anterior and/or posterior colporraphy). 2. Abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function 

Urogenital distresinventory (UDI) to measure discomfof urinary incontinence symptoms Domascores of the UD(from 0 = lowest 100 = highest discomfort) 

Surgical treatments to treat female stress urinary incontinence

Sand, 2000638

RCT to examine effects of modified Burch procedure 

36 women with stress incontinence, low-pressure urethra, and urethral hypermobility (straining cotton swab angle >30 degrees), maximum urethral closure pressure of ≤20cm/H2O in the sitting position, who failed previous 

1. Burch procedures with 4 2-0 polytetrafluoroethylene sutures and tension placed on the periurethral sutures (modified 

Objective cure of stress incontinenas no leakage of urine at maximum 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F617 

Study Participants Clinical Interventions Outcomes (Incidence) 

or suburethral sling on females stress incontinence complicated by a low-pressure urethra. Duration of followup: 3 months 

surgery and medications. Exclusion criteria: significant anterior pelvic support defects. Loss of followup: none 

Tanagho method). 2. Suburethral sling with continuous polytetraflouroethylene strip from rectus fascia into retropubic space and beneath urethra at urethrovesical junction level 

cystometric capaduring coughing Valsalva maneuvin sitting or standposition. Subjectcure as no loss ourine during any activity that increases intraabdominal press

Demirci, 2001 639

RCT to examine effects of pubovaginal sling or Burch colposuspension operations on females with type I/type II genuine stress urinary incontinence. Duration of followup: 1 year 

46 women with type I/type II genuine stress urinary incontinence. Exclusion criteria: preoperative detrusor instability, recurrent genuine stress urinary incontinence, severe pelvic prolapse, Valsalva leak point pressure >90 cm/H20. Loss of followup: 26% 

1. Burch colposuspension (Tanagho); 9 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy. 2. McGuire’s free-rectus fascial sling from inferior leaf of rectus fascia (5 to 6cm in length, 2cm 

center diameter and 1.5cm at either end; 8 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy. 

Self reported urincontinence (dry) urodynamic outcomes. 

Culligan, 2003 640

RCT to examine effects of modified Burch procedure or sling procedure on female stress incontinence with a low-pressure urethra. Duration of followup: 72.6 months 

36 women with urodynamic stress incontinence, lowpressure urethra, urethral hypermobility. Exclusion criteria: significant anterior or apical pelvic floor support defects. Loss of followup: 18% 

1. Burch colposuspension (Tanagho). 2. Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension. 

Objective cure of stress incontinenas negative strestest and negative pad-weight test. Subjective cure ostress incontinenno incontinence episodes on a 1-week voiding diaand voiding functstudies 

Bai, 2005641RCT to examine effects of Burch colposuspension, pubovaginal sling, and tension-free 

92 women with Grade 1 or 2 stress urinary incontinence. Exclusion criteria: detrusor overactivity, urinary tract infection, intrinsic sphincter deficiency, pelvic organ prolapse >stage II. Loss of followup: not reported. 

1. Burch colposuspension. 2. Pubovaginal sling using autologous rectus muscle fascia. 3. Tension-free vaginal tape 

Self reported urincontinence. 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F618 

Study Participants Clinical Interventions Outcomes (Incidence) 

vaginal tape on female stress urinary incontinence. Duration of followup: 12 months Liapis, 2002642

RCT to examine effects of tensionfree vaginal tape or Burch colposuspension on female genuine stress incontinence. Duration of followup: 12-24 months 

72 women with genuine stress incontinence. Exclusion criteria: prolapse >1degree, previous surgical treatment of stress urinary incontinence, and detrusor 

instability. Loss of followup: not reported 

1. Laparoscopic Burch colposuspension. 2. Tension-free vaginal tape procedure 

Objective cure as pad weight difference <1g, aimprovement as reduction of urine loss to less than 50% of urine loss prior to the opera- measured with hour pad test 

Paraiso, 2004643

RCT to examine effects of laparoscopic Burch colposuspension or tension-free vaginal tape procedure on female stress urinary incontinence. Duration of followup: 12 months. The trial was stopped early due to slow recruitment and lack of funding, prior to statistical analysis 

72 females candidates for surgical correction of primary urodynamic stress incontinence , with abdominal leakpoint pressures greater >60cm/H2O (or a positive cough stress test if the patient did not leak with the catheters in place); urethral hypermobility defined as maximal straining cotton-tipped swab angle >30°; and ability to undergo general anesthesia and laparoscopy. Exclusion criteria: previous anti-incontinence surgery; detrusor overactivity on urodynamic studies defined by a rise in the true detrusor pressure not due to bladder compliance of >15cm/H2O; anterior vaginal wall prolapse to or beyond the hymen. Loss of followup: 8.3% 

1. Burch colposuspension (Tanagho). 2. Tension-free vaginal tape procedure. Concomitant procedures were performed in both groups. 

Objective cure as urinary leakage during urodynamstudies. Self reported urinary symptoms using Urogenital DistreInventory with scrange of 0 to 300higher scores indicating greatedistress. Incontinence ImpQuestionnaire wiscore range of 0 400, higher scoreindicating greateadverse impact oquality of life. 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F619 

Study Participants Clinical Interventions Outcomes (Incidence) 

Ustun, 2003644

RCT to examine effects of laparoscopic Burch colposuspension or tension-free vaginal tape procedure on female genuine stress incontinence. Duration of followup: 18 months 

46 women with genuine stress incontinence. Exclusion criteria: not reported. Loss of followup: not reported. 

1. Laparoscopic Burch colposuspension. 2. Tension-free vaginal tape procedure 

Urodynamic outcomes. Objective cure as urinary leakage in urodynamic examSubjective cure ano pad use and nurinary leakage in urodynamic exam 

El-Barky, 2005645

RCT to examine effects of Burch colposuspension or tension-free vaginal tape procedure on female genuine stress incontinence. Duration of followup: 6 months 

50 women with genuine stress incontinence Exclusion criteria: high grade cystocele, previous surgical failure for stress incontinence, uninhibited detrusor contraction during bladder filling on urodynamic study, incompetent internal sphincters. Loss of followup: not reported 

1. Burch colposuspension. 2. Tension-free vaginal tape procedure 

Self reported streurinary incontinen

Wang, 2003646

RCT to examine effects of modified Burch colposuspension tension-free vaginal taping on female genuine stress incontinence. Duration of followup: 1 year 

116 women with genuine stress incontinence. Exclusion criteria: pelvic prolapse, bladder outlet obstruction defined as presence of maximal flow rate of noninvasive uroflowmetry <2ml/second in repeated free uroflow studies combined with detrusor pressure at maximal flow >20cm/H2O or postvoid residual urine >100ml; previous anti-incontinence surgery. 

Loss of followup: 16.3% 

1. Modified Burch colposuspension. 2. Tension-free vaginal taping 

Objective cure as demonstrable involuntary urine during any provocative maneuver in mulchannel urodynatests in the absenof detrusor instabor pad weight 2g less. Objective improvement as decrease in urine loss during pad teby >50% from 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F620 

Study Participants Clinical Interventions Outcomes (Incidence) 

baseline. Subjective cure ano loss of urine during physical exercise. Subjectimprovement as reduction by >50amount of preoperative leakepisode 

Colombo, 1996647

RCT to examine effects of Burch colposuspension or abdominal paravaginal defect repair on female stress urinary incontinence. Duration of followup: 6 months 

36 women with stress urinary incontinence. Exclusion criteria: urethral sphincter weakness (maximum urethral closure pressure <20cm/H20), detrusor instability (occurrence of uninhibited detrusor contraction of any size during bladder filling), and previous failed abdominal antiincontinence procedures. Loss of followup: none. 

1. Burch colposuspension with placement of 2 couples of permanent polybutylate-coated polyester sutures. 2. Abdominal paravaginal defect repair with 5-7 pairs of permanent braided siliconecoated polyester suture. 

Cure as no incontinence episodes by histoand no urine loss stress test Profilometry outcomes. 

Gilja, 1998648

RCT to examine effects of Raz, Burch and transvaginal Burch procedures on females stress urinary incontinence. Duration of followup: 3 years. 

146 women operated on for stress urinary incontinence. 

Exclusion criteria: prior gynecological or urological operation for urinary incontinence and a clear neuropathic condition. Loss of followup: 28%. 

1. Transvaginal Burch procedure. 2. Burch retropubic urethropexy. 3. Modified bladder neck suspension by Raz 

Subjective cure fstress urinary incontinence as nleakage episodes and symptoms. Objective cure as urine loss in urodynamic exam

Berglund, 1996649

RCT to examine effects of retropubic urethrocystopexy or pubococcygeal repair on females stress urinary 

45 women with stress urinary incontinence. Exclusion criteria: age>65 years, previous surgery for stress urinary incontinence, other gynecological diseases necessitating immediate surgical treatment, severe somatic diseases, e.g. diabetes mellitus, neurological diseases, heart failure, chronic kidney disease and psychiatric disorders. Loss of followup: not reported 

1. Retropubic urethrocystopexy. 2. Pubococcygeal repair 

Subjective cure aself reported urincontinence. Objective cure as negative 1hour ptest. 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F621 

Study Participants Clinical Interventions Outcomes (Incidence) 

incontinence. Duration of followup: 12 months Lalos, 1993650

RCT to examine effects of retropubic urethrocystopexy or pubococcygeal repair on females stress urinary incontinence. Duration of followup: 1 year 

45 women with stress incontinence. Exclusion criteria: age>65 years, previous surgery for stress urinary incontinence. Loss of followup: 20% 

1. Retropubic urethrocystopexy. 2. Pubococcygeal repair 

Subjective cure aself reported urincontinence. Objective cure as negative 1hour ptest. 

Osman, 2003 651

RCT to examine effects of anticholinergic treatment or surgery on female urinary incontinence. Duration of followup: 6 months 

75 women with mixed urinary incontinence and negative cystometrogram for detrusor overactivity for >6 months. Exclusion criteria: other treatment for incontinence for ≥3 months, non-sterile urine culture; cystometrogram positive for motor detrusor overactivity and detrusor pressure rise of >5cm/H2O); obstructed uroflow; previous surgery for incontinence; carcinoma in situ and interstitial cystitis. Loss of followup: 9.3% 

1. Burch retropubic suspension (if Valsalva leak-point pressure >90cm/H20) with simple elevation of vaginal wall and periurethral fascia to 1/2way between original position of bladder neck and Cooper ligament Pubovaginal sling (if Valsalva leak-point pressure <90cm/H20) with minimal tension by McGuire. 2. Oxybutynin hydrochloride 5mg 3 times/day 

Self reported symptoms of urinincontinence and urodynamic test 

Costantini, 2007652

RCT to examine effects of sacropexy combined with a Burch colposuspension on urinary incontinence in females with advanced prolapse. Duration of followup: 40 months 

66 consecutive continent patients with advanced prolapse with negative stress test before and after prolapse reduction. Exclusion criteria: history of symptoms of urinary incontinence, positive symptoms questionnaire, and leakage during urodynamics tests. Loss of followup: not reported 

1. Sacropexy combined with a Burch colposuspension. 2. Colposacropexy, no prophylactic colposuspension 

Incidence of ex nurinary incontinenmeasured with Ingelman Sunderberg scale incontinence, Urogenital DistreInventory. Urodynamic outcomes. 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F622 

Study Participants Clinical Interventions Outcomes (Incidence) 

Persson, 2002653

RCT to examine effects of laparoscopic colposuspension or tension-free vaginal tape on female stress urinary incontinence. Duration of followup: 1 year 

79 consecutive women presenting for evaluation of stress urinary incontinence symptoms urethral closing pressure ≥20cm/H2O, urethral functional length ≥25mm, hypermobility of the bladder neck (>45 degrees of down rotation at valsalva maneuver), and >5ml leaking on pad test. Exclusion criteria: predominant urge incontinence, previous surgery for stress urinary incontinence, incontinence after previous vaginal repair, >2 grad uterovaginal prolapse, not having completed childbirth, need of gynecologic surgery, contraindication to incontinence surgery, increased risk for complications during general anesthesia or laparoscopic surgery, i.e. those with cardiovascular disease, known or suspected intra-abdominal adhesions, or abdominal obesity. Loss of followup: 13.9% 

1. Laparoscopic colposuspension. 2. Tension-free vaginal tape by Ulmsten 

Objective cure as leaking at postoperative patest, improvemenless than one thirthe preoperative leakage 

Fatthy, 2001654

RCT to examine effects of laparoscopic or open Burch colposuspension on female genuine stress incontinence. Duration of followup: 18 months 

74 women with genuine stress incontinence. Exclusion criteria: urinary tract infection, detrusor instability, under-active detrusor, intrinsic sphincter deficiency (Valsalva leak point pressure <90cm/H20), limited vaginal mobility, stages III and IV of vaginal prolapse, contraindications to surgery. Loss of followup: 1.4% 

1. Laparoscopic Burch colposuspension with polypropylene suture. 2. Open Burch colposuspension with polypropylene suture 

Cure as no self reported urine losnegative stress teand no leakage in urodynamic examUrodynamic outcomes. 

Kitchener, 2006655

RCT to examine effects of open or laparoscopic colposuspension on female stress urinary incontinence. Duration of followup: 24 months 

291 women with urodynamic stress urinary incontinence requiring colposuspension who failed previous anterior colporrhaphy. Exclusion criteria: comprised detrusor overactivity, previous retropubic surgery, severe obesity. Loss of followup: 7.9% 

1. Open abdominal retropubic colposuspension. 2. Laparoscopic colposuspension 

Objective cure as negative 1-hour ptest (<1g/hour). Subjective cure aresponse of ‘perfectly happy/pleased’ to question 33 of thBristol questionn(If you had to spethe rest of your lifwith your urinary symptoms as the
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F623 

Study Participants Clinical Interventions Outcomes (Incidence) 

are now, how woyou feel?). Quality of life usinUK version of ShForm-36 (SF-36)Bristol Female LoUrinary Tract Symptom questionnaire, Symptom Severitand Symptom Impact Index and EQ-5D. 

Cheon,2003656

RCT to examine effects of laparoscopic and open colposuspension in women with genuine stress incontinence. Duration of followup: 12 months 

90 women with urodynamically proven genuine stress incontinence. Exclusion criteria: intrinsic sphincter deficiency, reduced vaginal capacity or fibrosis, previous anti-continence surgery or intrinsic sphincter deficiency (resting maximum urethral closure pressure <20cm/H2O or Valsalva leak point pressure <60cm/H2O). Loss of followup: not reported. 

1. Laparoscopic colposuspension. 2. Burch open colposuspension 

Objective cure as during severe coon urodynamic testing. Self reported improvement in urinary incontinensymptoms. 

Su, 1997657

RCT to examine effects of laparoscopic or open colposuspensions on female genuine stress incontinence. Duration of followup: 12 months 

92 patients with urodynamically proven genuine stress incontinence. Exclusion criteria: reduced vaginal capacity or fibrosis, uterine prolapse or cystocele>1 Grade, detrusor instability, under-active detrusor or outflow obstruction, previous anti-incontinent surgery or hysterectomy. Loss of followup: none 

1. Laparoscopic colposuspension. 2. Open Burch colposuspension 

Urodynamic outcomes. Objective cure as leakage during urodynamic exam

German, 1994658

RCT to examine effects of modified needle suspension procedure or 

50 women with proven genuine stress incontinence. Exclusion criteria: not reported. Loss of followup: not reported. 

1. Modified needle suspension procedure. 2. Vagina/obturator shelf procedure 

Self reported urincontinence and dnovo urge incontinence. 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F624 

Study Participants Clinical Interventions Outcomes (Incidence) 

vagina/obturator shelf procedure on female genuine stress incontinence. Duration of followup: 2 years Zullo ,2002659RCT to examine effects of transperitoneal laparoscopic urethropexy on female genuine stress incontinence Duration of followup: 12 months 

60 women with mild or moderate genuine stress incontinence. Exclusion criteria: sphincteric dysfunction (urethral pressure <20cm/H20 and Valsalva leak point pressure<60cm/H20), severe stress urinary incontinence. Prolapse >2 grade, previous pelvic or incontinence surgery, severe abdomino-pelvic infection, extensive abdominal adhesions, detrusor instability, other gynecological diseases, BMI>30kg/ml. Loss of followup: 6.7% 

1. Transperitoneal laparoscopic retropubic urethropexy using nonabsorbable sutures. 2. Transperitoneal laparoscopic retropubic urethropexy using polypropylene mesh fixed with tacks or staples 

Objective cure as leakage during cough and Valsamaneuver in standing position with bladder filled maximum cystometric capaduring multichannurodynamic examSubjective cure aself reported continence in Visanalog Scale (0=sensation, 10=severe leakag

Colombo, 2000660

RCT to examine effects of Burch colposuspension or the anterior colporrhaphy in women with both stress urinary incontinence and advanced anterior vaginal wall prolapse. Duration of followup: 14 years 

71 women undergoing surgery for primary genuine stress incontinence and concurrent grade 2 or 3 cystocele (descending at or outside the vaginal introitus) and positive cotton swab test. Exclusion criteria: detrusor instability, previous antiincontinence or prolapse surgery (retropubic or vaginal), concomitant pelvic diseases requiring laparotomy, medical conditions with a high risk of abdominal surgery. Loss of followup: 4.2% 

1. Burch colposuspension with abdominal hysterectomy. 2. Anterior colporrhaphy with vaginal hysterectomy 

Subjective cure ano incontinence episodes. Objective cure as negative stress teresult. 

Quadri, 1999661

RCT to examine effects of Burch colposuspension or Marshall30 women with stress urinary incontinence and low pressure (maximum urethral closure pressure of 

≤20cm/H2O throughout its entire length) and hypermobility 

of the urethra (difference of >30 degrees between results of the cotton swab test performed in the supine position at 

1. Burch colposuspension. 2. Marshall-Marchetti-Krantz urethropexies with videourethroscopic control 

Subjective cure ano incontinence episodes. Objective cure as negative stress te
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F625 

Study Participants Clinical Interventions Outcomes (Incidence) 

Marchetti-Krantz urethropexy with videourethroscopic control on stress urinary incontinence in females with low pressure and hypermobility of the urethra. Duration of followup: 12 months 

rest and during stress and as a straining angle of >30 degrees from the horizontal). Loss of followup: none 

result. 

Colombo, 1994662

RCT to examine effects of Burch colposuspension or modified MarshallMarchetti-Krantz urethropexy on female genuine stress urinary incontinence. Duration of followup: 2-7 years, median 3 years. 

80 women with moderate or severe genuine stress urinary incontinence. Exclusion criteria: urethral sphincter weakness (maximum urethral closure pressure <30cm/H2O), detrusor instability 

(occurrence of uninhibited detrusor contraction of any size during bladder filling), prolapse of genitourinary tract ≥ 2o, 

urethral diverticula, urogenital fistulas, and previous failed abdominal anti-incontinence procedures. Loss of followup: none. 

1. Burch colposuspension. 2. Modified Marshall-MarchettiKrantz urethropexy 

Subjective cure ano incontinence episodes by histoObjective cure as urine loss at strestest. Subjective improvement as clinical score of incontinence decreased from 8 ≤4 or from 4 to ≤2

Bergman, 1995663

RCT to examine effects of Kelly plication, modified Pereyra needle suspension, or Burch urethropexy on female stress urinary incontinence. Duration of followup: 5 years 

127 consecutive women with stress urinary incontinence. Exclusion criteria: failure of previous anti-incontinence procedures, gynecologic disease necessitating hysterectomy, other gynecologic operations, or other indications for laparotomy. Loss of followup: 26.7% 

1. Anterior colporrhaphy with 

Kelly plication. 2. Modified Pereyra needle urethropexy using inclusions of the pubourethral ligaments and endopelvic fascia at the level of the proximal urethra and bladder neck. 3. Burch urethropexy included the basic principles of the Tanagho modification: (1) minimal dissection within 2cm of the urethrovesical junction and urethra, (2) placement of sutures 

Subjective cure aabsence of complaint of persistent incontinence. Objective cure as evidence of loss urine on cough profile during urodynamic evaluation at maximum cystometric capa
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F626 

Study Participants Clinical Interventions Outcomes (Incidence) 

through full thickness of shiny white paravaginal fascia, (3) use of two sutures on each side, one opposite to the urethrovesical junction and another at the level of the midurethra, (4) removal of adipose tissue lateral to the sutures to stimulate fibrosis, and (5) facilitating typing of sutures to the Cooper ligament with intravaginal fingers elevating the anterior vaginal wall. 

Kammerer-Doak , 1999664RCT to examine effects of Burch retropubic urethropexy or modified anterior colporrhaphy on female genuine stress urinary incontinence. Duration of followup: 1 year 

35 women with stress incontinence with grading of prolapse (grades 0–4). Exclusion criteria: incontinence of neurological origin, detrusor instability, history of previous radical pelvic surgery, pelvic radiation, intrinsic sphincteric deficiency (low abdominal leak point and maximal urethral closure pressures <65 and <20cm/H20) and history of interstitial cystitis or urethral syndrome. Loss of followup: 5.7% 

1. Burch retropubic urethropexy by Tanagho. 2. Modified anterior colporrhaphy 

Objective cure as absence of urine during cough and valsalva maneuvthe supine and standing positionwith the bladder fto maximal cystometric capaMultichannel urodynamic outcomes. 20-mipad test, and subjective gradinincontinence sevwith questionnair(0 =none, 4 = mothan one daily), number of incontepisodes (0 = no= with every cougsneeze, or laughand self assessmscore (1 =dry, 10 severe leakage), overall quality of according to the Incontinence ImpQuestionnaire 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F627 

Study Participants Clinical Interventions Outcomes (Incidence) 

Bergman, 1989665

RCT to examine effects of anterior colporrhaphy, revised Pereyra procedure, or Burch retropubic urethropexy on female genuine stress incontinence. Duration of followup: 1 year. 

127 consecutive patients with urodynamic genuine stress 

incontinence. Exclusion criteria: other gynecological diseases necessitating hysterectomy, previous anti incontinence surgery, other indications for laparotomy. Loss of followup: 5.5% 

1. Anterior colporrhaphy with Kelly placation. 2. Modified Pereyra needle urethropexy using inclusions of the pubourethral ligaments and endopelvic fascia at the level of the proximal urethra and bladder neck. 3. Burch urethropexy included the basic principles of the Tanagho modification: (1) minimal dissection within 2cm of urethrovesical junction and urethra, (2) placement of sutures through full thickness of shiny white paravaginal fascia, (3) use of two sutures on each side, one opposite to the urethrovesical junction and another at the level of the midurethra, (4) removal of adipose tissue lateral to sutures to stimulate fibrosis, and (5) facilitating typing of sutures to the Cooper ligament with intravaginal fingers elevating the anterior vaginal wall 

Subjective cure aabsence of complaint of persistent incontinence. Objective cure as evidence of loss urine on cough profile during urodynamic evaluation at maximum cystometric capa

Persson, 2000666

RCT to examine effects of laparoscopic Burch colposuspension using one doublebite or two singlebite sutures on each side of the urethra on female stress urinary incontinence. Duration of followup: 1 year 

161 women with primary stress urinary incontinence, with normal urethral closing pressure and hypermobility of the bladder neck. Exclusion criteria: urge incontinence, stress incontinence due to low urethral closing pressure (< 20cm/H2O) , uterovaginal descent > grade 1 cystocele, incontinence after previous vaginal repair, recurrent incontinence, at increased risk for general anesthesia (i.e.), significant respiratory or cardiac disease, former complications attributable to general anesthesia, age >70 years old) and surgical complications (BMI>35kg/m2), known or suspected intra-abdominal adhesions, history of complications with laparoscopic surgery. Loss of followup: 2.5% 

1. Laparoscopic Burch colposuspension using one double-bite of polytetrafluoroethylene sutures placed on each side of the urethra under transperitoneal video laparoscopy. 2. Laparoscopic Burch colposuspension using two single-bite sutures of polytetrafluoroethylene sutures placed on each side of the urethra under transperitoneal video laparoscopy 

Objective cure as negative pad testImprovement as maximal one third preoperative leakvolume on pad teFailure as > one third of preoperatleaking volume opad test. Subjectcure rate as no reported leakage
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F628 

Study Participants Clinical Interventions Outcomes (Incidence) 

Zullo, 2001667RCT to examine effects of 2 transperitoneal laparoscopic Burch procedures on female genuine stress incontinence. Duration of followup: 1 year 

60 women with mild or moderate genuine stress incontinence. Exclusion criteria: severe genuine stress incontinence (loss of urine with minimal physical activity), prolapse >2o, previous pelvic or anti-incontinence surgery, history of 

severe abdomino-pelvic infections or known extensive abdomino-pelvic adhesions, detrusor instability and/or intrinsic sphincter dysfunction, presence of other gynecologic pathologies (e.g., fibroids, ovarian cysts), BMI>30kg/ml. Loss of followup: 11.7% 

1. Transperitoneal laparoscopic Burch procedure using nonabsorbable sutures. 2. Transperitoneal laparoscopic Burch procedure using Prolene mesh fixed with tacks or staples 

The subjective sereported urine losa visual analog sgraded from 0 (dsensation) to 10 (severe leakage)Subjective failure postoperative visanalog scale valuequal to or highethan that obtainebefore surgery. The objective curfailure as involunloss of urine durincough and Valsamaneuver in the standing position the bladder filled maximal cystomecapacity during clinical observatioabnormal urodyntests. 

Ankardal, 2005668

RCT to examine effects of open Burch colposuspension using sutures with laparoscopic colposuspension using sutures and laparoscopic colposuspension using mesh and staples on female stress UI. Duration of followup: 1 year 

Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component. Exclusion criteria: recurrent incontinence, detrusor instability diagnosed during filling cystometry, other gynaecologic surgery, e.g. hysterectomy or anterior colporaphia. Loss of followup: 1.4% 

1. Open Burch colposuspension using sutures. 2. Laparoscopic colposuspension using sutures. 3. Laparoscopic colposuspension using mesh and staples 

48-hour frequencvolume chart, a 4hour pad test and standardized stretest. Cure was defined a urinary leakage <8g/24 hours. Stress test cure wdefined as urinarleakage <5g. The patients’ degof overall satisfacregarding the resthe operation waalso estimated usa VAS scale (0 = lowest degree of 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F629 

Study Participants Clinical Interventions Outcomes (Incidence) 

satisfaction and 1maximum satisfaction). 

Ankardal, 2004669

RCT to examine effects of open Burch colposuspension using sutures or laparoscopic colposuspension using mesh and staples on female stress urinary incontinence Duration of followup: 1 year 

240 women with genuine stress urinary incontinence or mixed incontinence with a predominant stress component. Exclusion criteria: recurrent incontinence, need of additional gynecological surgery, extremely large 24 hours urinary volumes. Loss of followup: 2.1% 

1. Open Burch colposuspension using sutures. 2. Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

Objective and subjective cure rafrom 48-hour frequency-volumchart, a 48-hour test and a subjecassessment of thwoman's incontinence and quality of life( Visanalog scale gradwith maximum scof 100 for maximbother) 

Ross, 1996670

RCT to examine effects of laparoscopic Burch procedure with mesh and staples or suture technique on female genuine stress incontinence. Duration of followup: 1 year 

69 previously untreated women with genuine stress incontinence and hyper mobile urethrovesical junction. Exclusion criteria: previous incontinence surgery, detrusor instability, inferred intrinsic sphincter dysfunction. Loss of followup: for cure rate not reported. Urodynamic outcomes reported in 30%. 

1. Laparoscopic Burch procedure with sutures for bladder neck elevation. 2. Laparoscopic Burch procedure with mesh and staples for bladder neck elevation 

Objective cure as negative stress te

Klarskov, 1986671

RCT to examine effects of pelvic floor training program or surgery on female genuine urinary stress incontinence. Duration of followup: 4 months 

50 consecutive female patients with genuine urinary stress incontinence Exclusion criteria: previous surgery or pelvic floor training, significant urge incontinence, need of other gynecological surgery (prolapse, hysterectomy), mental impairment. Loss of followup: not reported. 14 patients did not have 

urodynamic exam. 

1. Pelvic floor training program 5 times/week guided by trained physiotherapists. 2. Surgery: Burch colposuspension for anterior suspension defect. Vaginal repair for posterior bladder descent. 

Self reported urinincontinence and cystometric outcomes. 
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F630 

Study Participants Clinical Interventions Outcomes (Incidence) 

Albo, 2007672

RCT of “The Stress Incontinence Surgical Treatment Efficacy Trial” to examine effects of pubovaginal sling, using autologous rectus fascia, or Burch colposuspension on female stress incontinence. Duration of followup: 24 months 

655 women with predominant stress urinary incontinence 

for at least 3 months, positive standardized urinary stress test and urethral hyper mobility. Exclusion criteria: not reported. Loss of followup: 21% 

1. Burch colposuspensions. 2. Pubovaginal sling, using autologous rectus fascia. Key elements of the two surgical procedures were standardized among all participating surgeons (the use of preoperative antibiotics, skin-incision length, number and type of Burch sutures, fascial-sling length and width, and cystoscopic evaluation of the bladder). 

Overall success ano self-reported symptoms of urinincontinence, an increase <15g in weight during a 2hour pad test, no incontinence episodes recordea 3-day diary, a negative urinary stress test (no leakage noted on examination durincough and Valsamaneuvers at a standardized bladvolume of 300mland no retreatmefor urinary incontinence. Incidence if urge incontinence 6 weeks after surgePatient satisfactioassessed with thquestion; (“How satisfied or dissatisfied are ywith the result of bladder surgery related to urine leakage?”). 5 response optionsfrom “completely satisfied” to “completely dissatisfied.” 

Carey, 2006673

RCT to examine the effects of laparoscopic 

200 women with urodynamic stress incontinence who failed conservative therapy. Exclusion criteria: previous retropubic continence surgery, maximum urethral closure pressure <20cm/H2O; 

1. Laparoscopic Burch colposuspension 2. Open Burch colposuspension by Tanagho with 2 polyester 

Cure as absence USI at 6 months following surgerySelf reported qua
Table F131. Surgical interventions on risk and progression of incontinence in women (continued) 

F631 

Study Participants Clinical Interventions Outcomes (Incidence) 

Burch colposuspension and open Burch colposuspension on urinary stress incontinence. Duration of follow up: 6 months 

medically unsuitable for laparoscopic or open surgery; major degrees of coexisting pelvic organ prolapse, requiring surgery other than a simple rectocele repair. Loss of follow up: 12.5% 

sutures in each side and third suture if a cystocele was present 

of life using. The Short Form-36 (S36) with lower scfor better generaphysical, and mehealth; the Short Urinary Distress Inventory (SUDI) Short IncontinencImpact Questionnaire (S
F632 

Table F132. Effects of surgical interventions on improvement of urinary incontinence in females (events) (table sorted by rate oactive group treatment, from highest to lowest) 

Author Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relativ

Risk 

(95%C

Cheon, 2003656N = 90 

Laparoscopic colposuspension 

Burch open colposuspension 

Subjective improvement in stress urinary incontinence 

38 37 80.9 86.0 0.9 (0.8; 1

Persson, 2000666N = 161 

Laparoscopic Burch colposuspension using one double-bite of polytetrafluoroethylene sutures placed on each side of the urethra under transperitoneal video laparoscopy 

Laparoscopic Burch colposuspension using two singlebite sutures of polytetrafluoroethylene sutures placed on each side of the urethra under transperitoneal video laparoscopy 

Subjective improvement 

25 6 32.1 7.2 4.4 

 (1.9; 10

Ankardal, 2004669N = 240 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

Improvement in Visual analog scale 

37 62 30.8 51.7 0.6 (0.4; 0

Improvement in Visual analog scale 

Ankardal, 24 19 30.4 35.8 0.8 (0.5; 12005668N = 121 

Open Burch colposuspension using sutures 

Laparoscopic colposuspension using mesh and staples Improvement 

in Visual analog scale 

24 41 30.4 77.4 0.4 (0.3; 0
Table F132. Effects of surgical interventions on improvement of urinary incontinence in females (events) (table sorted by rate o

active group treatment, from highest to lowest) (continued) 

F633 

Author Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relativ

Risk 

(95%C

Klarskov, 1986671N = 40 

Surgery: Burch colposuspension when patients had anterior suspension defect. Vaginal repair when patients had posterior bladder descent 

Pelvic floor training program 5 times in weekly lessons guided by trained physiotherapists 

Self reported improvement in urinary incontinence 

7 14 26.9 58.3 0.5 (0.2; 0

Berglund, 1996649N = 45 

Retropubic urethrocystopexy 

Pubococcygeal repair 

Improved stress urinary incontinence 

8 3 26.7 20.0 1.3 (0.4; 4

Kitchener, 2006655N = 291 

Laparoscopic colposuspension 

Open abdominal retropubic colposuspension 

Improvement in stress urinary incontinence with <1 leak/month 

39 48 26.5 33.3 0.8 (0.6; 1

Persson, 2000666N = 161 

Laparoscopic Burch colposuspension using one double-bite of polytetrafluoroethylene sutures placed on each side of the urethra under transperitoneal video laparoscopy 

Laparoscopic Burch colposuspension using two singlebite sutures of polytetrafluoroethylene sutures placed on each side of the urethra under transperitoneal video laparoscopy 

Improved pad test 

20 9 25.6 10.8 2.4 (1.1; 4

Lalos, 1993650N = 36 

Retropubic urethrocystopexy 

Pubococcygeal repair 

Improved stress urinary incontinence 

5 3 22.7 21.4 1.1 (0.3; 3

El-Barky, 2005645N = 50 

Burch colposuspension 

Tension-free vaginal tape procedure 

Improved stress urinary incontinence 

4 5 16.0 20.0 0.8 (0.2; 2
Table F132. Effects of surgical interventions on improvement of urinary incontinence in females (events) (table sorted by rate o

active group treatment, from highest to lowest) (continued) 

F634 

Author Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relativ

Risk 

(95%C

Wang, 2003646N = 98 

Modified Burch colposuspension 

Tension-free vaginal taping 

Objective improvement as decrease un urine loss during pad test by >50% from baseline 

5 4 10.2 8.2 1.3 (0.4; 4

Colombo, 1994662N = 80 

Burch colposuspension 

Modified MarshallMarchetti-Krantz urethropexy 

Subjective improvement as clinical score of incontinence decreased; from 8 to ≤4 

or from 4 to ≤2. 

3 6 7.5 15.0 0.5 (0.1; 1

Liapis, 2002642N = 71 

Burch colposuspension 

Tension-free vaginal tape procedure 

Improvement as reduction of urine loss to less than 50% of urine loss at baseline during 1hour pad test 

2 3 6.0 7.0 0.7 (0.1; 3

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F635 

Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events) 

Author Active Treatment Control Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Sand, 2000638N = 36 

Burch procedures with four 2-0 polytetrafluoroethylene sutures and tension placed on the periurethral sutures (modified Tanagho method) 

Suburethral sling with continuous polytetraflouroethylene strip from rectus fascia into Retropubic space and beneath urethra at urethrovesical junction level 

De novo Detrusor instability 

1 4 5.3 23.5 0.2 

(0.0; 1.8) 

Culligan, 2003640N = 36 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension 

De novo Detrusor instability 

1 4 5.3 23.5 0.2 

(0.0; 1.8) 

Laurikainen, 2007629

N = 273 

Retropubic tension-free vaginal polypropylene tape procedure by Ulmsten 

Transobturator tension-free vaginal polypropylene tape procedure by de Leval 

De novo urge symptoms 

3 3 2.2 2.3 1.0 

(0.2; 4.7) 

Paraiso, 2004643N = 72 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Detrusor over activity 

2 6 5.6 16.7 0.3 

(0.1; 1.5) 

Bump, 1996635N = 32 

Needle colposuspension 

Bladder neck endopelvic fascia plication 

Emptying phase dysfunction 

5 7 31.0 43.0 0.7 

(0.3; 1.8) 
Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events) (continued) 

F636 

Author Active Treatment Control Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Demirci, 2001639N = 46 

Burch colposuspension (Tanagho); 9 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy. 

McGuire’s freerectus Fascial sling from inferior leaf of rectus fascia (length 5 to 6cm, 2cm in center diameter and 1.5cm at either end; 8 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy. 

Incidence of Detrusor instability 

1 1 4.3 4.3 1.0 

(0.1; 15.0) 

Incidence of mixed urinary Incontinence 

3 2 8.8 6.3 1.4 

(0.3; 7.9) 

Costantini, 2007652N = 66 

Sacropexy combined with a Burch colposuspension 

Colposacropexy, no prophylactic colposuspension 

Incidence of stress urinary Incontinence 

9 1 26.5 3.1 8.5 

(1.1; 63.1) 

Burch retropubic urethropexy 

Modified bladder neck suspension by Raz 

Incidence of urge urinary incontinence 

1 3 1.8 6.5 0.3 

(0.0; 2.5) 

Gilja, 1998648N = 204 

Transvaginal Burch procedure 

Modified bladder neck suspension by Raz 

Incidence of urge urinary incontinence 

2 3 4.5 6.5 0.7 

(0.1; 4.0) 

Incidence of urinary Incontinence 

12 3 35.3 9.4 3.8 

 (1.2; 12.1) 

Costantini, 2007652N = 66 

Sacropexy combined with a Burch colposuspension 

Colposacropexy, no prophylactic colposuspension 

Incidence of urinary Incontinence in those with MUCP<35cm/H20 

5 2 14.7 6.3 2.4 

(0.5; 11.3) 
Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events) (continued) 

F637 

Author Active Treatment Control Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Incidence of urinary Incontinence in those with MUCP>35cm/H20 

6 1 17.6 3.1 5.6 

(0.7; 44.4( 

El-Barky, 2005645N = 50 

Burch colposuspension 

Tension-free vaginal tape procedure 

Incidence of urinary urgency 

3 2 12.0 8.0 1.5 

(0.3; 8.2) 

German, 1994658N = 50 

Modified needle suspension procedure 

Vagina/obturator shelf procedure 

Incidence of urinary urgency 

2 1 7.7 4.2 1.8 

(0.2; 19.1) 

Open Burch colposuspension using sutures 

Laparoscopic colposuspension using sutures 

Leakage <5g at stress test 

55 43 69.6 81.1 0.9 

(0.7; 1.0) 

Open Burch colposuspension using sutures 

Laparoscopic colposuspension using mesh and staples 

Leakage <5g at stress test 

55 44 69.6 83.0 0.8 

(0.7; 1.0) 

Open Burch colposuspension using sutures 

Laparoscopic colposuspension using sutures 

Leakage<8g/ 24 hour at 48-hour pad test 

56 39 70.9 73.6 1.0 

(0.8; 1.2) 

Ankardal, 2005668N = 211 

Open Burch colposuspension using sutures 

Laparoscopic colposuspension using mesh and staples 

Leakage<8g/24 hour at 48-hour pad test 

56 51 70.9 96.2 0.7 

(0.6; 0.9) 

Ankardal, 2004669N = 240 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using mesh and staples 

Leakage<8g/24 hour at 48-hour pad test 

84 71 70.0 59.2 1.2 

(1.0; 1.4) 

Colombo, 1996633N = 107 

Cystopexy alone Cystopexy with 

posterior pubourethral ligaments plication 

negative cotton swab test 6 months after surgery 

23 40 42.6 75.5 0.6 

(0.4; 0.8) 
Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events) (continued) 

F638 

Author Active Treatment Control Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Kammerer-Doak, 1999664N = 35 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Pad weight <1g 

15 6 78.9 37.5 2.1 

(1.1; 4.1) 

Culligan, 2003640N = 36 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension. 

Positive pad test 

1 0 7.6 0.1 2.7 

(0.1; 62.2) 

Ustun, 2003644N = 46 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Positive QTip test 0 2 0.1 8.6 0.2 (0.0; 4.0) 

Burch urethropexy 

Modified Pereyra needle urethropexy 

Positive Qtip test (>35 degrees) 

1 18 2.6 52.9 0.0 

(0.0; 0.4) 

Bergman, 1989665N = 127 

Burch urethropexy 

Anterior colporrhaphy with Kelly plication 

Positive Qtip test (>35 degrees) 

1 27 2.6 77.1 0.0 

(0.0; 0.2) 

Culligan, 2003640N = 36 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension. 

Positive stress test 

3 0 15.4 0.1 6.3 

(0.3; 113.8)

Brubaker, 2006634N = 322 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Positive Stress testing (bladder volume at maximum cystometric capacity of 300ml) 

7 14 4.7 8.6 0.5 

(0.2; 1.3) 
Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events) (continued) 

F639 

Author Active Treatment Control Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Colombo, 1997636N = 109 

Posterior pubourethral ligament placation 

Pereyra suspension 

Self reported stress urinary incontinence 

20 21 36.4 38.9 0.9 

(0.6; 1.5) 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Self reported symptoms of stress incontinence3 months after surgery 

29 60 19.0 39.7 0.5 

(0.3; 0.7) 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Self reported urge urinary incontinence 3 months after surgery 

10 18 6.8 11.9 0.6 

(0.3; 1.2) 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Self reported urinary urgency 3 months after surgery 

9 14 5.9 9.2 0.7 

(0.3; 1.5) 

Brubaker, 2006634N = 322 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Stress incontinence3 months after surgery 

35 67 23.8 44.1 0.5 

(0.4; 0.8) 

Osman, 2003651N = 75 

Burch retropubic suspension or Pubovaginal sling 

Oxybutynin hydrochloride 5mg 3 times/day 

Stress urinary incontinence 

1 12 2.0 48.0 0.0 

(0.0; 0.3) 

Cystopexy alone Cystopexy with 

posterior pubourethral ligaments plication 

Stress urinary incontinence 1 year after surgery 

4 4 7.4 7.5 1.0 

(0.3; 3.7) 

Colombo, , 1996633N = 107 

Cystopexy alone Cystopexy with 

posterior pubourethral ligaments plication 

Stress urinary incontinence 6 months after surgery 

4 3 7.4 5.7 1.3 

(0.3; 5.6) 
Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events) (continued) 

F640 

Author Active Treatment Control Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Brubaker, 2006634N = 322 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Urge outcome 3 months after surgery 

50 58 32.7 38.4 0.9 

(0.7; 1.2) 

Paraiso, 2004643N = 72 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Urge urinary incontinence 

11 5 30.0 15.0 2.2 

(0.9; 5.7) 

Osman, 2003651N = 75 

Burch retropubic suspension or Pubovaginal sling 

Oxybutynin hydrochloride 5mg 3 times/day 

Urge urinary incontinence 

4 0 8.0 0.0 4.6 

(0.3; 82.0) 

Kammerer-Doak, 1999664N = 35 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Urinary urgency several times/week 

4 8 21.1 50.0 0.4 

(0.2; 1.1) 

Urodynamic stress incontinence 

6 1 16.7 2.8 6.0 

 (0.8; 47.4) 

Paraiso, 2004643N = 72 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Using pads for urinary incontinence 

11 10 30.0 29.0 1.1 

(0.5; 2.3) 

Brubaker, 2006634N = 322 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Bothersome stress incontinence 3 months after surgery 

9 37 6.1 24.5 0.3 

(0.1; 0.5) 

Voiding dysfunction 

7 46 2.0 14.0 0.2 

(0.1; 0.3) 

Incidence of urge incontinence 

11 11 3.3 3.4 1.0 

(0.4; 2.3) 

Postoperativeurge incontinence that needed treatment 

65 87 19.8 26.7 0.7 

(0.6; 1.0) 

Albo, 2007672N = 655 

Burch colposuspension 

Pubovaginal sling, using autologous rectus fascia 

Persistent urge incontinence 

59 79 17.9 24.2 0.7 

(0.5; 1.0) 
Table F133. Effects of surgical interventions on risk and progression of urinary incontinence in females (events) (continued) 

F641 

Author Active Treatment Control Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Treatment failure 

179 151 54.3 46.3 1.2 

 (1.0; 1.4) 

Positive stress test 

74 34 22.5 10.6 2.2 

 (1.5; 3.1) 

Self reported 

urinary stress incontinence

20 23 19.23 23.96 0.80 

(0.47; 1.37) 

Detrusor overactivity 

13 10 12.50 10.42 1.20 

(0.55; 2.61) 

Self reported urinary stress incontinence and/or Detrusor overactivity 

29 30 27.88 31.25 0.89 

(0.58; 1.37) 

Stress incontinence Occasionally 

18 24 17.31 25.00 0.69 

(0.40; 1.19)

Stress incontinence Frequently 

9 5 8.65 5.21 1.66 

(0.58; 4.78) 

Urinary 

urgency: Occasionally 

44 30 42.31 31.25 1.35 

(0.93; 1.96)

Urinary urgency: Frequently 

9 17 8.65 17.71 0.49 

(0.23; 1.04) 

Urge 

incontinence: Occasionally 

334 29 32.69 30.21 1.08 

(0.72; 1.63) 

Carey, 2006673

N = 200 6 months 

Laparoscopic 

Burch colposuspension

Open Burch 

colposuspension 

Urge 

incontinence Frequently 

9 13 8.65 13.54 0.64 

(0.29; 1.43) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group) ; A - avoided; E- excessive events 
F642 

Table F134. Effect of surgical interventions on self reported severity of urinary incontinence in females 

Author Active Control Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95%CI) 

Kammerer-Doak, 1999664N = 35 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Self assessment score (1 =dry, 10 = severe leakage) 

1.0 ± 4.7 5.0 ± 2.7 -1.0 (-1.7; -0

Brubaker, 2006634

N = 322 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Medical, Epidemiological, and Social Aspects of Aging score for stress incontinence (0-never to 3-often for 9 questions) 

13.3 ± 19.0 23.3 ± 24.7 -0.5 (-0.7; -0

Klarskov, 1986671

N = 40 

Surgery: Burch colposuspension when patients had anterior suspension defect. Vaginal repair when patients had posterior bladder descent 

Pelvic floor training program 5 times in weekly lessons guided by trained physiotherapists 

Number of incontinence episodes/3 days 

0.0 9± .3 2.0 ± 12.0 -0.2 (-0.7; 0.

Overall quality of life according to the Incontinence Impact Questionnaire 

0.3 ± 0.2 0.9 ±0.0 -4.3 (-5.5; -3

Incontinence episodes/week 

0.0 ± 4.0 4.0 ± 1.3 -1.3 (-2.0; -0

Kammerer-Doak1999664

N = 35 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Pads/week 0.0 ± 2.7 3.0 ± 0.7 -1.5 (-2.2; -0
Table F134. Effect of surgical interventions on self reported severity of urinary incontinence in females (continued) 

F643 

Author Active Control Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95%CI) 

Brubaker2006634

N = 322 

Sacrocolpopexy with Burch colposuspension 

Sacrocolpopexy alone 

Medical, Epidemiological, and Social Aspects of Aging score for urinary urge (0-never to 3-often for 9 questions) 

11.8 ± 14.0 16.8 ± 18.8 -0.3 (-0.5; -0

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Questionnaire with scores range from 0 to 400, with larger scores indicating greater adverse impact on quality of life. 

38.0 ± 51.0 49.0 ± 38.0 -0.2 (-0.7; 0.

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Urogenital Distress Inventory scores from 0 to 300, larger scores indicating greater distress 

4.0 ± 2.0 6.0 ± 2.0 -1.0 (-1.5; -0

Paraiso, 2004643

N = 72 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Incontinence episodes/week 

0.4 ± 1.6 1.8 ± 5.1 -0.4 (-0.8; 0.

Kitchener, 2006655

N = 291 

Laparoscopic colposuspension 

Open abdominal retropubic colposuspension 

Physical subscale in quality of life (SF-36 scores) 

79.3 ± 27.6 77.6 ± 27.7 0.1 (-0.2; 0.

Ankardal, 2004669

N = 240 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

Quality of life: working ability (100 = maximum bother) 

0.0 ± 0.0 0.0 ± 8.7 
Table F134. Effect of surgical interventions on self reported severity of urinary incontinence in females (continued) 

F644 

Author Active Control Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95%CI) 

Urogenital Distress Inventory–Short Form 

7.0 ± 2.0 7.0 ± 1.0 0.0 (-0.2; 0.

Incontinence Impact Questionnaire–Short Form 

8.0 ± 2.0 7.0 ± 2.0 0.5 (0.3; 0.7

Visual analog scale 

7.0 ± 14.0 6.0 ± 1.0 0.1 (-0.1; 0.

Detrusor Instability Score 

2.0 ± 2.0 2.0 ± 2.0 0.0 (-0.2; 0.

Laurikainen, 2007629

N = 273 

Retropubic tension-free vaginal polypropylene tape procedure by Ulmsten 

Transobturator tension-free vaginal polypropylene tape procedure by de Leval 

Urinary Incontinence Severity Score 

0.7 ± 1.6 0.4 ± 1.0 0.2 (0.0; 0.5

Quality of life: social life (100 = maximum bother) 

Ankardal, 0.0 ± 0.0 0.0 ± 13.3 669N = 240 

Open Burch colposuspension using sutures 

Laparoscopic transperitoneal colposuspension using polypropylene mesh and staples 

Quality of life: physical activity (100 = maximum bother) 

0.0 ± 2.7 1.0 ± 30.7 0.0 (-0.3; 0.

Laurikainen, 629N = 273 

Retropubic tension-free vaginal polypropylene tape procedure by Ulmsten 

Transobturator tension-free vaginal polypropylene tape procedure by de Leval 

Euro Quality-ofLife Five Dimensions Index 

0.9 ± 0.1 0.9 ± 0.1 -0.1 (-0.4; 0.

Urogenital distress inventory scores for overactive bladder 

Roovers, 2004 9.4 ± 2.2 18.1 ± 3.5 -3.0 (-3.6; -2

637

N = 82 

Vaginal hysterectomy (combined with anterior and/or posterior colporraphy) 

Abdominal sacrocolpopexy (with preservation of the uterus) on Urogenital function Urogenital 

distress inventory scores for urinary incontinence 

7.2 ± 2.1 13.2 ± 3.5 -2.1 (-2.6; -1

Carey, 2006673N = 200 

Laparoscopic Burch 

Open Burch colposuspension 

General health

2.60 ± 1.02 2.22 ± 1.06 0.37 (0.09; 0.
Table F134. Effect of surgical interventions on self reported severity of urinary incontinence in females (continued) 

F645 

Author Active Control Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95%CI) 

SF-36 Physical Component Summary

49.54 ± 10.41 49.14 ± 11.21 0.04 

(-0.24; 0.31

SF-36 Mental Component Summary

42.70 ± 13.03 48.31 ± 10.01 -0.48 

(-0.76; -0.20

the Short Urinary Distress Inventory 

23.92 ± 17.90 21.56 ± 16.92 0.14 

(-0.14; 0.41

colposuspension 

Short Incontinence Impact Questionnaire 

31.40 ± 23.83 26.87 ± 29.36 0.17 

(-0.11; 0.45

Bold- significant differences in outcomes at 95% confidence level
F646 

Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures) 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean differenc

(95%CI) 

Demirci, 2001639N = 46 

Burch colposuspension (Tanagho), 9 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy. 

McGuire’s freerectus Fascial sling from inferior leaf of rectus fascia (length 5 to 6cm, 2cm in center diameter and 1.5cm at either end; 8 patients had abdominal hysterectomy with or without bilateral salpingooopherectomy. 

Bladder neck position, (mm) 

25.0 ± 4.6 24.4 ± 3.7 0.2 (-0.4; 0.7) 

Post void residual volume (ml) 

51.8 ± 89.7 31.1 ± 27.0 0.3 (-0.4; 1.0) 

Average flow rate during void (ml/second) 

4.7 ± 3.0 4.8 ± 2.8 0.0 (-0.7; 0.6) 

Maximum cystometric capacity (ml) 

398.0 ± 76.8 444.0 ± 95.9 -0.5 (-1.2; 0.1) 

Functional urethral length (mm) 

25.7 ± 10.0 27.2 ± 7.3 -0.2 (-0.8; 0.5) 

Pressure transmission ratio 

1.1 ± 0.2 1.5 ± 0.4 -1.4 (-2.1; -0.7) 

Culligan, 2003640N = 36 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension. 

Maximum urethral closure pressure (cm/H2O) 

16.4 ± 8.2 39.8 ± 23.0 -1.4 (-2.1; -0.7) 

Ustun, 2003644N = 46 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Bladder capacity, (ml) 

489.4 ± 1,16.0 484. ± 140.1 0.0 (-0.5; 0.6) 

Lalos, Maximal flow rate 19.5 ± 19.7 18.0 ± 10.7 0.1 (-0.6; 0.8) 1993650N = 36 

Retropubic urethrocystopexy 

Pubococcygeal repair Bladder volume, 

(ml) 

567.5 ± 178.3 662.5 ± 171.7 -0.5 (-1.2; 0.1) 
Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures) (continued) 

F647 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean differenc

(95%CI) 

Colombo, 1996647N = 36 

Burch colposuspension with placement of two couples of permanent polybutylate-coated polyester sutures 

Abdominal paravaginal defect repair with 5-7 pairs of permanent braided siliconecoated polyester suture. 

Maximum straining angle at cotton swab test 

17.4 ± 5.8 31.4 ± 11.2 -1.6 (-2.3; -0.8) 

PdetQmax (cm/H2O) 

13.0 ± 18.7 17.0 ± 38.7 -0.1 (-0.5; 0.3) 

Pdetmax (cm/H2O) 

30.0 ± 58.7 28.0 ± 45.3 0.0 (-0.4; 0.4) 

Wang, 2003646N = 98 

Modified Burch colposuspension 

Tension-free vaginal taping 

Residual urine (ml) 

20.0 ± 320.0 20.0 ± 53.3 0.0 (-0.4; 0.4) 

Ustun, 2003644N = 46 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

First desire to mixture (ml) 

158.2 ± 112.5 161.7 ± 58.7 0.0 (-0.6; 0.5 0 

Wang, 2003646N = 98 

Modified Burch colposuspension 

Tension-free vaginal taping 

Volume voided (ml) 

271.0 ± 283.3 255.0 ± 342.7 0.1 (-0.3; 0.4) 

Sand, , 2000638N = 36 

Burch procedures with four 2-0 polytetrafluoroethylene sutures and tension placed on the periurethral sutures (modified Tanagho method) 

Suburethral sling with continuous polytetraflouroethylene strip from rectus fascia into Retropubic space and beneath urethra at urethrovesical junction level 

Pressure transmission ratio 

1.1 ± 0.2 1.5 ± 0.4 -1.4 (-2.1; -0.7) 

Maximum flow rate (ml/second) 

42.9 ± 8.1 35.9 ± 9.3 0.8 (0.2; 1.4) 

Maximum Detrusor activity (cm/H20) 

12.0 ± 6.2 9.2 ± 6.4 0.4 (-0.1; 1.0) 

Ustun, 2003644N = 46 

Laparoscopic Burch colposuspension 

Tension-free vaginal tape procedure 

Leak point pressure (cm/H20) 

68.3 ± 22.3 104.7 ± 9.1 -2.1 (-2.9; -1.4) 

Liapis, 2002642N = 71 

Burch colposuspension 

Tension-free vaginal tape procedure 

Peak flow rate (ml/second) 

25.8 ± 9.5 26.7 ± 9.0 -0.1 (-0.6; 0.4) 
Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures) (continued) 

F648 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean differenc

(95%CI) 

Culligan, 2003640N = 36 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension. 

Average flow rate during void (ml/second) 

 0.58 (-2.5; 4.4) 

Wang, 2003646N = 98 

Modified Burch colposuspension 

Tension-free vaginal taping 

FreeQmax (ml/second) 

19.1 ± 16.2 19.0 ± 19.2 0.0 (-0.4; 0.4) 

Mean pressure transmission %6 weeks after operation 

120.0 ± 22.0 94.0 ± 14.0 1.4 (0.6; 2.2) 

Mean closure pressure (cm/H20) 6 weeks after operation 

16.0 ± 4.0 21.0 ± 12.0 -0.6 (-1.3; 0.1) 

Maximum closure pressure (cm/H20) 6 weeks after operation 

35.0 ± 21.0 27.0 ± 10.0 0.5 (-0.2; 1.2) 

Bump, 1996635N = 32 

Needle colposuspension 

Bladder neck endopelvic fascia plication 

Functional length (mm) 6 weeks after operation 

35.0 ± 12.0 25.0 ± 6.0 1.1 (0.3; 1.8) 

Colombo, 1996633N = 107 

Cystopexy alone Cystopexy with 

posterior pubourethral ligaments plication 

Maximum urethral closure pressure (cm/H2O) 6 months after surgery 

72.8 ± 30.0 75.6 ± 36.4 -0.1 (-0.5; 0.3) 

Bump1996635

N = 32 

Needle colposuspension 

Bladder neck endopelvic fascia plication 

Maximum closure pressure (cm/H20) 6 months after operation 

47.0 ± 29.0 44.0 ± 23.0 0.1 (-0.6; 0.8) 
Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures) (continued) 

F649 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean differenc

(95%CI) 

Needle colposuspension 

Bladder neck endopelvic fascia plication 

Mean closure pressure (cm/H20) 6 months after operation 

25.0 ± 12.0 26.0 ± 12.0 -0.1 (-0.8; 0.6) 

Colombo, 1996633N = 107 

Cystopexy alone Cystopexy with 

posterior pubourethral ligaments plication 

Urethral functional length (mm) 6 months after surgery 

25.7 ± 5.4 28.1 ± 5.3 -0.4 (-0.8; -0.1) 

Functional urethral length (mm) 

25.7 ± 10.0 27.2 ± 7.3 -0.2 (-0.8; 0.5) 

Maximum voiding Detrusor pressure (cm/H2O) 

21.3 ±8.0 28.8 ± 12.3 -0.7 (-1.4; -0.1) 

Average flow rate during void (ml/second) 

4.7 ± 3.0 4.8 ± 2.8 0.0 (-0.7; 0.6) 

Maximum flow rate during void (ml/second) 

10.6 ± 5.3 13.5 ± 6.6 -0.5 (-1.2; 0.2) 

Sand, 2000638N = 36 

Burch procedures with four 2-0 polytetrafluoroethylene sutures and tension placed on the periurethral sutures (modified Tanagho method) 

Suburethral sling with continuous polytetraflouroethylene strip from rectus fascia into Retropubic space and beneath urethra at urethrovesical junction level 

Post void residual volume (ml) 

51.8 ± 89.7 31.1 ± 27.0 0.3 (-0.4; 1.0) 

Bump, 1996635N = 32 

Needle colposuspension 

Bladder neck endopelvic fascia plication 

Functional length (mm) 6 months after operation 

25.0 ± 7.0 25.0 ± 7.0 0.0 (-0.7; 0.7) 

Sand, 2000638N = 36 

Burch procedures with four 2-0 polytetrafluoroethylene sutures and tension placed on the periurethral sutures (modified Tanagho method) 

Suburethral sling with continuous polytetraflouroethylene strip from rectus fascia into Retropubic space and beneath urethra at urethrovesical junction level 

Maximum urethral closure pressure (cm/H2O) 

16.4 ± 8.2 39.8 ± 23.0 -1.4 (-2.1; -0.7) 

Lalos, 1993650N = 36 

Retropubic urethrocystopexy 

Pubococcygeal repair 

Urethral length, (mm) 

25.0 ± 8.7 26.0 ± 6.7 -0.1 (-0.8; 0.5) 
Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures) (continued) 

F650 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean differenc

(95%CI) 

Colombo, 1997636N = 109 

Posterior pubourethral ligament placation 

Pereyra suspension Maximum 

urethral closure pressure (cm/H2O) 

56.2 ± 23.5 70.6 ± 35.9 -0.5 (-0.9; -0.1) 

Culligan, 2003640N = 36 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension 

Maximum voiding Detrusor pressure (cm/H2O) 

21.3 ± 8.0 28.8 ± 12.3 -0.7 (-1.4; -0.1) 

Colombo, 1997636N = 109 

Posterior pubourethral ligament placation 

Pereyra suspension Urethral 

functional length (mm) 

26.8 ± 4.2 25.5 ± 4.9 0.3 (-0.1; 0.7) 

Bump, 1996635N = 32 

needle colposuspension 

Bladder neck endopelvic fascia plication 

Mean pressure transmission % 6 months after operation 

125.0 ± 55.0 104.0 ± 30.0 0.5 (-0.2; 1.2) 

Su, 1997657N = 92 

Laparoscopic colposuspension 

Open Burch colposuspension 

Bladder neck position, rest 

0.8 ± 0.4 0.9 ± 0.5 -0.3 (-0.7; 0.1) 

KammererDoak, 1999664N = 35 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Proximal transmission ratio 

102.4 ± 15.0 77.2 ± 23.0 1.3 (0.6; 2.1) 

Cheon, 2003656N = 90 

Laparoscopic colposuspension 

Burch open colposuspension 

Urine loss in pad test ,g 

3.6 ± 11.1 4.4 ± 20.3 0.0 (-0.5; 0.4) 

Urethral functional test 

Bergman, 2.3 ± 1.3 2.9 ± 1.3 -0.5 (-0.9; 0.0) 1995663N = 127 

Burch urethropexy Modified Pereyra 

needle urethropexy 

Urethral closure pressure 

25.0 ± 10.0 36.0 ± 9.0 -1.2 (-1.7; -0.7) 

Volume at first desire to void, ml 

175.9 ± 65.3 164.4 ± 26.0 0.2 (-0.2; 0.6) 

Maximum cystometric capacity, ml 

344.9 ± 52.7 335.3 ± 40.1 0.2 (-0.2; 0.6) 

Su, 1997657N = 92 

Laparoscopic colposuspension 

Open Burch colposuspension 

Maximal urethral pressure (cm/H20) 

78.3 ± 16.9 82.5 ± 19.8 -0.2 (-0.6; 0.2) 
Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures) (continued) 

F651 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean differenc

(95%CI) 

Urethral closure pressure at rest (cm/H20) 

67.1 ± 16.6 71.2 ± 18.1 -0.2 (-0.6; 0.2) 

Bergman, 1995663N = 127 

Burch urethropexy Modified Pereyra 

needle urethropexy 

Pressure transmission ratio 

89.0 ± 6.0 89.0 ± 10.0 0.0 (-0.5; 0.5) 

Su, 1997657N = 92 

Laparoscopic colposuspension 

Open Burch colposuspension 

Minimal urethral resistance 

0.2 ± 0.2 0.3 ± 0.3 -0.3 (-0.7; 0.1) 

KammererDoak, 1999664N = 35 

Burch retropubic urethropexy 

Modified anterior colporrhaphy 

Midurethral pressure transmission ratio 

94.3 ± 11.0 75.7 ± 13.0 1.6 (0.8; 2.3) 

Bergman, 1995663N = 127 

Burch urethropexy Anterior 

colporrhaphy with Kelly plication 

Urethral functional test 

2.3 ± 1.3 3.1 ± 1.3 -0.6 (-1.1; -0.1) 

Urine loss in 1 hour pad test 

Su, 1.6 ± 4.9 2.9 ± 8.4 -0.2 (-0.6; 0.2) 1997657N = 92 

Laparoscopic colposuspension 

Open Burch colposuspension 

Bladder neck position, stress 

0.2 ± 0.5 0.6 ± 0.6 -0.7 (-1.2; -0.3) 

Urethral closure pressure 

Bergman, 25.0 ± 10.0 44.0 ± 22.0 -1.1 (-1.6; -0.6) 1995663N = 127 

Burch urethropexy Anterior 

colporrhaphy with Kelly plication Pressure 

transmission ratio 

89.0 ± 6.0 74.0 ± 14.0 1.4 (0.9; 1.9) 

Urethral resistance 

0.6 ± 0.1 0.3 ± 0.1 3.0 (2.3; 3.6) 

Detrusor pressure at peak flow, cm/H20 

28.7 ± 12.6 21.4 ± 11.8 0.6 (0.1; 1.0) 

Mean flow, ml/second 

8.8 ± 4.8 6.7 ± 4.2 0.5 (0.0; 0.9) 

Colombo, 1994662N = 80 

Burch colposuspension 

Modified MarshallMarchetti-Krantz urethropexy 

Peak flow. Ml/second 

13.0 ± 5.6 16.5 ± 7.7 -0.5 (-1.0; -0.1) 

Urethral functional length (mm) in cured 

Quadri, 21.5 ± 4.2 23.6 ± 7.5 -0.3 (-1.1; 0.4) 1999661N = 30 

Burch colposuspensions 

Marshall-MarchettiKrantz urethropexy with video urethroscopic control Maximum 

urethral closure pressure (cm/H2O) in cured 

20.3 ± 6.3 23.9 ± 12.1 -0.4 (-1.1; 0.3) 
Table F135. Effect of surgical interventions on progression of urinary incontinence in females (severity measures) (continued) 

F652 

Author Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean differenc

(95%CI) 

Laurikainen, 2007629

N = 273 

Retropubic tensionfree vaginal polypropylene tape procedure by Ulmsten 

Transobturator tension-free vaginal polypropylene tape procedure by de Leval 

Post void residual urine volume 

28.0 ± 49.0 43.0 ± 78.0 -0.2 (-0.5; 0.0) 

Culligan, 2003640N = 36 

Burch colposuspension (Tanagho) 

Suburethral sling (Horbach) with polytetrafluororthylene strip from rectum fascia beneath urethra under minimal tension. 

Maximum flow rate during void (ml/second) 

10.6 ± 5.3 13.5 ± 6.6 -0.5 (-1.2; 0.2) 

Su, 1997657N = 92 

Laparoscopic colposuspension 

Open Burch colposuspension 

Transmission ratio, Q4 

0.3 ± 0.2 0.2 ± 0.2 0.4 (-0.1; 0.8) 

Bold- significant differences in outcomes at 95% confidence level
F653 

Table F136. Effects of radiotherapy on urinary incontinence in adults with adenocarcinoma of the rectum 

Study Participants Clinical Interventions Outcomes 

Peeters, 2005,674

RCT to examine effects of preoperative shortterm radiotherapy in patients treated with total mesorectal excision. Duration of followup: 5 years 

1,861 patients with histologically confirmed adenocarcinoma of the rectum with inferior margin of the tumor had <15cm from the anal verge and below the level of S1 and S2. Exclusion criteria: distant metastases, fixed tumors, locally treated (transanal resected) tumors. Loss of followup: 32%, 597responded to questionnaire. 

1. Radiotherapy with total dose of 25Gy administered in 5 fractions over 5 to 7 days before total mesorectal excision. 2. Total mesorectal excision 

Self reported urinand fecal incontinence with point scale from “never” to “sometimes” (<1/week), “often(>1/ week but noevery day), and “always” (every dafor time-dependesymptoms and fr“no, not at all” to little,” “pretty mucand “very seriousfor time-independsymptoms. 
F654 

Table F137. Effects of radiotherapy on urinary incontinence in 597 adults (38% women) adenocarcinoma of the rectum (events) 

Active Control Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95%CI) 

Num

Need

Tre

(95% 

Total mesorectal excision 

Use of pads for urinary incontinence 

Peeters, 2005 67 62 21.9 21.3 1.0 (0.8; 1.4) 674

Radiotherapy with total dose of 25Gy administered in 5 fractions over 5 to 7 days before total mesorectal excision. 

Total mesorectal excision 

Urinary incontinence 

118 109 38.6 37.5 1.0 (0.8; 1.3) 

Pollack, 2006675N = 1,406 56% female Followup 180 Abdominal rectal resection with preoperative radiotherapy

Abdominal rectal resection without preoperative radiotherapy

Urinary incontinence

29 20 4.87 2.47 1.97 

(1.13, 3.45) 

42 (322
F655 

Table F138. Clinical interventions to reduce risk and progression of urinary incontinence in males with urologic diseases

Study Participants Clinical Interventions Outcomes 

Little, 2003676

Followup RCT to examine effects of radiotherapy for prostate cancer on urinary incontinence and bowel function. Duration of followup: 3 years 

301 patients 3 with histologically confirmed adenocarcinoma of the prostate and no metastatic disease treated with a four-field box technique to a dose of 46Gy. Exclusion criteria: not reported. Response rate 70%. 

1. Radiation with a four-field box technique to a dose of 70Gy arm. 2. Radiation with three-dimensional conformal techniques to generate a sixfield boost plan of a total dose of 78Gy 

Self reported bladder, bowel and sexual function (Fowler) 

Srougi ,2005677

RCT to examine effects of bladder neck mucosal eversion during retropubic radical prostatectomy on urinary incontinence Duration of followup: 6 months 

100 patients with stage T1c–T2c prostate cancer. Exclusion criteria: previous TURP, suprapubic prostatectomy or local radiotherapy; a history of neurological diseases; surgical pathology specimens that showed positive margins at bladder neck. Loss of followup: 5% 

1. Retropubic radical prostatectomy and vesico-urethral anastomosis with bladder neck mucosal eversion. 2. Retropubic radical prostatectomy and vesico-urethral anastomosis without bladder neck mucosal eversion 

Self reported urinary incontinence (more than one pad/day) 

Wasson, 1995678

RCT to examine effects of transurethral resection of the prostate or watchful waiting in men with moderate symptoms

of benign prostatic hyperplasia.Duration of followup: 3 years 

556 men over the age of 54 years with symptoms of benign prostatic hyperplasia. Exclusion criteria: < 55 years old, 

previous prostate surgery or radiation treatment, unable to walk, 

active urinary tract infection not responding to treatment, diagnosed prostate or bladder cancer, residual urinary volume after voiding >350ml, 

serious medical conditions including 

uncontrolled diabetes, neurogenic 

bladder, cirrhosis, active alcoholism, bleeding diathesis, psychosis, and 

late-stage cardiac or respiratory disease, creatinine concentration >3.0mg/deciliter (265 μmol per liter) Loss of followup: 7.4% 

1. Transurethral resection of prostate. 2. Watchful waiting 

Urinary symptoms were scored on a scale ranging from 0 to 27 points with the 

use of a nine-question interview. Persistent incontinence requiring the use of a pad, penile clamp, or condom 
Table F138. Clinical interventions to reduce risk and progression of urinary incontinence in males with urologic diseases (cont

F656 

Study Participants Clinical Interventions Outcomes 

Van Cangh, 1998679

RCT to examine effects of postoperative radiotherapy for locally advanced disease on urinary incontinence. Duration of followup: 3 years 24 months 

100 patients with N0M0 prostate cancer treated with radical prostatectomy for locally advanced disease (positive surgical margin, capsular perforation and/or seminal vesicle infiltration). Exclusion criteria: not reported. Loss of followup: none 

1. 60Gy. external radiotherapy with 18MV photon beams between 12 and 16 weeks after radical prostatectomy. 2. Radical prostatectomy alone 

A validated modified pad weighing test by the International Continence Society: grade 0 - dry-< 1gm. with no pads, grade 1 –“minimal” between 1 and 9gm with 1 to 4 pads, grade 2 –“moderate” 10 -50gm. with 1 to 4 pads (soaked) and grade 3 “severe”- >50gm. with >4 pads 

Srougi ,2001680

RCT to examine effects of bladder neck preservation and resection radical retropubic Prostatectomy. Duration of followup: 6 months 

70 patients with clinical stage T1 or T2 prostate cancer who were scheduled for radical prostatectomy and 2 patients with T3a with small prostatic nodules that may have been invading the prostatic capsule but with no established periprostatic tumor extension. Exclusion criteria: transurethral prostate resection, neurogenic dysfunction of the lower urinary tract. Loss of followup: 1.4% 

1. Radical retropubic prostatectomy with bladder neck preservation according to the technique described by Malizia. 2. Radical retropubic prostatectomy with bladder neck resection according to that of Walsh, . 

Self reported urinary continence (1 or no protective pad daily) 

Ghaly, 2003681

RCT to examine effects of supplemental beam radiation on prostate brachytherapy-related urinary incontinence. Duration of followup: 12 months 

Trial 1: 106 low-risk patients, with Gleason Grade 2–6, prostatespecific antigen (PSA) 4–10ng/ml, Trial 2: 108 intermediate-risk patients, with Gleason Grade 7 or higher or PSA of 10—20ng/ml Exclusion criteria: not reported. Loss of followup: not reported. 

Trial 1: 1. I-125 (144Gy, TG-43) I-125 source strength ranged from 0.4 to 0.89mCi (median .55mCi). 2. Pd-103 (125Gy, NIST-99) and Pd103 source strength ranged from 1.6 to 2.0mCi (median 2.0mCi). Trial 2: 1. Pd-103, delivering 90Gy (with 44Gy external beam irradiation delivered with a four-field arrangement, designed to cover the prostate and seminal vesicles with a 2cm margin (reduced to 1.0cm posteriorly). 2. Pd-103, delivering 115Gy 20Gy external beam irradiation delivered with a four-field arrangement, designed to cover the prostate and seminal vesicles with a 2cm margin (reduced to 1.0cm posteriorly). 

Self reported urinary incontinence using standard American Urologic Association (AUA) Grade 1: Occasional use of incontinence pads (<1/week), Grade 2: Intermittent use of incontinence pads (<1/day), Grade 3: Regular use of incontinence pad or self-catheterization, Grade 4: Permanent catheter or surgical intervention 
Table F138. Clinical interventions to reduce risk and progression of urinary incontinence in males with urologic diseases (cont

F657 

Study Participants Clinical Interventions Outcomes 

Imamoglu, 2005682

RCT to examine effects of macroplastique injection with artificial urinary sphincter implantation on postprostatectomy incontinence. Duration of followup: 48-60 months 

45 patients with urinary incontinence for >6 months after radical retropubic prostatectomy, transvesical prostatectomy, and transurethral prostatectomy. Exclusion criteria: radiotherapy for prostate carcinoma, minimum bladder capacity of 150cc, detrusor instability or hyperreflexia. Loss of followup: not reported. 

1. Artificial urethral sphincter implantation. 2. Macroplastique injection (polydimethylslioxane elastomer implants as the solute component and hydrogel as the carrier) of 5–7.5cc above or around the striated sphincter region of the urethra submucosally. 

Minimal incontinence was defined as total number of pads, total weight of pads. Continent (“dry”)- no need to use pads; ‘‘socially continent’’ - <1pad; ‘incontinent’’- >1pad/day 

Deliveliotis, 2005 683

RCT to examine effects of applying local steroids to the neurovascular bundles of the prostate after bilateral nerve-sparing radical retropubic prostatectomy. Duration of followup: 12 months 

60 potent men <60 years old undergoing bilateral nerve-sparing radical retropubic prostatectomy for clinically localized prostate cancer Exclusion criteria: allergy to steroids, assistance to obtain erections. Loss of followup: not reported. 

1. 10ml of betamethasone cream 0.1% was applied locally to both neurovascular bundles. 2. Usual neurovascular bundles with no corticoid cream. 

Urinary continence - wearing no pads or one pad that remained dry. 

Parsons , 2004684

Placebo controlled RCT to examine effects of postoperative methylprednisolone on urinary incontinence after nerve-sparing radical retropubic prostatectomy. Duration: 6 days Duration of followup: 12 months 

70 potent men ≤ 60 years old, undergoing bilateral nerve-sparing radical retropubic prostatectomy for clinically localized adenocarcinoma of the prostate. Exclusion criteria: no sexual partner, prior history of an allergic reaction to steroids, prior steroid use, or active use of sildenafil citrate for the treatment of erectile dysfunction. Loss of followup: 11.4%. 

1. Methylprednisolone beginning on postoperative day 1: 24mg intravenously on postoperative day 1, 20mg orally on day 2, 16mg orally on day 3, 12mg orally on day 4, 8mg orally on day 5, and 4mg/orally on day 6. 2. Placebo. 

Urinary continence as participant-reported wearing no pads or a single pad that remained dry. 
Table F138. Clinical interventions to reduce risk and progression of urinary incontinence in males with urologic diseases (cont

F658 

Study Participants Clinical Interventions Outcomes 

Akakura, 1999685

RCT to examine effects of radical prostatectomy versus radiotherapy with the combination of endocrine therapy on urinary incontinence. Duration of followup: 58.5 months 

100 patients 75 years old or younger with a performance status of 0 or 1 and adenocarcinoma of the prostate by needle core biopsy before treatment. Exclusion criteria: obvious enlargement of pelvic lymph nodes by computed tomography or magnetic resonance imaging. Loss of followup: 5%. 

1. Radical prostatectomy with pelvic lymph node dissection with 300mg of diethylstilbestrol diphosphate/day 8 

weeks before surgery or radiation, and continued thereafter. 2. External beam radiation by linear accelerator with 40 to 50Gy to the whole pelvis and a 20Gy boost to the prostatic area and with 300mg of diethylstilbestrol diphosphate/day 8 weeks before surgery or radiation, and continued thereafter 

Urinary incontinence using quality-of-life questionnaire of EORTC. 

Fransson, 2001686

RCT to examine effects of radiotherapy for localized prostate carcinoma. Duration of followup: 30-40 months 

166 patients with localized prostate carcinoma cytologically or histologically verified as T1a-T2, G1-G2, pN0, and M0. Exclusion criteria: expected survival <10 years. Loss of followup: 35%. 

1. Radiotherapy with a total dose of 4.8Gy (range, 62.3–70.0Gy) given for 5 days a week, 2Gy per fraction. 2. Active surveillance 

Self reported urinary and fecal incontinence using validated symptom specific self-assessment questionnaire, QUFW94 with values between 0 and 10; 0 - “no problem/very good function” and 10 - “many problems/very bad function.” 

Gupta, 2002687

RCT to examine effects of transurethral vesection of the prostate or vapor resection of prostate on urinary incontinence. Duration of followup: 1 year 

100 patients with benign prostatic hyperplasia and prostate size >40cc. Exclusion criteria: finasteride preoperatively, histopathologic adenocarcinoma of the prostate. Loss of followup: not reported 

1. Transurethral vesection of the prostate with the thick vapor resection loop using electrosurgical generator with settings of 120 to 150W and 50 to 70W for cutting and coagulating. 2. Transurethral resection of the prostate with standard wire loop using electrosurgical generator with settings of 70 to 80W and 40 to 50W for cutting and coagulating 

Self reported urinary incontinence using International Prostate Symptom Score. Urodynamic outcomes. 

Gallucci ,1998688

RCT to examine effects of transurethral electrovaporization of the prostate on urinary incontinence. Duration of followup: 12 months 

150 patients with symptoms due to obstructive benign prostatic hypertrophy, urodynamically obstructed. Exclusion criteria: complete urinary retention, bladder calculi, neurogenic bladder, prostate weight>70g, bladder cancer, prostate cancer, mental illness. Loss of followup: none 

1. Transurethral electrovaporization of the prostate. 2. Transurethral resection of the prostate 

I-PSS score. Urodynamic outcomes 
Table F138. Clinical interventions to reduce risk and progression of urinary incontinence in males with urologic diseases (cont

F659 

Study Participants Clinical Interventions Outcomes 

Wilson, 2006689

RCT to examine effects of holmium laser enucleation of the prostate or transurethral resection of the prostate for treatment of men with bladder outflow obstruction secondary to benign prostatic hyperplasia. Duration of followup: 24 months 

61 men with bladder outflow obstruction secondary to benign prostatic hyperplasia and prostate size 40-200g, maximum urinary flow rate of 15 ml/second or less, American Urological Association symptom score of ≥8, post-void residual assessment of less than 400ml, and urodynamic Schaffer grade 2 or greater. Exclusion criteria: prostatic carcinoma, catheterization, history of previous urethral or prostatic surgery. Loss of followup: 21.3% 

1. Holmium laser enucleation of the prostate with maximum power set at 100W for each case. 2. Transurethral resection of the prostate with a tungsten cutting wire at 160W cutting and 80W coagulating current 

Urinary incontinence using American Urological Association symptom score. Maximum urinary flow rates 

Steineck , 2002690

RCT to examine the effects of radical prostatectomy or watchful waiting of incontinence in patients with localized cancer. Duration of follow up: 12 months after surgery and 14 months after randomization 

376 men <75 years with life expectancy >10 years (as judged by the attending physician) from the Scandinavian Prostatic Cancer Group Study # 4, with localized prostate cancer (T0d, T1, or T2 and grade 1 or 2 according to the criteria of the World Health Organization Against Cancer). Exclusion criteria: previously diagnosed cancer, concurrent disorder considered to increase the risk of operative mortality, or inability to comply with treatment and followup. Loss of follow up: 13.3% 

1. Radical prostatectomy 2. Watchful waiting with no advice for initial radical therapy was given 

Self reported urinary incontinence using the Spielberger’s Trait Measure from the State–Trait Anxiety Inventory 
F660 

Table F139. Effects of clinical intervention on urinary continence in males (events) (sorted by rate of urinary continence after ahighest to lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

(95%C

Srougi, 2001680N = 70 

Radical Retropubic prostatectomy with bladder neck preservation according to the technique described by Malizia 

Radical Retropubic prostatectomy with bladder neck resection according to that of Walsh et. al. 

Urinary continence using 1 or no pad daily 

30 36 96.8 92.3 1.0 (0.9; 

Imamoglu, 2005682N = 24 

Macroplastique injection (polydimethylslioxane elastomer implants as the solute component and hydrogel as the carrier) of 5–7.5cc above or around the striated sphincter region of the urethra submucosally. 

Artificial urethral sphincter implantation. 

Self reported urinary continence in patients with minimal baseline incontinence 

8 10 80.0 90.9 0.9 (0.6; 

Van Cangh, 1998679N = 100 

60Gy. external radiotherapy with 18MV photon beams 12 - 16 weeks after radical prostatectomy 

Radical prostatectomy alone 

Complete Urinary continence 

37 43 77.0 83.0 0.9 (0.8; 
Table F139. Effects of clinical intervention on urinary continence in males (events) (sorted by rate of urinary continence after a

highest to lowest) (continued)

F661 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

(95%C

‘‘socially continent’’ - <1pad/day in patients with total baseline incontinence 

Imamoglu, 5 2 38.5 18.2 2.1 (0.5; 2005682N = 24 

Macroplastique injection (polydimethylslioxane elastomer implants as the solute component and hydrogel as the carrier) of 5–7.5cc above or around the striated sphincter region of the urethra submucosally. 

Artificial urethral sphincter implantation. 

‘‘socially continent’’ - <1pad/day in patients with minimal baseline incontinence 

1 1 10.0 9.1 1.1 (0.1; 
F662 

Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence affrom lowest to highest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatme

nt 

Relative R

(95%CI

Gupta*, 2002687N = 100 

Transurethral vesection of the prostate with the thick vapor resection loop using electrosurgical generator with settings of 120 to 150W and 50 to 70W for cutting and coagulating 

Transurethral vesection of the prostate with standard wire loop using electrosurgical generator with settings of 70 to 80W and 40 to 50W for cutting and coagulating 

Self reported urinary incontinence 

0 2 0.0 4.0 0.2 (0.0; 4

Gallucci*, 1998688N = 150 

Transurethral resection of the prostate 

Transurethral electro vaporization of the prostate 

Transient stress urinary incontinence 

0 13 0.1 18.6 0.0 (0.0; 0

Ghaly, 2003681N = 54 

I-125 (144Gy, TG43) I-125 source strength ranged from 0.4 to 0.89mCi (median .55mCi) 

Pd-103 (125Gy, NIST-99) and Pd103 source strength ranged from 1.6 to 2.0mCi (median 2.0mCi) 

Regular use of incontinence pad or selfcatheterization incontinence pad or selfcatheterization for urinary incontinence 

1 5 1.0 10.0 0.2 (0.0; 1

Wasson*, 1995678N = 556 

Transurethral resection of prostate 

Watchful waiting High residual 

urinary volume 

3 16 1.1 5.8 0.2 (0.1; 0

Gallucci*, 1998688N = 150 

Transurethral resection of the prostate 

Transurethral electro vaporization of the prostate 

Stress urinary incontinence 

1 4 1.3 5.7 0.2 (0.0; 1
Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence af

from lowest to highest) (continued)

F663 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatme

nt 

Relative R

(95%CI

Wasson*, 1995678N = 556 

Transurethral resection of prostate 

Watchful waiting Persistent 

urinary incontinence 

4 4 1.4 1.4 1.0 (0.2; 3

Van Cangh, 1998679N = 100 

60Gy. external radiotherapy with 18MV photon beams 12 - 16 weeks after radical prostatectomy 

Radical prostatectomy alone 

Severe urinary incontinence with implantation of artificial sphincter 

1 1 2.1 1.9 1.1 (0.1; 16

Gallucci*, 1998688N = 150 

Transurethral resection of the prostate 

Transurethral electro vaporization of the prostate 

Urge urinary incontinence 

2 0 2.5 0.1 4.4 (0.2; 89

Incident of stress incontinence 

Wilson*, 1 0 3.3 0.1 3.0 (0.1; 702006689N = 61 

Holmium laser enucleation of the prostate with maximum power set at 100W for each case 

Transurethral resection of the prostate with a tungsten cutting wire at 160W cutting and 80W coagulating current 

Incident of urge incontinence 

1 0 3.3 0.1 3.0 (0.1; 70

Little, 2003676N = 301 

Radiation with a fourfield box technique to a dose of 70Gy arm 

Radiation with three-dimensional conformal techniques to generate a sixfield boost plan of a total dose of 78Gy 

Wears protection for urinary incontinence 

4 5 3.7 4.9 0.8 (0.2; 2

Ghaly, 2003681N = 108 

Pd-103, delivering 90Gy (with 44Gy external 

Pd-103, delivering 115Gy, 20Gy external beam irradiation delivered with a 

Regular use of incontinence pad or selfcatheterization incontinence 

3 5 5.0 10.0 0.5 (0.1; 2
Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence af

from lowest to highest) (continued)

F664 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatme

nt 

Relative R

(95%CI

beam irradiation delivered with a fourfield arrangement, designed to cover the prostate and seminal vesicles with a 2cm margin (reduced to 1.0cm posteriorly). 

four-field arrangement, designed to cover the prostate and seminal vesicles with a 2cm margin (reduced to 1.0cm posteriorly). 

pad or selfcatheterization incontinence pad or selfcatheterization for urinary incontinence Nocturia present: 4-5 times/night 

7 7 6.5 6.8 1.0 (0.3; 2

Stress urinary incontinence: Leakage with cough/sneeze 

7 7 6.5 6.8 1.0 (0.3; 2

Little, 2003676N = 301 

Radiation with a fourfield box technique to a dose of 70Gy arm 

Radiation with three-dimensional conformal techniques to generate a sixfield boost plan of a total dose of 78Gy Urinary 

Incontinence amount: >1 Tablespoon/day 

7 2 6.5 1.9 3.3 (0.7; 15

Great distress 14 5 7.41* 2.67 2.77 

(1.02; 7.5

Urinary problems affecting sexual life :Moderately or severely 

15 5 7.94* 2.67 2.97 

(1.10; 8.0

Steineck, 2002690N = 376

12 months

Radical prostatectomy 

Watchful waiting 

Great distress from all urinary symptoms 

15 8 7.94* 4.28 1.86 

(0.81; 4.2
Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence af

from lowest to highest) (continued)

F665 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatme

nt 

Relative R

(95%CI

Regular dependence on diaper or urine bag 

23 1 12.17* 0.53 22.76 

(3.10; 166

Moderate or severe leakage 

30 3 15.87* 1.60 9.89 

(3.07; 31.

Fransson, 2001686N = 166 

Radiotherapy with a total dose of 4.8Gy (range, 62.3–70.0Gy) given for 5 days a week, 2Gy per fraction. 

Active surveillance 

Use of pad for urinary incontinence 

10 1 17.5 2.1 8.3 (1.1; 62

Imamoglu, 2005682N = 24 

Macroplastique injection (polydimethylslioxane elastomer implants as the solute component and hydrogel as the carrier) of 5–7.5cc above or around the striated sphincter region of the urethra submucosally 

Artificial urethral sphincter implantation. 

Self reported urinary continence in patients with total baseline incontinence 

3 8 23.1 72.7 0.3 (0.1; 0
Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence af

from lowest to highest) (continued)

F666 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatme

nt 

Relative R

(95%CI

Moderate or 

great distress 

from all 

urinary 

symptoms 

44 28 23.28* 14.97 1.55 

(1.01; 2.3

Steineck, 2002690N = 376

12 months

Radical prostatectomy 

Watchful waiting 

Moderate or 

great distress 

from urinary 

leakage 

47 15 24.87* 8.02 3.10 

(1.80; 5.3

Urinary Incontinence frequency: >once per day 

Little, 26 30 24.1 29.1 0.8 (0.5; 12003676N = 301 

Radiation with a fourfield box technique to a dose of 70Gy arm 

Radiation with three-dimensional conformal techniques to generate a sixfield boost plan of a total dose of 78Gy 

Urinary Incontinence present 

40 32 37.0 31.1 1.2 (0.8; 1

Steineck, 2002690N = 376

12 months

Radical prostatectomy 

Watchful waiting Regular 

dependence on some form of protective aid 

71 16 37.57* 8.56 4.39 

(2.65; 7.2

Imamoglu, 2005682N = 24 

Macroplastique injection (polydimethylslioxane elastomer implants as the solute component and hydrogel as the carrier) of 5–7.5cc above or around the striated sphincter region of the urethra submucosally. 

Artificial urethral sphincter implantation. 

Urinary incontinence: >1pad/day in patients with total baseline incontinence 

5 1 38.5 9.1 4.2 (0.6; 3
Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence af

from lowest to highest) (continued)

F667 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatme

nt 

Relative R

(95%CI

Akakura, 1999685N = 100 

Radical prostatectomy with pelvic lymph node dissection with 300mg of diethylstilbestrol diphosphate/day 8 weeks before surgery or radiation, and continued thereafter 

External beam radiation by linear accelerator with 40 to 50Gy to the whole pelvis and a 20Gy boost to the prostatic area and with 300mg of diethylstilbestrol diphosphate/day 8 weeks before surgery or radiation, and continued thereafter 

Urinary incontinence using qualityof-life questionnaire of EORTC 

22 0 40.0 1.0 35.5 

(2.2; 569

Steineck, 2002690N = 376

12 months

Radical prostatectomy 

Watchful waiting Leakage once 

a week or more often 

80 33 42.33* 17.65 2.40 

(1.69; 3.4

Little, 2003676N = 301 

Radiation with a fourfield box technique to a dose of 70Gy arm 

Radiation with three-dimensional conformal techniques to generate a sixfield boost plan of a total dose of 78Gy 

Urge urinary incontinence: Leakage with full bladder 

47 37 43.5 35.9 1.2 (0.9; 1

Wilson*, 2006689N = 61 

Holmium laser enucleation of the prostate with maximum power set at 100W for each case 

Transurethral resection of the prostate with a tungsten cutting wire at 160W cutting and 80W coagulating current 

Self reported regained urinary incontinence 

15 8 50.0 26.7 1.9 (0.9; 3
Table F140. Effects of clinical interventions on urinary incontinence in males (events) (sorted by rate of urinary incontinence af

from lowest to highest) (continued)

F668 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatme

nt 

Relative R

(95%CI

Steineck, 2002690N = 376 12 months 

Radical prostatectomy 

Watchful waiting At least some 

leakage 

101 53 53.44* 28.34 1.89 

(1.45; 2.4

Sroug, 2005677N = 100 

Retropubic radical prostatectomy and vesicourethral anastomosis with bladder neck mucosal eversion 

Retropubic radical prostatectomy and vesico-urethral anastomosis without bladder neck mucosal eversion 

Urinary incontinence 

44 43 91.7 91.5 1.0 (0.9; 1

Bold- significant differences in outcomes at 95% confidence level; *- the patients were continent at baseline (no baseline UI reported); Nhave avoided or excessive outcome in 1 patient =1/(rate of the outcome in the control – rate of the outcome in the active group); Numbe

1000*(rate of the outcome in the control – rate of the outcome in the active group); A - avoided; E - excessive events 
F669 

Table F141. Effect of surgical intervention on perceived urinary incontinence in males (severity measures) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Differen

(95%C

Ghaly, 2003681

N = 54 

I-125 (144Gy, TG-43) I-125 source strength ranged from 0.4 to 0.89mCi (median .55mCi) 

Pd-103 (125Gy, NIST-99) And Pd103 source strength ranged from 1.6 to 2.0mCi (median 2.0mCi) 

Self reported urinary scores American Urologic Association and Radiation Therapy Oncology Group criteria 

0.2 ± 0.0 0.1 ± 0.0 11.0 (9.5; 

Ghaly, 2003681

N = 108 

Pd-103, delivering 90Gy (with 44Gy external beam irradiation delivered with a four-field arrangement, designed to cover the prostate and seminal vesicles with a 2cm margin (reduced to 1.0cm posteriorly). 

Pd-103, delivering 115Gy 20Gy external beam irradiation delivered with a four-field arrangement, designed to cover the prostate and seminal vesicles with a 2cm margin (reduced to 1.0cm posteriorly). 

Regular use of incontinence pad or self-catheterization incontinence pad or self-catheterization incontinence pad or self-catheterization for urinary incontinence 

0.3 ± 0.1 0.3 ± 0.1 0.0 (-0.4; 

Wasson, 1995678

N = 556 

Transurethral resection of prostate 

Watchful waiting Bother from urinary 

difficulties on a scale ranging from 0 (greatest impairment) to 100 (least impairment). 

75.7± 23.9 57. ± 28.3 0.7 (0.5; 

Wilson2006689N = 61 

Holmium laser enucleation of the prostate with maximum power set at 100W for each case 

Transurethral resection of the prostate with a tungsten cutting wire at 160W cutting and 80W coagulating current 

Urinary incontinence using American Urological Association symptom score 

6.1 ± 1.0 5.2 ± 0.8 1.0 (0.5; 
Table F141. Effect of surgical intervention on perceived urinary incontinence in males (severity measures) (continued)

F670 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Differen

(95%C

Fransson, 2001686

N = 166 

Radiotherapy with a total dose of 4.8Gy (range, 62.3–70.0Gy) given for 5 days a week, 2Gy per fraction. 

Active surveillance 

Self reported urinary incontinence0 - “no problem/very good function” and 10 - “many problems/very bad function.” 

1.5 ± 2.7 0.6 ± 1.4 0.4 (0.0; 

Wilson, 2006689

N = 61 

Holmium laser enucleation of the prostate with maximum power set at 100W for each case 

Transurethral resection of the prostate with a tungsten cutting wire at 160W cutting and 80W coagulating current 

Urinary incontinence using American Urological Association symptom score 

4.6 ± 0.7 4.7 ± 0.9 -0.1 (-0.6; 

Bold- significant differences in outcomes at 95% confidence level 
F671 

Table F142. Effect of surgical interventions on progression of urinary incontinence in males (urodynamic measures) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD After 

Control 

Treatment 

Mean Difference 

(95%CI) 

Ch

From 

(9

Wasson, 1995678N = 556* 

Transurethral resection of prostate 

Watchful waiting 

Peak urinaryflow rate (ml/sec) 

17.8 ± 9.1 12.7 ± 7.6 0.6 (0.4; 0.8) 4.8 

Maximum urinary flow rate 

Wilson*, 21.0 ± 2.0 19.3 ± 2.2 0.8 (0.3; 1.3) 4.2 2006689N = 61 

Holmium laser enucleation of the prostate with maximum power set at 100W for each case 

Transurethral resection of the prostate with a tungsten cutting wire at 160W cutting and 80W coagulating current 

Maximum urinary flow rate 

21.3 ± 2.1 18.9 ± 2.8 1.0 (0.4; 1.5) 5.1 

Gallucci*, 1998688N = 150 

Transurethral resection of the prostate 

Transurethral electro vaporization of the prostate 

Post void residual volume (ml) 

3.2 ± 17.5 5.2 ± 20.4 -0.1 (-0.4; 0.2) -2.1 

Wasson, 1995678N = 556 

Transurethral resection of prostate 

Watchful waiting 

Residual urinary volume (ml) 

51.0 ± 54.0 72.0 ± 73.0 -0.3 (-0.5; -0.2) -0.5 

* Patients with benign prostate diseases; Bold - significant differences in outcomes at 95% confidence level 
F672 

Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women 

Study Participants Clinical Interventions Outcomes 

Goldstein, 2005691

Placebo-controlled RCT to examine the efficacy and safety of raloxifene for osteoporosis prevention in postmenopausal women. Duration: 36 months 

619 women age 40 - 60 years, postmenopausal (naturally or surgically), with a hysterectomy no more than 15 years before beginning study, serum estradiol ≤73pmol/l (≤ 20pg/ml) and follicle-stimulating hormone 

≥40 IU/l. Exclusion criteria : history of breast carcinoma or estrogen-dependent tumors, cancer within the last 5 years (except excised skin cancers), estrogen therapy (other than vaginal estrogens), progestin, androgen, calcitonin, or systemic corticosteroids within the previous 6 months, a history of thromboembolic disorders or diabetes mellitus or other endocrine disorders requiring therapy (except thyroid hormone replacement), or serious postmenopausal symptoms. Loss of followup 4.5%; Discontinuation - adverse events (17.6%), 

personal reasons (11.0%). The percentage of women missing at least 20% of study medication was similar across the groups (10% to 14%; P

= 0.71) 

1. Raloxifene HCl 60mg/day. 2. Raloxifene HCl 150mg/day. 3. Conjugated equine estrogen 0.625mg/day 4. Placebo supplement of 400/600mg/day elemental calcium 

Self-reported new worsening urinarincontinence rateas "mild," "moderate," or "severe." 

Vardy, 2003692

Placebo-controlled RCT to examine urogenital effects of raloxifene, tamoxifen, conjugated equine estrogen, and placebo in healthy postmenopausal women Duration: 5 month 

100 healthy white postmenopausal women > 1 year from last menstrual period, age 45 - 70 years, with normal mammogram within 6 months of 

the study and free from any serious acute or chronic medical disorder. Exclusion criteria: previous hysterectomy or reconstructive pelvic surgery, intake of estrogen, calcitonin, fluoride steroid, or diuretic 

therapy within 6 months, contraindication to hormone replacement therapy or either SERM 

1. 0.625mg/day conjugated equine estrogen 2. 20mgday tamoxifen 3. 60mg/day raloxifene 4. Placebo 

Weekly symptom diaries to report urinary urgency, frequency, and incontinence rankas “new,” “worsened,” “improved,” or “remained the same.” Pelvic organ prolapse quantitation. Urethral axis deflection by cottswab. 

Warming, 2003693

Placebo-controlled RCT To examine the adverse events after 12 month treatment with levormeloxifene and followup of 12 

234 generally healthy women, age 45 - 65 years, at least 1 year postmenopausal and with an intact uterus. Exclusion criteria: known or suspected acute or chronic disease, or 

taking medication known to interfere with the results of the study. Completed 12 months treatment 77% Withdrawn at the end of 12 months 0.7% Included in followup 78% Withdrawn during followup (adverse event) 0.3% Completed 12-month followup 77% 

1. Levormeloxifene at 1.25 ,5, 10, or 20mg/per day, 2. Continuous combined HRT (17β-oestradiol 1 

mg and norethisterone acetate 0.5mg per 

Self-reported urinincontinence (including worsenof a previously existing conditionUtero-vaginal prolapse detectetransvaginal ultrasonography 
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F673 

Study Participants Clinical Interventions Outcomes 

months without treatment. 

day). 3. Placebo: calcium supplement 500/mg/day 

Steinauer, 2005694

Placebo-controlled RCT The Heart Estrogen/progestin Replacement Study to examine HRT for the prevention of heart disease events in women with established heart disease Duration: 4.2 years 

1,208 postmenopausal women age <80 years, with coronary heart 

disease and an intact uterus who reported no loss of urine in the 

previous 7 days at baseline Loss of followup: 1 participant taking hormone therapy discontinued due to adverse reactions, 58 died, and 5 failed to return, and 11 were lost to followup for other reasons. Placebo group: 60 died, 5 failed to return, and 12 were lost to followup for other reasons. 

The compliance rates were 80% in the placebo group and 68% in the hormone groups

1. Conjugated estrogen (0.625mg) and medroxy

progesterone acetate (2.5mg) in 1 pill 2. Identical looking placebo 

Self-reported urinincontinence (including worsenof a previously existing conditionStress incontinenunintentionally leaking some urinwith coughing, sneezing, straininlaughing, or lifting Urge incontinencunintentionally leaking some urinbefore getting to bathroom. Weekly incontine>1 episodes in thprevious week 

Hendrix, 2005695Placebo-controlled RCT. Women's Health Initiative Study to examine effects of HRT in preventing coronary heartdisease and hip fractures in postmenopausal women. Duration: 1 year 

25,597 women age 50 to 79 years, postmenopausal, and likely to reside in the study area for 3 years with adherence rate of 80% or greater 

during 4-week placebo run-in. 

Exclusion criteria: breast cancer, other invasive cancer in the last 10 years, venous thromboembolism, hypertriglyceridemia, medical condition likely to result in death within 3 years, or unwillingness to be 

randomized to placebo, severe menopausal symptoms. Loss of followup: in 1st group 0.2% deceased and 0.1% lost to followup, 9.7% and 6.6% in placebo stopped taking study pills for various reasons. 

Adherence 74% and 81% in the placebo group at 1 year. 

2nd active group: 0.4% deceased, 8.4% and 8.0% in placebo stopped taking study pills for various reasons. Adherence: 77.4% and 81.4% in placebo at 1 year. 

1. 0.625mg/day conjugated equine estrogen plus 2. 5mg/day of 

medroxyprogesterone acetate 2. 0.625mg/day conjugated equine estrogen 3. Placebo estrogen plus 

progestin 4. Placebo estrogen alone 

Self-reported incident at 1 yearPrevalent incontinence: eve

leaking any amouof urine. Stress incontinenleaking of urine during a cough, laugh, sneeze, lifstand up or exerc

Urge incontinencleaking of urine before getting to toilet. Mixed incontinena combination of stress and urge 
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F674 

Study Participants Clinical Interventions Outcomes 

symptoms. Continence – no leaking urine oncduring the past ye

or no longer leakurine. Changes in self-reported frequency, amou(barely noticeablesoaked underpansoaked through touter clothing), limitations in daily activities (never tvery often), and bother/disturbanc(not at all to very disturbing) as besame, or worse 

Vestergaard, 2003696RCT of The Danish Osteoporosis Prevention Study (DOPS) to examine effects of HRT for primary prevention of osteoporotic fractures in healthy recently postmenopausal women. Duration: 5 years. 

1,006 women age (45-58 years) from a random sample of 47,720 with intact uterus and 3-24 months past last menstrual bleeding or experiencing perimenopausal symptoms (including irregular menstruations), the latter combined with elevated serum follicular stimulating hormone (FSH), and hysterectomised women age 45-52 

years with elevated FSH. Exclusion criteria: (1) Metabolic bone disease, including osteoporosis defined as nontraumatic vertebral fractures on X-ray. (2) Current oestrogen use or oestrogen use within the past 3 months. (3) Current or past treatment with glucocorticoids <6 months. (4) Current or past malignancy. (5) Newly diagnosed or uncontrolled chronic disease. (6) Alcohol or drug addiction 

1. Sequential oestrogen and progestogen (28 day cycle: 2mg oestradiol for the first 12 days, 2mg oestradiol and 1mg norethisterone acetate for the next 10 days followed by 1mg oestradiol for 6 days, in women with intact uterus 2. Continuous oestradiol 2mg/day in hysterectomised women 3. No HRT 

Self reported presence of incontinence. Symptom scores were recorded on modified Greene scale (range 0-4 0 equaling no symptoms, and 4 maximal symptom
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F675 

Study Participants Clinical Interventions Outcomes 

Goldstein, 2002697

Placebo-controlled RCT to examine different doses of levormeloxifene for the treatment of postmenopausal osteoporosis and prevention of vertebral compression fractures in elderly women. Planned duration: 3 years, stopped after 10 months 

2,924 generally healthy women age ≥65 years, with diagnosed 

osteoporosis. Exclusion criteria: known or suspected hormone-dependent or other cancers, previous myocardial infarctions, deep venous thrombosis, corticosteroid treatment, or endometrial thickness >8mm, as gauged by transvaginal ultrasound scanning. Loss of followup: 9.6% before the trial was discontinued because of adverse events and other reasons that included noncompliance 

1. 0.5 or 1.25mg of levormeloxifene 2. Placebo: Daily dietary supplement of 800/1000mg calcium and 400IU vitamin D 

Self reported new urinary incontinenmicturition frequency, and thfrequency of urinincontinence as aadverse event 

Kok, 1999698

Randomized non controlled clinical trial to examine effects of HRT for endometrial protection in healthy postmenopausal women. Duration: 6 months 

102 healthy postmenopausal nonhysterectomized women amenorrhoeic for at least 12 months with postmenopausal status confirmed by 

elevated serum FSH (>35 IU/l) and LH (>10 IU/l) levels and decreased oestradiol (<120pmol/l) levels. Loss of followup: 7% stopped HRT due to irregular bleeding episodes, lack of medication compliance and lack of improvement of climacterial complaints other than urinary complaints 

2mg 17 betaestradiol continuously combined with one of four doses (2.5, 5, 10, or 15mg) of dydrogesterone. No placebo group: before-after comparison in one active group 

Diurnal micturitionumber of reportvoids during the dfrequency as mothan seven times day. Nocturnal micturition - numof times one has get up to void at night and nocturicondition with mothan two voids a night 

Long, 2006699RCT to examine effects of oral and vaginal estrogen therapy on the lower urinary tract in postmenopausal 

57 hysterectomised, postmenopausal women with serum FSH level of >40 IU/l and an E2 level of <20pg/ml. 

Exclusion criteria: vasoactive medication, prior breast or endometrial cancer, diabetes, anemia (Hg <10g/dl), urinary tract infection, use of HRT in the previous 12 months, and non visible periurethral vessels during ultrasonographic assessment. 16 patients interrupting ET were excluded from the analysis 

1. Oral 0.625mg of conjugated equine estrogen per tablet 2. Topical 0.625mg conjugated equine estrogen per 1g vaginal cream 

The Bristol FemaLower Urinary TrSymptoms Questionnaires astandardized urindiary to report episodes of total, urge, and stress 
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F676 

Study Participants Clinical Interventions Outcomes 

women with prior hysterectomy Duration: 3 months 

urinary incontinenand episodes of stress urinary incontinence/wee

Jackson, 2002700

Placebo-controlled RCT to examine effects of HRT in improvement of quantity or quality, of pelvic collagen in postmenopausal women. Duration: 6 months 

67 postmenopausal women with urodynamic diagnosis of genuine stress incontinence without symptomatic prolapse. 55 consented to vaginal 

biopsy and were randomized. Loss of followup: 3 dropped the trial due to personal reasons, vaginal discharge, and advice from general practitioner. 3 preferred not to undergo a second biopsy. 49 women included in the analysis 

1. Oestradiol valerate 2mg/day. 2. Placebo 

Clinical improvemin urinary incontinence diagnosed with urodynamic tests 

Fantl, 1996701

Placebo-controlled RCT to examine efficacy of cyclic postmenopausal hormone replacement in treating urinary incontinence in hypo estrogenic women. Duration: 3 months 

83 hypo estrogenic women 45 years or older, who reported involuntary loss of urine at least once a week. Exclusion criteria: institutionalization, permanent catheterization, 

impaired mental status, functional disability limiting use of the toilet (alone or assisted), neuropathic or uncontrolled metabolic conditions, chronic urinary tract infection, reversible causes of urinary incontinence, or major contraindications for the use of estrogen therapy. Loss of followup: none 

1. Conjugated equine estrogens (0.625mg) and medroxyprogesterone (10mg) cyclically. 2. Placebo 

Number of incontinent episodes/week recorded in standardized urindiary. Amount of fluid lo(measured by a standardized pad test) and the numof voluntary diurnand nocturnal micturition per weobtained with the same diary technique. 
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F677 

Study Participants Clinical Interventions Outcomes 

Jackson,1999702

Placebo-controlled RCT to examine effect of hormone replacement therapy on postmenopausal urinary stress incontinence Duration: 6 months 

67 post-menopausal women with genuine stress incontinence confirmed with urodynamic evaluation, not taking hormone replacement therapy. Exclusion criteria: history of cancer of the endometrium, liver, or breast; 

endometrium more than 4mm thick. Loss of followup: 5 women did not complete the trial; one woman underwent surgical treatment 

1. Oestradiol valerate 2mg daily. 2. Placebo 

Urinary diary to report subjective incontinence symptoms, frequency, and severity. Standard perineapad test, and urodynamic evaluation to measure functioncapacity, detrusopressure, voiding flow, post-micturiresidual, and voluat first desire to micturate 

Ishiko, 2001703

RCT to examine effects of combination pelvic floor muscle exercise and estriol on postmenopausal stress incontinence. Duration: 2 years 

73 women with postmenopausal stress incontinence. Exclusion criteria: urge or mixed incontinence. Loss of followup: 6 women withdrew for personal reasons, one due to adverse effects 

1. Combination of estriol (1 mg/day) and pelvic floor muscle exercise 2. Pelvic floor muscle exercise alone 

Standardized questionnaire to report severity of stress incontinenscored ranked m(10-17), moderat(18-23), and seve(24-26) incontineContinent rate in groups 

Rufford, 2003704

Placebo-controlled RCT to examine the effect of systemic estrogen on the 'urge syndrome' in postmenopausal women. Duration: 6 months 

40 postmenopausal women (>1 year at menopause) with the 'urge syndrome'; with estradiol <150pmol/l in women after hysterectomy with no contraindication for estrogen therapy. Exclusion criteria: medication treatment of urge syndrome, diuretics, 

HRT, history of diabetes, endometrial thickness >4mm urinary tract infection, pelvic masses and urogenital prolapse. Loss of followup: 11 women decided not to participate 

1. 25mg 17 betaestradiol implant subcutaneous tissue. 2. Placebo implant 

Urodynamic outcome; frequenvolume chart with self reported incontinence symptoms 
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F678 

Study Participants Clinical Interventions Outcomes 

Ahlstrom, 1990705

Placebo-controlled crossover RCT to examine effects of estrogen with alpha-adrenoreceptor agonist compared to estrogen alone on incontinence in postmenopausal women. Duration: 6 weeks 

29 postmenopausal women with slight to severe stress urinary incontinence and estrogen deficiency symptoms confirmed during urodynamic exam. Exclusion criteria: use of hypotensives, neuroleptics, sedatives, antihistamines, ephedrine, HRT, bacteriuria, history of breast cancer. 

Loss of followup: none, one woman was excluded from the analysis due to failure in medication 

1. Estriol 4mg/day and 50mg phenylpropanolamine twice daily. 2. Estriol 4mg/day and placebo 

Urodynamic outcomes : meamaximum urethrapressure, mean maximum urethraclosure, mean functional urethralength, and abdominal presstransmission ratio the urethra 

Cardozo, 1993706

Placebo-controlled multicenter RCT to examine effects of oestriol in treatment of postmenopausal sensory and motor urge incontinence. Duration: 3 months 

64 postmenopausal women with symptoms of sensory and motor urge incontinence, at least 1 year without menstruation, FSH>40UI/l and oestradiol <220pmol/l. Exclusion criteria: voiding difficulties, incontinence before menopause, pelvic anatomical defect requiring surgery, neurological disease, medications to treat incontinence. Loss of followup: 27% 

3mg oral oestriol/day. Placebo 

Self reported incontinence episodes/day. Urodynamic outcomes. 

Kinn, 1988707

Cross-over RCT to examine effects of oral estriol, phenylpropanolamine, and its combination on stress urinary incontinence in postmenopausal women Duration: 4 weeks/treatment 

36 women 1 or more years after post-menopause with stress incontinence verified with urodynamic examination. Exclusion criteria: use of hormones, alpha-agonists and alphaantagonists, urinary tract infection. Loss of followup: 16.6% 

1. Oral estriol (Triovex, 2mg x 1) + Placebo. 2. Phenylpropanolamine (Kontexin, 50mg x 2) + Placebo. 3. Combination of oral estriol and phenylpropanolamine 

Micturition schedrecorded in the dUrodynamic outcomes. 

Wilson, 1987708

Placebo-controlled RCT to examine 

36 postmenopausal women with stress incontinence confirmed with urodynamic examination. Exclusion criteria: outflow obstruction, use of HRT, urinary tract infection. 

1. Cyclical treatment with piperazine 

7-day bladder churethral pressure profiles (UPP) 
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F679 

Study Participants Clinical Interventions Outcomes 

effect of oestrogens in treatment of genuine stress incontinence in postmenopausal women Duration: 3 months 

Loss of followup: 6%. oestrone sulphate 

2. Placebo 

Waetjen, 2004709

RCT to examine effects of treatment with raloxifene on urinary incontinence in postmenopausal women. Duration: 3 years. 

Multiple Outcomes of Raloxifene trial included women age ≤80 years, >2 years past menopause, who met the World Health Organization criteria for osteoporosis. Exclusion criteria: use of estrogen, progestins, or androgens within 6 months of enrollment, known or suspected cancer, abnormal uterine bleeding, history of thromboembolic disease, and secondary causes of osteoporosis. Loss of followup: 21% 

Daily supplements of 400 to 600IU of cholecalciferol and 500mg of calcium raloxifene 60mg/day or raloxifene 120mg/day Placebo 

Severity of incontinence usinthe validated San4-level index: mimoderate, severeand very severe. “Worsened” – sescore was higher years after basel“no change” whethere was no chafrom baseline, an“improved” if the severity score decreased. The effect of incontinence on dactivities in 0 (noto 10(most of the time). The effect incontinence on feeling with scale from 0 (not at all) 10 (extremely disturbing) 

Grady, 2001710

RCT to examine the effects of postmenopausal hormone therapy on severity of 

2,763 postmenopausal women < 80 years with coronary disease and intact uteri- from the Heart and Estrogen/Progestin Replacement Study. The outcomes are reported for 1,525 women who reported at least one episode of incontinence/week at baseline. Exclusion criteria: average compliance with treatment <80% by pill count Loss of follow up: 21% and 16% in active and placebo groups 

1. 0.625mg/day of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate in one 

Self reported severity of incontinence as  -improved (decrease of at le2 episodes/week
Table F143. Effects of hormone replacement therapy on risk and progression of urinary incontinence in women (continued) 

F680 

Study Participants Clinical Interventions Outcomes 

urinary incontinence. Duration of follow up: 4.1 years 

respectively (excluded from analysis because of bad compliance). tablet 

2.Placebo 

-unchanged (chaof at most 1 episode/week), -worsened (increof at least 2 episodes/week) 
F681 

Table F144. Effects local estrogen therapy on progression of urinary incontinence in women 

Study Participants Clinical Interventions Outcomes 

Von Holst, 2000711

Placebo controlled RCT with initial screening phase (phase I), a 3-month placebocontrolled phase (phase II) and a 3-month open followup phase (phase III) to examine the efficacy and tolerability of a continuously applied 7-dayEstradiol patch in the treatment of hysterectomised women with postmenopausal complaints compared with placebo Duration: 6 months 

186 hysterectomised women age 40-65 years, with postmenopausal complaints, normal gynecological history and examination, serum estradiol < 30pg/ml and follicle stimulating hormone > 30IU/ml. Exclusion criteria: use of sex hormones taken orally within the last 28 days; locally-applied sex hormones within the last 21 days or injectable sex hormones within the last 6 months. Loss of followup: one patient did not receive any study medication and 12 patients (5 in active and 7 in placebo group) were excluded from the intention-to-treat analysis of the placebo-controlled phase due to lack of availability of efficacy data 

1. 7-day-Estradiol patch (1.5mg estradiol/week or 50mg estradiol/24 hours). All patients received active drug therapy (7-days). Estradiol patch) for a further 3 months (three cycles). 2. Placebo onceweekly 

The sum of scorefor self-reported incontinence symptoms that occurred since thprevious visit. Thseverity of these symptoms was assessed on a fopoint scale (0; no symptoms, 1; milsymptoms; 2; moderate sympto3; severe and hesymptoms). 

Waetjen, 2005712

Placebo-controlled RCT to examine effect of ultra lowdose transdermal estradiol (E2) on incontinence in postmenopausal women Duration: 2 years 

417 postmenopausal women age 60-80 years, with a uterus and at least 5 years after menopause, with normal bone mineral density for age (z score not below –2.0 at the lumbar spine). Exclusion criteria: use of estrogen or progestin within 3 months of 

randomization or having unexplained uterine bleeding, endometrial 

hyperplasia or an endometrium 5mm or more in double-wall thickness, abnormal mammogram, breast cancer, a history of metabolic bone disease, cancer, coronary disease, cerebrovascular disease, uncontrolled hypertension, uncontrolled thyroid disease, liver disease, fasting triglycerides >300mg/dl, or fasting glucose >180mg/dl. Loss of followup: 10%. 83% of the women in active group and 77% in the placebo group continued to use their assigned patch; 84% in both groups used at least 75% of their patches 

1. 14mg of transdermal E2 per day. 2. Placebo. 

Self-reported streIncontinence: leakage “while coughing, sneezistraining, laughinor lifting”; and urgincontinence: “an urge to urinate ancould not get to ttoilet fast enoughChanges in frequency of incontinence from baseline to 4 moand 2 years as 
Table F144. Effects local estrogen therapy on progression of urinary incontinence in womenwomen (continued) 

F682 

Study Participants Clinical Interventions Outcomes 

“worsened”: episodes increasby 2 or more per week; “unchangefrequency changby no more than episode per wee“improved”: incontinence episodes per weedecreased by 2 omore 

Holtedahl, 1998713

RCT to examine effects of conservative treatment for urinary incontinence Duration: 6 months for controlled trial 

95 women, 50-74 years of age with regular incontinence (>2 leakage episodes per month) diagnosed during gynecological examinations, with positive pad test, or self reported in 48 hour chart. Exclusion criteria: Cardiac pacemaker, dementia, medical conditions that would prevent following the protocol. Loss of followup: 3 patients were found protocol deviant and excluded 

from the analysis. 

1. Local estrogen in vagitories or jelly plus physiotherapy and electrostimulation 2. Delayed treatment 

1. Change in sevof incontinence frstart of treatment (index range 0-8)2. Change in impfrom start of treatment (index range 0-4). 3. Quantitative measures in relato micturition. 4. Criteria based classification; curimproved, unchanged, wors

Dessole, 2004 714

Placebo-controlled RCT to examine the efficacy and safety of intravaginal estriol administration on urinary incontinence, urogenital atrophy, and recurrent urinary tract infections in postmenopausal women. 

88 postmenopausal women with incontinence confirmed by the direct visualization of loss of urine from the urethra during the standard stress 

test and by urodynamic investigation. Exclusion criteria: estrogen treatment, anatomical lesions of the urogenital tract, detrusor over activity and abnormal maximal cystometric capacity; presence of severe systemic disorders, thromboembolic diseases, biliary lithiasis, previous breast or uterine cancer, abnormal 

uterine bleeding, and body mass index of ≥25kg/ml. 

Loss of followup: 11 women, 4 due to discomfort and 3 due to local adverse reactions 

1. Intravaginal estriol ovules: 1 ovule/day (1mg) for 2 weeks and then 2 ovules/week for 6 months. 2. Placebo: vaginal suppositories 

Self-reported urinincontinence complaints as nomild, moderate, osevere. Cured: change fr“mild,” “moderate“severe” to “noneImproved – chanfrom “moderate” “mild” or from “severe” to “moderate/mild.” Urodynamic outcomes: mean 
Table F144. Effects local estrogen therapy on progression of urinary incontinence in womenwomen (continued) 

F683 

Study Participants Clinical Interventions Outcomes 

Duration: 6 months 

maximum urethrapressure, mean maximum urethraclosure, mean functional urethralength, and abdominal presstransmission ratio the urethra. Urethrocystometroutcomes. 

Zullo, 2005632RCT to examine the efficacy of tension-free vaginal tape procedure and topical estrogen therapy on overactive bladder symptoms in menopausal women. Duration: 6 months 

59 women with confirmed urodynamic stress incontinence, at least 1 year at menopause status, with serum estradiol <150pmol/l after hysterectomy, without contraindications to local estrogen therapy or to vaginal surgery. Exclusion criteria: urogenital prolapse above grade 1, detrusor over 

activity, intrinsic urethral sphincter deficiency, previous urogynecologic surgery, endometrial thickness more than 4mm, previous estrogen therapy within the past 6 months, unexplained uterine bleeding, or history of diabetes mellitus or insipidus, congestive cardiac failure, diuretic therapy, or neoplasms. Loss of followup: 3 eligible patients (5%) refused to participate 

1. Tension-free vaginal tape procedure plus postoperative vaginal estrogen: 1 estriol ovule/day (1mg) for 1 month, then 2 ovules a week for the 5 months. 2. Tension-free vaginal tape procedure alone 

Self-reported urinsymptoms using standardized questions (International Continence Sociedefinition). Urodynamic outcomes. 

Mikkelsen, 1995715Placebo-controlled RCT to examine effects of low-dose vaginal treatment with oestradiol before vaginal operation. Duration: 3 years 

47 postmenopausal women (>1 year after menopause) scheduled for vaginal repair operation for genital descensus, 7 patients with urinary stress incontinence. Exclusion criteria: previous breast and uterine malignancies and other hormone dependent neoplasm, genital bleeding, acute thrombophlebitis. Loss of followup: 3 patients preferred conservative treatment, one died, 43 patients included in the analysis. 

1. Vagifem (25mg/day oestradiol) administered as vaginal pessaries 3 weeks prior to surgery. 2. Placebo administered daily as vaginal pessaries 3 weeks prior to surgery. 

Self perceived satisfaction with ttreatment resultspresented as currate. 

Akhila, 2006716

RCT to examine the clinical efficacy of oral hormone 

116 menopausal women with self-reported post-menopausal symptoms. Exclusion criteria: contraindications for hormone replacement therapy Loss of followup: 28 women excluded from the analysis. 

1. Conjugated equine oral estrogen 0.625mg/day. 

Self reported urinsymptoms of incontinence 
Table F144. Effects local estrogen therapy on progression of urinary incontinence in womenwomen (continued) 

F684 

Study Participants Clinical Interventions Outcomes 

therapy, percutaneous gel, and transdermal patch in incontinent menopausal women. Duration: 1 year 

2. Estradiol gel percutaneous 1.25g/day. 3. Transdermal patch with 50mg/day estradiol 

Lose, 2000717RCT to examine the efficacy of an oestradiolreleasing vaginal ring and oestriol pessaries on lower urinary tract symptoms in postmenopausal women. Duration: 24 weeks 

251 women reporting at least one bothersome lower urinary tract symptom after spontaneous or surgical post menopause. Exclusion criteria: known or suspected oestrogen-dependent neoplasia or malignancy, vaginal bleeding, clinically significant liver diseases, acute or intermittent porphyria, uterovaginal prolapse II-III, sex hormone treatment within 6 months, vaginal irritation or atrophy or ulceration. Loss of followup: none 

1. Oestradiolreleasing ring, 7.5mg oestradiol. 2. Oestriol pessaries 0.5mg every second day. 

Subjective scores urgency, frequennocturia, dysuriastress incontinenand urge incontinence. 

Chompootaweep 1998, 718RCT to examine Effects of combined contraceptive intravaginal pill and standard conjugated estrogen cream on urogenital symptoms in postmenopausal Thai women. Duration: 8 weeks 

40 postmenopausal women with urogenital symptoms related to estrogen deficiency. Exclusion criteria: thromboembolic disorders, severe liver diseases, estrogen-dependent tumors, high blood pressure (diastolic >140mm/Hg). Loss of followup: none. 

1. Combined contraceptive intravaginal 1 pill/week at bedtime with 250mg levonorgestrel +30mg ethinyl estradiol. 2. Intravaginal conjugated estrogen cream (1g=0.625mg conjugated equine estrogens) at bedtime, 3/week in week 1, 2/week in week 2, and then 1/week for the 6 weeks 

Self reported urinurgency 
Table F144. Effects local estrogen therapy on progression of urinary incontinence in womenwomen (continued) 

F685 

Study Participants Clinical Interventions Outcomes 

Blom,1995,719

Crossover RCT to examine effects of a transdermal estradiol delivery system, alone and in combination with naproxen, in elderly women with confirmed urge incontinence. Duration: 8 weeks, 2 week washout period. 

19 ambulant elderly women (52 years and older) with confirmed urge incontinence. Exclusion criteria: history of breast and endometrial cancer, thromboembolic disorders, severe hypertension, cardiac failure, diabetes mellitus, peptic ulceration. Loss of followup: 15.8% 

1. Estradiol transdermal therapeutic system (0.05mg estradiol/day). 2. Estradiol transdermal therapeutic system (0.05mg estradiol/day) combined with naproxen 250mg tablets twice daily. 3. Placebo matching estradiol transdermal therapeutic system 

Bladder-diary chawith frequency of urination, nocturiand episodes of incontinence. Cystometric outcomes 
F686 

Table F145. Effects of hormone therapy on urinary continence in females (events) (sorted by the rate of continence after the ac

highest to lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Estradiol gel percutaneous 1.25g/day 

Transdermal patch with 50mg/day estradiol 

Akhila, % cured 26 40 90.0 100.0 0.9 (0.8; 1.0) 2006716N = 116 

Conjugated equine estrogen 0.625mg/day orally 

Transdermal patch with 50mg/day estradiol 

% cured 19 40 40.0 100.0 0.4 (0.3; 0.6) 

Waetjen, 2004709N = 963 

Raloxifene 60mg/day or raloxifene 120mg/day 

Placebo Continence 

at 3 years 

243 125 38.2 38.5 1.0 (0.8; 1.2) 

Rufford, 2003704N = 40 

25mg 17 betaestradiol implant subcutaneous tissue 

Placebo implant 

Urge incontinence % cured 

7 6 35.0 30.0 1.2 (0.5; 2.9) 

Mikkelsen, 1995715N = 47 

Vagifem (25mg/day oestradiol) administered as vaginal pessaries 3 weeks prior to surgery 

Placebo administered as vaginal pessaries daily 3 weeks prior to surgery 

Cured rate 5 6 25.0 33.0 0.8 (0.3; 2.1) 

Kok, 1999698

N = 102 

2mg 17 boestradiol in combination with 2.5, 5, 10 or 15mg dydrogesterone orally once a day. 

Changes from baseline. No placebo group 

Cured Incontinence (became continent) 

23 0 23.0 0.1 47.0 

(2.9; 763.5)
Table F145. Effects of hormone therapy on urinary continence in females (events) (sorted by the rate of continence after the ac

highest to lowest) (continued)

F687 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Holtedahl, 1998713N = 90 

Local estrogen in vagitories or jelly plus physiotherapy and electro stimulation 

No treatment 

Number of cured : no reported leakage and no wet episodes 

8 0 22.0 0.0 20.7 

(1.2; 346.5)

Stress incontinence % cured 

4 3 20.0 15.0 1.3 (0.3; 5.2) 

Dysuria, % of cured 

4 3 20.0 15.0 1.3 (0.3; 5.2) 

Rufford, 2003704N = 40 

25mg 17betaestradiol implant subcutaneous tissue 

Placebo implant 

Urgency, % of cured 

3 2 15.0 10.0 1.5 (0.3; 8.0) 

Grady, 2001710N = 1,525 100% female Followup 48 months 

0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate in one tablet daily 

Placebo No 

incontinent episodes in the previous week 

109 134 14.19 17.70 0.80 

(0.64; 1.01)

Jackson, 1999702N = 67 

Change from baseline after oestradiol valerate 2mg/day 

Change from baseline after placebo 

% with cured stress incontinence 

5 5 14.0 14.0 1.0 (0.3; 3.2) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group; Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F688 

Table F146. Effects of hormone therapy on improvement of urinary incontinence in females (events) (sorted by rate of improveactive treatment, from the highest to the lowest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

N

Ne

(9

Dessole, 2004714N = 88 

Intravaginal estriol ovules: 1 ovule/day (1mg) for 2 weeks and then 2 ovules once weekly for 6 months. 

Placebo vaginal suppositories 

Rate of cured and improved 

30 7 68.2 16.0 4.3 (2.1; 8.7) 2 

Kok, 1999698

N = 102 

2mg 17 boestradiol in combination with 2.5, 5, 10 or 15mg/day dydrogesterone, orally 

Changes from baseline. No placebo group 

Disappearacne of Nocturia 

67 0 65.4 0.1 135.0 

(8.5; 2151.4) 

2 

Waetjen, 2004709N = 963 

Raloxifene 60mg/day or raloxifene 120mg/day 

Placebo Improved 

urinary incontinence at 3 years 

102 48 27.4 25.5 1.1 (0.8; 1.5) 

Ahlstrom, 1990705N = 29 

Estriol 4mg/day and phenylpropanolamine 50mg twice daily 

Estriol 4mg once daily 

Self-reported improvement in incontinence symptoms 

13 11 45.0 40.0 1.2 (0.6; 2.2) 
Table F146. Effects of hormone therapy on improvement of urinary incontinence in females (events) (sorted by rate of improve

active treatment, from the highest to the lowest) (continued)

F689 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

N

Ne

(9

Holtedahl, 1998 713N = 90 

Local estrogen in vagitories or jelly plus physictherapy and electro stimulation 

No treatment Number of 

improved: reduction in frequency amount, or wet episodes 

14 4 39.0 9.0 4.3 

 (1.5; 11.9) 

3 

Placebo 4 

months 

Improved; decrease of at least 2/week in episodes 

214 248 27.89* 32.77 0.85 

(0.73; 0.99) 

20 

Placebo 12 months 

Improved; decrease of at least 2/week in episodes 

191 236 24.89* 31.17 0.80 

(0.68; 0.94) 

16 

Placebo 24 months 

Improved; decrease of at least 2/week in episodes 

181 222 23.55* 29.36 0.80 

 (0.68; 0.95) 

17 

Placebo 36 months 

Improved; decrease of at least 2/week in episodes 

162 203 21.08* 26.84 0.79 

 (0.66; 0.94) 

17 

Placebo 48 months 

Improved; decrease of at least 2/week in episodes 

215 241 27.96* 31.87 0.88 

(0.75; 1.03)

Grady; 2001710N = 1,525 100% female 

0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate in one tablet daily 

Placebo 48 months 

Improved or markedly improved 

158 194 20.57* 25.66 0.80 

 (0.67; 0.97) 

20 
Table F146. Effects of hormone therapy on improvement of urinary incontinence in females (events) (sorted by rate of improve

active treatment, from the highest to the lowest) (continued)

F690 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

N

Ne

(9

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 2 years 

Placebo 2 years 

Improved incontinence; the number of incontinence episodes per week decreased by 2 or more 

57 80 27.4 38.2 0.7 (0.5; 0.9) 9 

Vardy, 2003692N = 58 

Conjugated equine estrogen 0.625mg 

Placebo Pelvic organ 

prolapse quantization, % of subjects with improved scores 

4 0 25.0 0.1 7.9 

(0.5; 133.8) 

Waetjen, 2005712N = 417 

14mg/day of transdermal E2 for 4 months 

Placebo for 4 months 

Improved incontinence: the number of incontinence episodes per week decreased by 2 or more 

52 74 25.0 35.2 0.7 (0.5; 1.0) 

Long,2006699N = 73 

Oral 0.625mg of conjugated equine Estrogen/tablet 

Topical 0.625mg conjugated equine Estrogen/1g vaginal cream 

Bristol Female Lower Urinary Tract Symptoms Questionnaires. improvement in stress urinary incontinence 

8 9 21.6 25.0 0.86 

(0.38; 1.99) 
Table F146. Effects of hormone therapy on improvement of urinary incontinence in females (events) (sorted by rate of improve

active treatment, from the highest to the lowest) (continued)

F691 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

N

Ne

(9

Vardy, 2003692N = 58 

Conjugated equine estrogen 0.625mg; 

Placebo Improvement 

of urinary symptoms; Average change in angle of deflection 

3 0 20.0 0.0 6.1 

(0.3; 108.6) 

Improved stress incontinence: the number of incontinence episodes per week decreased by 2 or more 

Waetjen, 37 61 17.9 29.2 0.6 (0.4; 0.9) 9 2005712 14mg of transdermal 

E2 per day for 2 years 

Placebo 2 years 

Improved urge incontinence: the number of incontinence episodes per week decreased by 2 or more 

27 35 13.1 16.9 0.8 (0.5; 1.2) 

Vardy, 2003692N = 58 

Raloxifene 60mg 

Placebo Improvement 

of urinary symptoms; Average change in angle of deflection 

1 0 6.7 0.0 2.6 

(0.1; 59.4) 

Bold- significant differences in outcomes at 95% confidence level; Number of attributable events = 1000*(rate of the outcome in the contthe active group); A - avoided; E - excessive events 
F692 

Table F147. Effects of hormone therapy on risk of urinary incontinence in females (events) (sorted by rate of outcome after actlowest to highest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

New or worsening urinary incontinence during the study 

1 2 0.6 1.3 0.5 

(0.0; 5.3) 

Newly developed urinary incontinence 

1 1 0.6 0.7 1.0 

(0.1: 15.3)

New or worsening urinary incontinence during the study 

1 2 0.7 1.3 0.5 

(0.0; 5.5) 

Goldstein, 2005691N = 619 

Raloxifene, 150mg/day 

Placebo 

Newly developed urinary incontinence 

1 1 0.7 0.7 1.0 

(0.1; 15.8)

12 months after discontinuation of levormeloxifene 1.25, 5, 10, or 20mg/day, 

Placebo Urogenital 

prolapse 

2 0 1.0 0.1 1.3 

(0.1; 25.9)

Warming, 2003693N = 301 

Levormeloxifene 1.25, 5, 10, or 20mg/day 

Placebo Urogenital 

prolapse 

6 0 3.0 0.1 3.3 

(0.2; 57.3) 

Hendrix, 2005695N = 5,182 

Estrogen plus progestin (E+ P): 0.625mg of CEE plus 2.5mg of medroxyprogester1 acetate 

Placebo Incident 

mixed incontinence 

99 69 3.7 2.8 1.3 

(1.0; 1.8) 
Table F147. Effects of hormone therapy on risk of urinary incontinence in females (events) (sorted by rate of outcome after act

lowest to highest) (continued)

F693 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Estrogen alone: 0.625mg conjugated equine estrogen 

Placebo Incident 

mixed incontinence 

76 50 5.0 3.2 1.5 

 (1.1 2.2) 

Goldstein, 2005691N = 619 

Conjugated equine estrogen 0.625mg/day 

Placebo Newly 

developed urinary incontinence 

8 1 5.1 0.7 7.7 

(1.0; 60.8) 

Long, 2006699N = 73 

Oral 0.625mg of conjugated equine Estrogen tablet 

Topical 0.625mg conjugated equine Estrogen/1g vaginal cream 

Bristol Female Lower Urinary Tract Symptoms Questionnaire-urge urinary incontinence 

2 3 5.4 8.3 0.65 

(0.12; 3.66)

Jackson, 1999702N = 67 

Post oestradiol valerate 2mg/day 

Post placebo 

Incontinence with intercourse 

2 1 7.0 3.0 2.1 

(0.2; 21.7) 

Goldstein, 2005691N = 619 

Conjugated equine estrogen 0.625mg/day 

Placebo New or 

worsening urinary incontinence during the study 

11 2 7.0 1.3 5.3 

(1.2; 23.5) 

Vestergaard, 2003696N = 1,006 

Sequential oral oestrogen and progestogen oral continuous oestradiol 

No HRT Incontinence 

with moderate to severe discomfort (2-4) 

40 45 8.0 9.0 0.9 

(0.6; 1.3) 

Long, 2006699N = 73 

Oral 0.625mg of conjugated equine Estrogen tablet 

Topical 0.625mg conjugated equine Estrogen/1g vaginal cream 

Bristol Female Lower Urinary Tract Symptoms Questionnaire -urinary frequency 

3 12 8.1 33.3 0.24 

(0.07; 0.79)
Table F147. Effects of hormone therapy on risk of urinary incontinence in females (events) (sorted by rate of outcome after act

lowest to highest) (continued)

F694 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Goldstein, 2002697N = 2,924 

Levormeloxifene 0.5mg/day 

Placebo Self reported 

micturition frequency in both active groups 

184 39 9.0 4.0 4.7 

(3.4; 6.5) 

Estrogen plus progestin (E + P): 0.625mg CEE plus 2.5mg medroxyprogester1 acetate 

Placebo Incident urge 

incontinence 

304 272 11.4 10.0 1.0 

(0.9; 1.2) 

Estrogen alone: 0.625mg conjugated equine estrogen 

Placebo Incident urge 

incontinence 

210 184 13.8 11.9 1.2 

(1.0; 1.4) 

Hendrix, 2005695N = 5,182 

0.625mg CEE plus 2.5mg medroxyprogester1 acetate 

Placebo Incident 

Stress Urinary Incontinence 

429 218 16.0 8.7 1.8 

(1.6; 2.2) 

Long, 2006699N = 73 

Oral 0.625mg conjugated equine Estrogen/tablet 

Topical 0.625mg conjugated equine Estrogen/1g vaginal cream 

Bristol Female Lower Urinary Tract Symptoms Questionnaires stress urinary incontinence 

6 13 16.2 36.1 0.45 

(0.19; 1.05)

Goldstein, 2002697N = 2,924 

Levormeloxifene 0.5mg/day 

Placebo Self reported 

Urinary incontinence on both active groups 

338 37 17.0 4.0 9.1 

(6.5; 12.6) 

Hendrix, 2005695N = 3,073 

Estrogen alone: 0.625mg conjugated equine estrogen 

Placebo Incident 

Stress Urinary Incontinence 

266 131 17.4 8.5 2.1 

 (1.7; 2.5) 
Table F147. Effects of hormone therapy on risk of urinary incontinence in females (events) (sorted by rate of outcome after act

lowest to highest) (continued)

F695 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Vestergaard, 2003696

N = 1,006 

Sequential oral oestrogen and progestogen 

No HRT Incontinence 

with mild discomfort 

100 101 20.0 20.0 1.0 

(0.8; 1.3) 

Vardy, 2003692N = 58 

Conjugated equine estrogen 0.625mg; 

Placebo Consideration 

of any indicator of prolapse. 

3 2 22.0 18.0 1.3 

(0.3; 6.6) 

Lose, 2000717N = 251 

Oestradiolreleasing ring, 7.5mg oestradiol 

Oestriol pessaries 0.5mg every second day 

Self reported urgency 

36 39 27.0 33.0 0.8 

(0.6; 1.2) 

Long, 2006699N = 73 

Oral 0.625mg of conjugated equine Estrogen tablet 

Topical 0.625mg conjugated equine Estrogen/1g vaginal cream 

Bristol Female Lower Urinary Tract Symptoms Questionnaire Nocturia 

10 3 27.0 8.3 3.24 

(0.97; 10.83)

Jackson, 1999702N = 67 

Post oestradiol valerate 2mg/day 

Post placebo 

Abnormal stream 

10 7 30.0 22.0 1.5 

(0.6; 3.4) 

Lose, 2000717N = 251 

Oestradiolreleasing ring, 7.5mg oestradiol 

Oestriol pessaries 0.5mg every second day 

Self reported Nocturia 

42 41 31.0 35.0 0.9 

(0.6; 1.3) 

Dessole, 2004714N = 88 

Intravaginal estriol ovules: 1 ovule (1mg)/day for 2 weeks and then 2 ovules once weekly for 6 months. 

Placebo vaginal suppositories 

Subjective complaints of stress urinary incontinence. 

14 37 31.8 84.1 0.4 

(0.2; 0.6) 

Lose, 2000717N = 251 

Oestradiolreleasing ring, 7.5mg 

Oestriol pessaries 0.5mg 

Self reported urge incontinence 

44 0 33.0 77.8 

(4.8; 

1,249.4) 
Table F147. Effects of hormone therapy on risk of urinary incontinence in females (events) (sorted by rate of outcome after act

lowest to highest) (continued)

F696 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

oestradiol every 

second day 

Self reported stress incontinence 

46 48 34.0 41.0 0.8 

(0.6; 1.2) 

Waetjen, 2005712N = 417 

14mg/day of transdermal E2 for 2 years 

Placebo 2 years 

New developed incontinence at 2 years 

81 77 39.0 36.8 1.1 

(0.8; 1.4) 

Steinauer, 2005694N = 1,208 

Oral conjugated estrogen (0.625mg) and medroxy progesterone acetate (2.5mg) in 1 pill/day 

Placebo New report of 

weekly urge incontinence 

287 220 48.0 36.0 1.3 

(1.2; 1.5) 

Intermittent stream 

17 20 50.0 60.0 0.9 

(0.5; 1.3) 

Jackson, 1999702N = 67 

Post oestradiol valerate 2mg daily 

Post placebo 

Changing outer clothing 

17 17 53.0 50.0 1.0 

(0.6; 1.7) 

New report of weekly stress incontinence 

322 232 54.0 38.0 1.4 

(1.3; 1.6) 

Steinauer, 2005694N = 1,208 

Oral conjugated estrogen (0.625mg) and medroxy progesterone acetate (2.5mg) in 1 pill/day 

Placebo 

New report of weekly incontinence in women , 60 years of age 

57 42 59.0 48.0 1.2 

(0.9; 1.6) 

Vardy, 2003692N = 58 

Tamoxifen 20mg; 

Placebo Consideration 

of any indicator of prolapse. 

9 2 60.0 18.0 3.9 

(1.0; 14.9) 

Jackson, 1999702N = 67 

Post oestradiol valerate 2mg/day 

Post placebo 

Inability to stop midstream 

20 24 60.0 72.0 0.9 

(0.6; 1.2) 
Table F147. Effects of hormone therapy on risk of urinary incontinence in females (events) (sorted by rate of outcome after act

lowest to highest) (continued)

F697 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95%CI) 

Steinauer, 2005694N = 1,208 

Oral conjugated estrogen (0.625mg) and medroxy progesterone acetate (2.5mg) in 1 pill/day 

Placebo New report of 

weekly incontinence 

382 302 64.0 49.0 1.3 

 (1.2; 1.4) 

Unexplained incontinence 

24 16 73.0 47.0 1.5 

(1.0; 2.3) 

Jackson, 1999702N = 67 

Oestradiol valerate 2mg/day 

Placebo 

Wearing protection 

24 24 73.0 72.0 1.0 

(0.8; 1.4) 

Vardy, 2003692N = 58 

Raloxifene 60mg 

Placebo Consideration 

of any indicator of prolapse. 

11 2 75.0 18.0 4.8 

 (1.3; 17.7)

Urinary urgency 

31 33 93.0 97.0 1.0 

(0.9; 1.1) 

Stress Incontinence 

33 34 100.0 100.0 

Jackson, 1999702N = 67 

Oestradiol valerate 2mg/day 

Placebo 

Urge Incontinence 

33 33 100.0 97.0 1.0 

(0.9; 1.1) 

Placebo Stress urinary 

incontinence at 3 years 

99 55 15.6 16.9 0.9 

(0.7; 1.2) 

Urge urinary incontinence at 3 years 

164 89 25.8 27.4 0.9 

(0.8; 1.2) 

Waetjen, , 2004709N = 963 

Raloxifene 60mg/day or raloxifene 120mg/day 

Mixed urinary incontinence at 3 years 

111 47 17.5 14.5 1.2 

(0.9; 1.6) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome in 1 pa

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group); A - avoided; E - excessive events 
F698 

Table F148. Effects of hormone therapy on progression of urinary incontinence in females (events) (sorted by rate of progresstreatment, from lowest to highest) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Raloxifene, 60mg/day 

Placebo Severity of 

incontinence: moderate or severe 

0 1 0.0 50.0 0.5 

(0.0; 7.1) 

Goldstein, 2005691N = 619 

Raloxifene, 150mg/d 

Placebo Severity of 

incontinence: moderate or severe 

0 1 0.0 50.0 0.5 

(0.0; 7.1) 

14mg/day transdermal E2 for 4 months 

Placebo 4 months 

Worsened urge incontinence: the number of incontinence episodes/week increased by 2 or more. 

5 21 2.4 10.2 0.2 

(0.1; 0.6) 

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 2 years 

Placebo 2 years 

Worsened stress incontinence: the number of incontinence episodes/week increased by 2 or more. 

20 19 9.5 9.0 1.1 

(0.6; 1.9) 

Holtedahl, 1998713N = 90 

Local estrogen in vagitories or jelly plus physiotherapy and electro stimulation 

No treatment 

Worse incontinence: self reported worsening of severity or impact 

4 13 11.0 30.0 0.4 

(0.1; 1.1) 

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 2 years 

Placebo 2 years 

Worsened urge incontinence: the number of incontinence episodes/week increased by 2 or more. 

27 38 13.1 18.0 0.7 

(0.5; 1.1) 
Table F148. Effects of hormone therapy on progression of urinary incontinence in females (events) (sorted by rate of progress

treatment, from lowest to highest) (continued) 

F699 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Vestergaard, 2003696

N = 1,006 

Sequential oral oestrogen and progestogen 

No HRT Frequent 

voiding: Mild discomfort (1) 

70 81 14.0 16.0 0.9 

(0.6; 1.2) 

Vardy, 2003692N = 58 

Raloxifene 60mg 

Placebo Increase or 

worsening in symptoms of incontinence 

2 2 15.0 18.0 0.9 

(0.1; 5.3) 

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 2 years 

Placebo 2 years 

Worsened incontinence: the number of incontinence episodes/week increased by 2 or more. 

35 35 16.7 16.9 1.0 

(0.7; 1.5) 

Vardy, 2003692N = 58 

Conjugated equine estrogen 0.625mg 

Placebo Increase or 

worsening in symptoms of incontinence 

2 2 18.0 18.0 0.9 

(0.1; 5.3) 

Vestergaard, 2003 696N = 1,006 

Sequential oral oestrogen and progestogen 

No HRT Frequent 

voiding: Moderate to severe discomfort (2-4) 

100 96 20.0 19.0 1.0 

(0.8; 1.3) 

Worsened stress incontinence: the number of incontinence episodes/week increased by 2 or more. 

42 28 20.2 13.6 1.5 

(1.0; 2.3) 

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 4 months 

Placebo 4 months 

Worsened incontinence: the number of incontinence episodes/week increased by 2 or more. 

50 40 23.8 19.3 1.3 

(0.9; 1.8) 
Table F148. Effects of hormone therapy on progression of urinary incontinence in females (events) (sorted by rate of progress

treatment, from lowest to highest) (continued) 

F700 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Vardy, 2003692N = 58 

Conjugated equine estrogen 0.625mg 

Placebo Pelvic organ 

prolapse quantitation, % of subjects with worsened scores 

4 2 25.0 18.0 1.7 

(0.4; 8.0) 

Holtedahl, 1998713N = 90 

Local estrogen in vagitories or jelly plus physiotherapy and electro stimulation 

No treatment 

Unchanged incontinence: no changes in frequency, amount, or wet episodes 

10 27 28.0 61.0 0.5 

(0.3; 0.8) 

Worsenedincrease of at least 2/ week episodes 4 months 

202 166 26.35 21.91 1.20 

 (1.00; 1.43)

Worsenedincrease of at least 2/ week episodes 12 months 

224 180 29.18 23.80 1.23 

(1.04; 1.45) 

Worsenedincrease of at least 2/ week episodes 24 months 

246 178 32.05 23.56 1.36 

(1.16; 1.61)

Worsenedincrease of at least 2/ week episodes 36 months 

256 187 33.33 24.73 1.35 

(1.15; 1.58)

Grady, 2001710N = 1,525 

0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate in one tablet daily 

Placebo 

Worsenedincrease of at least 2/ week episodes 48 months 

290 212 37.80 28.02 1.35 

(1.17; 1.56)
Table F148. Effects of hormone therapy on progression of urinary incontinence in females (events) (sorted by rate of progress

treatment, from lowest to highest) (continued) 

F701 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Worsened or markedly worsened 48 months 

293 202 38.19 26.64 1.43 

(1.23; 1.66)

Pelvic organ prolapse quantitation, % of subjects with worsened scores 

5 2 31.0 18.0 2.2 

(0.5; 9.3) 

Vardy, 2003692N = 58 

Tamoxifen 20mg 

Placebo 

Increase or worsening in symptoms of incontinence 

5 2 33.0 18.0 2.2 

(0.5; 9.3) 

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 4 months 

Placebo for 4 months 

Unchanged incontinence: the number of incontinence episodes/week increased or decreased no more than 1 

106 95 51.2 45.5 1.1 

(0.9; 1.4) 

Vardy, 2003692N = 58 

Raloxifene 60mg 

Placebo Pelvic organ 

prolapse quantitation, % of subjects with worsened scores 

10 2 67.0 18.0 4.3 

(1.2; 16.3) 

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 2 years 

Placebo 2 years 

Unchanged stress incontinence: the number of incontinence episodes/week increased or decreased no more than 1 

151 129 72.6 61.8 1.2 

(1.0; 1.3) 
Table F148. Effects of hormone therapy on progression of urinary incontinence in females (events) (sorted by rate of progress

treatment, from lowest to highest) (continued) 

F702 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Jackson, 1999702N = 67 

Post oestradiol valerate 2mg/day 

Post placebo 

More than 7 episodes of daytime incontinence 

25 23 77.0 69.0 1.1 

(0.8; 1.5) 

Goldstein, 2005691N = 619 

Conjugated equine estrogen 0.625mg/day 

Placebo Severity of 

incontinence: moderate or severe 

9 1 81.8 50.0 1.6 

(0.4; 6.7) 

Waetjen, 2005712N = 417 

14mg/day transdermal E2 for 4 months 

Placebo 4 months 

Unchanged urge incontinence: the number of incontinence episodes/week increased or decreased no more than 1 

178 162 85.7 77.3 1.1 

 (1.0; 1.2) 

More than 7 episodes of nocturnal incontinence 

31 28 93.0 81.0 1.1 

(1.0; 1.4) 

Frequency of incontinence episodes (more than never) 

33 34 100.0 100.0 

Jackson, 1999702N = 67 

Post oestradiol valerate 2mg/day 

Post placebo 

Quantity of lost urine (more than none) 

33 34 100.0 100.0 

Severe and very severe at 3 years 

29 14 4.5 4.3 1.1 

 (0.6; 2.0) 

Incontinent episodes <1/month at 3 years 

146 67 22.9 20.6 1.1 

(0.9; 1.4) 

Waetjen, 2004709N = 963 

Raloxifene 60mg/day or Raloxifene 120mg/day 

Placebo 

Incontinent episodes/day at 3 years 

57 22 8.9 6.8 1.3 

(0.8; 2.1) 
Table F148. Effects of hormone therapy on progression of urinary incontinence in females (events) (sorted by rate of progress

treatment, from lowest to highest) (continued) 

F703 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Wears protection for incontinence at 3 years 

161 67 41.1 33.5 1.2 

(1.0; 1.6) 

Restricts daily activities: sometimes at 3 years 

389 198 99.2 99.0 1.0 

(0.9; 1.1) 

Restricts daily activities: Most of the time at 3 years 

3 2 0.8 1.0 0.8 

(0.1; 4.6) 

Effect on feelings: Somewhat at 3 years 

373 191 95.2 95.5 1.0 

(0.9; 1.1) 

Effect on feelings: Extremely at 3 years 

19 9 4.8 4.5 1.1 

(0.5; 2.4) 

No change in urinary incontinence at 3 years 

218 119 58.4 63.3 0.9 

(0.8; 1.1) 

Worsened urinary incontinence at 3 years 

53 21 14.2 11.2 1.3 

(0.8; 2.1) 

Bold- significant differences in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome inn1 poutcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F704 

Table F149. Effects of hormone therapy on perceived urinary incontinence in females (severity measures) 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Diurnal incontinence, episodes/day 

Cardozo, 2.7 ± 3.5 1.3 ± 2.3 0.5 (0.0; 1.0) 1993706N = 64 

3mg oral oestriol/day Placebo 

Nocturnal incontinence, episodes/day 

0.3 ± 0.7 0.3 ± 0.8 0.0 (-0.5; 0.5) 

Rufford, 2003704N = 40 

25mg 17 betaestradiol implant subcutaneous tissue 

Placebo implant 

Micturition/24 hours 

8.6 ± 1.4 8.0 ± 0.9 0.5 (-0.1; 1.1) 

No. of diurnal voluntary micturition//week 

Fantl, 1996 50.0 ± 14.0 49.0 ± 15.0 0.1 (-0.4; 0.5) 

701

N = 83 

Post conjugated equine estrogens (0.625mg) and medroxyprogesterone (10mg) cyclically 

Post placebo 

Number of nocturnal voluntary micturition/week 

9.0 ± 6.0 8.0 ± 5.0 0.2 (-0.3; 0.7) 

von Holst, 2000711N = 186 

7-day-Estradiol patch (1.5mg estradiol/week or 50mg estradiol/24 hour) 

Placebo Change from 

baseline in Incontinence scores 

-1.3 ± 2.0 -0.8± 1.5 -0.3 (-0.6; 0.0) 

Change in median frequency of Nocturia 

-0.1 ± 1.3 0.1± 0.1 -0.2 (-0.7; 0.3) 

Change in median in leaks/day 

0.4 ± 0.5 0.0 ± 0.4 0.9 (0.3; 1.4) 

Change in median in pads/day 

0.0± 1.1 0.0 ± 0.2 0.0 (-0.5; 0.5) 

Jackson, 1999702N = 67 

Change from baseline after oestradiol valerate 2mgday 

Change from baseline after placebo 

Change in median frequency in micturition/24hour 

0.1 ± 5.6 -0.6 ± 0.2 0.2 (-0.3; 0.7) 
Table F149. Effects of hormone therapy on perceived urinary incontinence in females (severity measures) (continued) 

F705 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Post conjugated equine estrogens (0.625mg) and medroxyprogesterone (10mg) cyclically 

Post placebo 

Number of incontinent episodes/week 

Fantl, 1996 10.0 ± 10.0 13.0± 14.0 -0.2 (-0.7; 0.2) 

701

N = 83 

Pre conjugated equine estrogens (0.625mg) and medroxyprogesterone (10mg) cyclically 

Post placebo 

Number of nocturnal voluntary micturition/week 

9.0 ± 6.0 8.0 ± 5.0 0.2 (-0.3; 0.7) 

Number of pads changes/day 

Wilson, 1.0 ± 1.9 1.7 ± 2.4 -0.3 (-1.0; 0.3) 1987708N = 36 

Cyclical treatment with piperazine oestrone sulphate 

Placebo 

Micturition/day 8.4 ± 3.0 10.4 ± 3.2 -0.6 (-1.3; 0.0) 

Number of incontinent episodes/week 

Fantl, 1996 10.0 ± 10.0 13.0 ± 14.0 -0.2 (-0.7; 0.2) 

701

N= =83 

Pre conjugated equine estrogens (0.625mg) and medroxyprogesterone (10mg) cyclically 

Post placebo 

No. of diurnal voluntary micturition/week 

50.0 ± 14.0 49.0 ± 15.0 0.1 (-0.4; 0.5) 

Vardy, 2003692

N = 58 

Tamoxifen 20mg; Placebo Improvement of 

urinary symptoms; Average change in angle of deflection 

0.0 ± 0.0 -0.5 ± 14.7 

Bold- significant differences in outcomes at 95% confidence level 
F706 

Table F150. Effects of hormone therapy on urinary incontinence in females (severity measures) 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differ

(95% C

Conjugated equine estrogen 0.625mg; 

Placebo Improvement of 

urinary symptoms; Average change in angle of deflection 

Vardy, 0.0 ± 0.0 -0.5 ± 14.7 2003692N = 58 

Raloxifene 60mg Placebo Improvement of 

urinary symptoms; Average change in angle of deflection 

0.0 ± 0.0 -0.5 ± 14.7 

Bladder volume at first desire to void. Ml 

3mg oral oestriol/day Placebo 206.0 ± 142.0 202.0 ± 114.0 0.0 (-0.5; 0

Detrusor pressure (cm/H2O) 

17.0 ± 15.0 22.0 ± 39.0 -0.2 (-0.7; 

Cystometric capacity, bladder volume, ml 

333.0 ± 163.0 365.0 ± 136.0 -0.2 (-0.7; 

Cardozo, 1993706N = 64 

3mg oral oestriol/day Placebo 

Cystometric Detrusor pressure (cm/H2O) 

25.0 ± 20.0 32.0 ± 65.0 -0.1 (-0.6; 

25mg 17 betaestradiol implant subcutaneous tissue 

Placebo implant 

First sensation 200.0 ± 37.5 150.0 ± 25.0 1.6 (0.9; 2

25mg 17 betaestradiol implant subcutaneous tissue 

Placebo implant 

Volume P>15cm/H2O 225.0 ± 87.5 250.0 ± 25.0 -0.4 (-1.0; 

25mg 17 betaestradiol implant subcutaneous tissue 

Placebo implant 

Maximum capacity 450.0 ± 13.0 320.0 ± 40.0 4.4 (3.2; 5

25mg 17 betaestradiol implant subcutaneous tissue 

Placebo implant 

Volume voided per micturition 

177.0 ± 16.0 161.0 ± 19.5 0.9 (0.2; 1

Rufford, 2003704N = 40 

25mg 17 betaestradiol implant subcutaneous tissue 

Placebo implant 

Pressure rise of filling 6.0 ± 5.0 10.0 ± 5.0 -0.8 (-1.4; 

Change in functional urethral length, mm 

 0.5 (-9.0; 1

Change in mean maximum urethral closure pressure 

 1.7 (-13.1; 

Ahlstrom, 1990705N = 29 

Estriol 4mg/day and phenylpropanolamine 50mg twice daily. 

Estriol 4mg/day 

Change in mean maximum urethral pressure 

 1.5 (-16.4; 
Table F150. Effects of hormone therapy on urinary incontinence in females (severity measures) (continued) 

F707 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differ

(95% C

Estriol 4mg/day and phenylpropanolamine 50mg twice daily. 

Estriol 4mg/day 

Leakage during the coughing test 

 -4.2 (-45.4; 

Estriol 4mg/day and phenylpropanolamine 50mg twice daily. 

Estriol 4mg/day 

Residual urine -2.1 (-81.3; 

Estriol 4mg/day and phenylpropanolamine 50mg twice daily. 

Estriol 4mg/day 

Abdominal pressure transmission ratio to the urethra,% 

 -5.1 (-73.7; 

Intravaginal estriol ovules: 1 ovule (1mg)/day for 2 week and then 2 ovules/week for 6 months. 

Placebo vaginal suppositories 

Urinary stimulus that cannot be postponed (ml) 

355.7 ± 23.3 346.3 ± 23.0 0.4 (0.0; 0

Bladder capacity (ml) 452.5 ± 47.4 429.0 ± 43.2 0.5 (0.1; 0Bladder compliance (ml/cm/H2O) 

41.1 ± 13.5 43.4 ± 13.9 -0.2 (-0.6; 

Intravaginal estriol ovules: 1 ovule (1mg)/day for 2 weeks and then 2 ovules/week for 6 months. 

Placebo vaginal suppositories 

maximum bladder pressure, (cm/H2O) 

10.6 ± 2.4 11.7 ± 3.1 -0.4 (-0.8; 

Intravaginal estriol ovules: 1 ovule (1mg)/day for 2 weeks and then 2 ovules/week for 6 months. 

Placebo vaginal suppositories 

Maximum urethral closure pressure; (cm/H2O) 

56.9 ± 9.2 43.3 ± 6.3 1.7 (1.2; 2

Maximum urethral pressure; (cm/H2O) 

62.2 ± 8.6 49.4 ± 6.5 1.7 (1.2; 2

Functional urethral length; (mm) 

28.0 ± 3.1 26.6 ± 2.5 0.5 (0.1; 0

Pressure transmission ratio, % 

88.9 ± 9.7 70.8 ± 9.0 1.9 (1.4; 2

First stimulus (ml) 160.3 ± 23.4 151.6 ± 15.1 0.4 (0.0; 0

Dessole, 2004714N = 88 

Intravaginal ovule (1mg)/day for 2 weeks and then 2 ovules/week for 6 months. 

Placebo vaginal suppositories 

Normal urinary stimulus (ml) 

185.9 ± 22.0 172.3 ± 16.6 0.7 (0.3; 1

Maximum voiding flow, ml/second 

Jackson, 1.0 ± 2.7 1.0 ± 2.7 0.0 (-0.5; 01999702N = 67 

Change from baseline after oestradiol valerate 2mg/day 

Change from baseline after placebo Change in median in 

average void volume, ml 

21.0 ± 18.7 -2.0 ± 33.3 0.8 (0.3; 1
Table F150. Effects of hormone therapy on urinary incontinence in females (severity measures) (continued) 

F708 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differ

(95% C

Change in median in functional capacity, ml 

37.0 ± 106.0 30.0 ± 66.0 0.1 (-0.4; 0

Change in median in post-Micturition residual, ml 

0.0 ± 0.0 0.0 ± 6.0 

Change in median in Detrusor pressure at maximum flow, cm water 

2.0 ± 4.7 0.0 ± 4.7 0.4 (-0.1; 0

Change in median in maximum urethral closure pressure, cm water 

-1.4 ± 9.8 1.5 ± 10.7 -0.3 (-0.8; 

Change in median in functional urethral length, mm 

2.3 ± 5.4 -0.1 ± 4.6 0.5 (0.0; 1

Change from baseline after oestradiol valerate 2mg/day 

Change from baseline after placebo 

Change in median in volume at first desire to micturate 

3.0 ± 78.0 19.0 ± 72.0 -0.2 (-0.7; 

Change from baseline after oestradiol valerate 2mg/day 

Change from baseline after placebo 

Change in median in maximum void volume, ml 

-10.0 ± 60.0 -30.0 ± 13.3 0.5 (0.0; 0

Post conjugated equine estrogens (0.625mg) and medroxyprogesterone (10mg) cyclically 

Fantl, Post placebo Fluid Loss in ml 101.0 ± 150.0 50.0 ± 68.0 0.4 (0.0; 01996701N = 83 

Pre conjugated equine estrogens (0.625mg) and medroxyprogesterone (10mg) cyclically 

Post placebo Fluid Loss in ml 101.0 ± 150.0 50.0 ± 68.0 0.4 (0.0; 0
Table F150. Effects of hormone therapy on urinary incontinence in females (severity measures) (continued) 

F709 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differ

(95% C

Estradiol transdermal therapeutic system (0.05mg estradiol/day) combined with naproxen 250mg tablets twice daily 

Placebo Volume at first desire 

to void (ml) 

185.6 ± 50.2 155.3 ± 46.6 0.6 (0.0; 1

Maximum bladder capacity (ml) 

Estradiol transdermal 318.1 ± 87.8 290.3 ± 77.4 0.3 (-0.3; 1therapeutic system (0.05mg estradiol/day) 

Placebo 

Volume at first desire to void (ml) 

171.9 ± 52.7 155.3 ± 46.6 0.3 (-0.3; 

Blom, 1995719N = 19 

Estradiol transdermal therapeutic system (0.05mg estradiol/day) combined with naproxen 250mg tablets twice daily 

Placebo Maximum bladder 

capacity (ml) 

315.6 ± 74.4 290.3 ± 77.4 0.3 (-0.3; 

Urine loss (ml/2hours of activity) 

Wilson, 6.0 ± 17.3 3.0 ± 15.2 0.2 (-0.5; 01987708N = 36 

Cyclical treatment with piperazine oestrone sulphate 

Placebo 

Maximal urethral closure pressure (cm/H2O) 

53.0 ± 10.8 50.0 ± 10.8 0.3 (-0.4; 0

Bold- significant differences in outcomes at 95% confidence level 
F710 

Evidence Tables—Clinical Interventions to Reduce Risk of Incidence anProgression of Fecal Incontinence in Adults 
F711 

Table F151. Clinical interventions on fecal incontinence in long-term care settings 

Study Participants Clinical Interventions Outcomes 

Effects of conservative management of fecal incontinence in the residents of nursing homesSchnelle, 1989457

RCT to examine the effects of prompted voiding treatment of urinary incontinence in nursing home patients Duration: 5-10 days 

126 incontinent patients from proprietary nursing homes (bed size 90-150), not affiliated with universities with correct discriminatory responses to the instructions to point shown subjects (pencil or glass). Exclusion criteria: continence, transfer to hospital during run-in period Loss of followup: 60% during the run-in period, 2.4% after randomization. 

1. Prompted voiding treatment: check for incontinence, asking for needed toileting assistance, prompted voiding, and socially reinforced for appropriate toileting. 2. Usual care. 

Urinary incontinence measured by nurse as wet checks/total checks and daily percent of appropriate toileting equal the number of times the patient voided in any toilet receptacle/total number of appropriate and incontinent voiding. 

No laballoBaSa

Ouslander, 2005458Crossover RCT to examine the effects of functional incidental training on incontinence in nursing homes. Duration 8 weeks 

107 patients in the nursing homes, (resided in the facility at least 30 days and not initially admitted for short term care; able to state their name, or in the presence of aphasia, capable of reliably pointing to two objects; required assistance by two or fewer people for transfer from bed to chair; with life expectancy of at least 6 months; not receiving active physical therapy; and ages 60 and older. Exclusion criteria: continence, severe behavioral changes, terminally ill. Loss of followup: 60% 

1. Functional Incidental Training: prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered 4 times per day, 5 days per week 2. Usual care. 

Urinary and fecal incontinence measured as wet checks/total checks of the participant's every 2 hours. Appropriate toileting rate: number of voids or bowel movements that were continent divided by the total number of voids or bowel movements. Change after the treatments in wet stool checks/total checks 0±22%, p<0.001 

No labrancondatranjus

Schnelle, 200459

RCT to examine the effects of integrated incontinence care and exercise on urinary exercise in nursing home residents. Duration 8 months 

256 incontinent residents in 4 nursing homes Exclusion criteria: post–acute skilled care units, terminally ill. Loss of followup: 26% 

1. Integrated incontinence care and exercise every 2 hours 5 days a week including fluid prompting, prompted toileting, and regular wet checks, arm raise and arm curl exercises. 2. Usual care. 

Fecal and urinary incontinence frequency as % of hourly wet checks and the appropriate toileting ratio calculated by dividing the number of times a resident used a toilet or toilet substitute by the total number of voids. 

No blinrancondatranjus
Table F151. Clinical interventions on fecal incontinence in long-term care settings (continued) 

F712 

Study Participants Clinical Interventions Outcomes 

Effects of pharmacological intervention on progression of fecal incontinence in residents of long term care units Chassagne, 2000720RCT to examine the effects of treatment of constipation in elderly patients with fecal incontinence. Duration: 2 months 

206 patients older than 65 years, residents of long-term care units, with daily fecal incontinence associated with chronic rectal 

emptying impairments such as fecal impaction. Exclusion criteria: severe diarrhea, non compliance (missing treatment of followup for >48 hours), refusal to participate. Loss of followup: 30.8%

1.Single osmotic laxative -30g lactulose 2. Osmotic agent 30g lactulose with a rectal stimulant (glycerine suppository) and weekly tapwater enemas 

Episodes of fecal incontinence reported by patients and caregivers and associated details of soiled laundry 

No laballorepconranjus

Effects of individualized evidence-based conservative management on fecal incontinence in patients after stroke Harari, 2004721

RCT to examine the effect of evidence based treatment program on fecal incontinence in patients after stroke. Duration of followup: 12 months 

146 stroke patients with constipation (<2 bowel movements per week or >2 of the following on more than 1 in 4 occasions: straining, hard stools, feeling of incomplete evacuation), rectal outlet delay (need for self-digitation or feeling of anal blockage or prolonged defecation >10 minutes), and fecal incontinence (any degree of bowel leakage). Exclusion criteria: acute diarrhea or colonic disease other than diverticular disease. Loss of followup: 28% 

1. RN assessment (history and rectal examination). 2. Patient care provider education with instructions on regular toilet habits, pelvic floor and sphincter-strengthening exercises, suppository insertion, and laxative and loperamide dose titration. 3. Evidence based treatment recommendations to patient's general practitioner 4. Regular care 

Self-reported fecal incontinence and bowel movements measured by postal prospective 7-day stool diary. Visual analogue scores for severity rating, quality of life (bowel-related and SF-12). 

InteExtranconBaadeSa

Effects of dietary interventions on progression of fecal incontinence in adultsBliss, 2001722

Placebo-controlled RCT to examine the effects of fiber supplements in community-living adults who were incontinent loose or liquid stools. Duration 31 days 

42 adult volunteers with incontinent loose or liquid stools at least weekly. Exclusion criteria: rectal prolapse, colon cancer, or a rectal fistula Lost of followup: 3 withdrew during the baseline period, 1 subject underwent a hysterectomy; 1 subject required treatment for diverticulitis, and 1 subject had a relapse of clinical depression with suicidal thoughts. 

1. Usual diet supplemented with 25g of Metamucil, 7.1g of psyllium/day 2. Usual diet supplemented with 25g of gum arabic/day 3. Usual diet supplemented with 0.25g of pectin/d as a placebo 

Self-reported fecal incontinence: involuntary passage of stool from the rectum. Stool composites 

No blinuncfor siz
F713 

F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults 

Study Participants Clinical Interventions Outcomes 

Effects of conservative management programs on postnatal fecal incontinence in femalesGlazener, 2001483

RCT to examine the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training among women with persistent postnatal incontinence Duration: 12 months 

747 women with urinary incontinence (defined as any involuntary loss of urine) three months postnatally, living within a 50 km radius and who delivered in these units during a 12 month recruitment period. Exclusion criteria: mothers of stillborn or dead neonates. Loss of followup: 25% in active and 35% in the control group. 

1. Assessment by nurses of fecal incontinence with conservative advice on pelvic floor exercises (8-10 sessions each day of fast and slow contractions with the aim of 80-100 contractions daily) at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months. 2. The control group did not receive any visits from research nurses but received peripartum preparation, which sometimes included pelvic floor exercises, and could seek medical advice. 

Self-reported Presence of fecal incontinence: ever lost control of wind or bowel motions from back passage between visits to the toilet 

InteCoranparof dothincoweecondatranjust

Glazener, 2005484

Glazener, 20014836 years followup RCT, 2005 to examine the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training among women with persistent postnatal incontinence 

747 women with urinary incontinence (defined as any involuntary loss of urine) three months postnatally, living within a 50km radius and who delivered in these units during a 12 month recruitment period. Exclusion criteria: mothers of stillborn or dead neonates. Loss of followup: 29% in active and 31% in the control group. 

1. Assessment by nurses of fecal incontinence with conservative advice on pelvic floor exercises (of 8-10 sessions each day of fast and slow contractions with the aim of 80-100 contractions daily) at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months. 2. The control group did not receive any visits from research nurses but received peripartum preparation, which sometimes included pelvic floor exercises, and could seek medical advice 

Self-reported 6 years after intervention presence of fecal incontinence: ever lost control of wind or bowel motions from back passage between visits to the toilet. Reported use of pelvic floor muscle training. 

InteCoranparof dothincoweecondatranthe in ayeajust

Effects of behavioral interventions on incidence and progression of fecal incontinence in femalesLabrecque, 2000482 RCT to examine the effects of perineal massage performed during 

Pregnant women with (n = 493) and without (n = 1,034) previous vaginal birth. Exclusion criteria: high risk of cesarean delivery, including previous cesarean delivery for cephalopelvic disproportion; multiple gestation; placenta previa; severe fetal growth 

1. Self administered perineal massage daily from the 34th or 35th week of pregnancy until delivery introducing 1 or 2 fingers 3 to 4 cm deep into the vagina and applying and 

Self-reported fecal incontinence as: never, less than once per week, 1 to 6 times a week, once a day, and more than once a 

InteCebalstravagatte
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F714 

Study Participants Clinical Interventions Outcomes 

pregnancy on perineal symptoms after delivery Duration of followup: 3 months 

restriction; breech presentation; preeclampsia; nonparticipating physicians; outbreak of genital herpes during the current pregnancy, inability to speak French or English, inability to understand the instructions, and already doing the massage. Loss of followup: 0.3% 

maintaining pressure 2. Usual obstetric care 

day. hos

conBasadeSam

Fynes, 1999723

RCT to examine the effects of augmented biofeedback with sensory biofeedback alone on fecal incontinence and anorectal manometry after obstetric trauma. Duration: 12 weeks 

40 females with impaired fecal continence after obstetric anal sphincter injury. Exclusion criteria: not reported Loss of followup: 1 woman 

1. Sensory biofeedback training with a vaginal perineometer and standard Kegel pelvic floor exercise. 2. Augmented biofeedback training of pelvic floor with audiovisual feedback and electric stimulation of slow and fast twitch fibers. 

Fecal continence questionnaire and anorectal manometry outcomes: mean maximum resting pressure, mean maximum squeeze pressure, squeeze increment, vector symmetry index. 

No blinranconBasadeSam

Ilnyckyj, 2005724

RCT to examine the effects of biofeedback on fecal incontinence in women. Duration: 2 months 

23 women over 18 years age with regular and frequent idiopathic fecal incontinence defined as soiling with formed or liquid stool and/or fecal staining or smearing of undergarments for 6 months or more, at least once weekly. Exclusion criteria: complicated diabetes, less than 6 months after postvaginal or Caesarean birth, irritable bowel syndrome, inability to attend weekly sessions for 2 months, and conversational insufficient English. Loss of followup: 22%. 

1. Education and explanation and instruction in pelvic floor muscle strengthening exercises with max possible squeeze duration for 5 repetitions spaced by a 20 second pause, 6 times/day. 2. Education and visual and verbal biofeedback therapy using a radial catheter with a latex balloon 

Self-reported success in bowel control: at least one weekly episode of any degree of incontinence (frank soiling, liquid seepage, staining or smearing) before the trial and no incontinence whatsoever after the trial. 

No laballoadeconrannot 

Effects of behavioral interventions on fecal incontinence in adults from the communityByrne, 2002725

RCT to examine the effects of biofeedback in patients with neuropathic fecal incontinence. Duration: unclear 

118 patients with neuropathic fecal incontinence. Exclusion criteria not reported Loss of followup: 14.2% 

1. Pelvic floor exercises and biofeedback 2. Usual care 

Direct questioning of objectives quality-oflife measure on a scale of 0 to 10 reported pre and post treatment. Saint Mark and Pescatori scores of quantitative incontinence were calculated. 

No laballoreprepjust
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F715 

Study Participants Clinical Interventions Outcomes 

Byrne, 2005726

Nonrandomized controlled CT to examine the effects of telephone-assisted biofeedback treatment for patients living in rural and remote areas with the standard face-toface protocol for patients with fecal incontinence. Duration: 6 months 

239 consecutive patients with fecal incontinence diagnosed by a colorectal surgeon with anal manometry and transanal ultrasound, with no improvement after usual conservative treatment including standard dietary advice, use of fiber supplements, constipating medications, and enemas. Inclusion criteria for telephone-assisted protocol: difficulties attending the clinic regularly, residence in remote areas, spoken English, and access to a telephone. Exclusion criteria: a complete external sphincter defect, a non functioning stoma, inflammatory bowel disease, acute perianal inflammation, a potentially reversible cause of incontinence (such as diarrhea), or untreated full-thickness rectal prolapse. Loss of followup: 44%

1. Initial face-to-face assessment and treatment with transanal manometry and ultrasound biofeedback, followed by three treatments conducted via telephone and a final face-to-face assessment. 2. Standard treatment with 5 face-to-face treatment sessions with manometry and ultrasound 

St. Mark’s Hospital fecal incontinence score (full continence 0; complete incontinence 13). Pescatori fecal incontinence score (full continence 0; complete incontinence 6). Anal manometry and external sphincter isometric and isotonic fatigue times. Treatment success: the patient’s selfassessed continence ranking (from a Visual Analog Scale), and a composite grading scored by independent colorectal surgeons. 

InteNodatsize 

Solomon, 2003727

RCT to examine the effects of pelvic floor exercises with biofeedback using anal manometry or transanal ultrasound, and pelvic floor exercises with feedback from digital examination alone. Duration: 4 months 

120 patients with mild to moderate fecal incontinence Loss of followup: 15% 

1. Biofeedback with anal manometry 2. Biofeedback with transanal ultrasound 3 .Pelvic floor exercises with feedback from digital examination alone. 4. 45 minute sections of sphincter exercises with biofeedback (instrumental or digital examination). 

St Mark Hospital Fecal incontinence score (0-13), Pescatori fecal incontinence score (0-6), self-reported fecal continence, physiologic sphincter strength, and compliance 

No blinchaAlloadeconranjust

Pager, 2002728

Solomon, 2003727

Followup evaluation in the participants of the RCT. Duration of followup: 42 months 

83 patients from 120 participants of the RCT with mild to moderate fecal incontinence. Loss of followup: 31% 

1. Pelvic floor exercises with feedback from digital examination alone every day or 2-3 times/week. 2. 45 minute sections of sphincter exercises with biofeedback (instrumental or digital examination). 

St Mark Hospital Fecal incontinence score (0-13), Pescatori fecal incontinence score (0-6), self-reported fecal continence, physiologic sphincter strength, and compliance 

The outsubtreaconbet
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F716 

Study Participants Clinical Interventions Outcomes 

Norton, 2003729

RCT to examine the effects of biofeedback in patients with fecal incontinence. Duration: 3 months. Duration of followup: 1 year. 

171 patients with fecal incontinence. Exclusion criteria: previous course of biofeedback or exercises for fecal incontinence, age less than 18 years, major neurologic disease significant cognitive impairment, active inflammatory bowel disease, unable to consider informed consent issues adequately with insufficient written English skills to complete the questionnaires. Loss of followup: 29% 

1. Standard care with 9 40–60-minute sessions to advise on diet, fluids intake, bowel training. 2. Standard care with 9 40–60-minute advice sessions on diet, fluids intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day. 3. Hospital-based computerassisted sphincter pressure biofeedback. 4. Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes. 

Self-reported symptoms of fecal incontinence, fecal continence score, patient's rating of effectiveness of treatment rated as “worse,” “same,” “improved,” or “cured,” and rating of that change on an ordinal scale of -5 to +5. Quality of life (disease specific). Anal manometry outcomes. 

InteRanumfunconBasadeSam

Jorge, 1994730

RCT to examine the effects of pelvic floor exercise program on fecal incontinence in patients after ileoanal reservoir procedure. Duration: 5 weeks. 

26 patients with ulcerative colitis after total colectomy with double-stapled ileoanal reservoir. Exclusion criteria: one stage double-stapled ileoanal reservoir without temporary ileostomy. Loss of followup: none 

1. Pelvic floor exercise program with 10 second contractions for 5 minutes 5 times/day before surgery 2. Regular care before surgery 

Self-reported fecal incontinence score from 0 to 20. Anal manometry outcomes 

No laballoaderepjust

Miner, 1990731

Crossover RCT to examine the effects of biofeedback training on fecal incontinence. Duration: 4 weeks Duration: of followup 1 year. 

25 consecutive patients with fecal incontinence. Most patients had idiopathic fecal incontinence associated with abnormal perineal descent and many also had features of the irritable bowel syndrome 

1. Pelvic floor exercise with active sensory retraining (3 20-minute sessions) to perceive small rectal volumes of air into the rectal balloon. 2. Pelvic floor exercise retraining with no instruction on how to improve performance. 

Self-reported fecal incontinence: -Do you believe your continence has improved? -Do you now have more warning before an imminent incontinent episode? -Has your life-style changed? -Are you able to go out more? -Can you travel farther 

InteOpand repconrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F717 

Study Participants Clinical Interventions Outcomes 

from the toilet? Anal manometry outcomes. 

Effects of electrical stimulation on fecal incontinence in adultsNorton, 2006732

RCT to examine the effects of anal electric stimulation in the absence of any adjunctive exercises or advice on fecal incontinence Duration: 8 weeks 

90 patients with fecal incontinence. Exclusion criteria: age under 18 years old; pregnancy; vaginal delivery <6 weeks ago; history of pelvic malignancy; active inflammatory bowel disease; active perianal sepsis or painful hemorrhoids or fissure, previous experience of using an electric stimulator to treat urinary or fecal incontinence. Loss of followup: 22.2% 

1. Active anal stimulation at 35Hz/ for 40 minutes a day. 2. Sham anal stimulation at 1Hz. 

1 week bowel diary, symptom questionnaire, manometry, and selfreported patients' evaluation of outcome 

InteCorannumconBasadeSam

Leroi, 2005733Crossover RCT to examine the effects of sacral nerve stimulation on fecal incontinence. Duration: 1 month 

34 patients with fecal incontinence to solid or liquid stools or urgency episodes causing patients to remain at home to avoid incontinence accidents, with >1/week incontinence episodes for at least 3 months, with demonstrable unilateral bulbo(clitorido)-cavernosus reflex, and who failed other conservative treatments Exclusion criteria: not reported. Loss of followup: 21% 

After permanent implantation of percutaneously placed lead turned ON for 1-3 months, subjects were randomized to: 1. Active sacral nerve continuous stimulation with pulse width of 210 microseconds, frequency 14 pulses/second, and amplitude adapted to the patient’s perception of perineal and anal sphincter muscle contraction. The stimulator was left on during defecation and urinary voiding. 2. Sham sacral nerve stimulation with lead turned off. 

Self-reported in patient diary number of weekly fecal incontinence and urgency episodes, and mean delay for postponing defecation and manometric outcomes. 

No blinranAlloadeconrannot 

Chang, 2003734RCT to examine the effects of electrical stimulation therapy in constipated patients with impaired rectal sensation. Duration: 10-14 days 

22 patients with functional constipation as defined by Rome II criteria and impaired rectal sensation (rectal desire threshold volume ≥90ml) on an anorectal manometry, not responsive to conventional therapy such as dietary modification or laxatives for at least 6 months. Exclusion criteria: diabetes mellitus, hypothyroidism, psychiatric disturbances, drug abuse, organic diseases that could lead to constipation. Loss of followup: none 

1. External electrical stimulation therapy using an anal plug with pulse generator in the anal canal once a day for 20 minutes over 10–12 sessions with pulse width of 360–960 μs, a 

frequency of 2–110Hz, and an amplitude of 30–35V. 2. Biofeedback therapy using the EMG system. The visual feedback observing changes in pressure activity on a monitor 

Self-reported bowel frequency and habit, degree of straining, sensation of incomplete evacuation, and anal obstruction using visual analogue scale. Anorectal manometry outcomes 

InteOpand repconrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F718 

Study Participants Clinical Interventions Outcomes 

screen during rise in rectal pressure synchronized with anal relaxation for 60–90 minutes over 10–14 sessions. 

Healy, 2006735RCT to examine the effects of chronic lowfrequency endoanal electrical stimulation on fecal incontinence. Duration 3 months

58 patients with fecal incontinence female with a mean age of 55 years (range 40–78). Exclusion criteria: significant anal sphincter disruption that needed early surgical repair. Loss of follow up: 17%

1.Endo-anal pudendal nerve stimulation daily at home with a portable home unit programmed for frequencies of 3, 10, 20, 30, 40 and 10 Hz and with a current train of 4 s on and 4 s off. 2. Endo-anal electrical stimulation underphysiotherapeutic supervision:  1-weekly treatment of two 15-min cycles of alternate stimulation followed by a patient contraction with EMG biofeedback unit. The first 15-min cycle used 10 Hz followed by a further 15-min cycle of 40 Hz. The second treatment used electrical stimulation alone using the same frequencies 2 times/weekly without biofeedback

Self reported qualityof-life questionnaire (RAND 36-item general health survey)

No laballorepcomjus

Effects of electrical stimulation on postpartum fecal incontinenceMahony, 2004736

RCT to compare intra-anal electromyographic biofeedback alone with intra-anal biofeedback with electrical stimulation of the anal sphincter in treatment of postpartum fecal incontinence. Duration: 12 weeks 

60 women with fecal continence 12 weeks after obstetric injury. Exclusion criteria: history of diabetes mellitus, inflammatory bowel disease, irritable bowel disease, previous anorectal surgery, or malignancy. Loss of followup: 6 women did not complete the study and were excluded from the analysis. 

Standard Kegel exercises daily: 1. Standard intra-anal electromyographic biofeedback training of the pelvic floor 2. Intra-anal electromyographic biofeedback with electrical stimulation of the anal sphincter weekly for 12 weeks by physiotherapists 

The structured bowel function questionnaire to report presence of fecal urgency, flatal incontinence, fecal soiling, frank fecal incontinence, and any impact on daily lifestyle scored from 0 (complete continence) to 20 (complete incontinence).Median resting pressure. Median squeeze pressure using anorectal manometry 

No blinRageof envconBaadeSa
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F719 

Study Participants Clinical Interventions Outcomes 

Effects of perineal massage in the second stage of labor on fecal incontinenceStamp, 2001574

RCT to examine effects of perineal massage in the second stage of labor on urinary and fecal incontinence. Duration: 3 months 

1340 women at 36 weeks' gestation expecting normal birth of a singleton progressed in labor to full dilatation of the cervix or 8cm or more if nulliparous or 5cm or more if multiparous. Exclusion criteria: caesarean section and instrumental birth Loss of follow up:30% 

1. Massage and stretching of the perineum during the second stage of labor with a water soluble lubricant 2. Usual Care 

Self reported using postal survey urinary and fecal incontinence 3 months after postpartum 

IntStrAlloadeconranjus

Effects of pharmacological agents on incidence and progression of fecal incontinence in adultsHo, 2005737

RCT to examine the effects of lateral sphincterotomy and tailored sphincterotomy on anal incontinence in patients with chronic anal fissure. Duration of followup: 4 months 

132 patients with chronic anal fissure and symptoms of sharp pain on defecation for more than 6 weeks and/or anal bleeding, together with exposure of internal anal sphincter muscle fibers at the base of the fissure, and the presence of a sentinel pile and/or hypertrophied anal papilla. Exclusion criteria: previous anal sphincter surgery, pre-existing fecal incontinence, concomitant hemorrhoids who required, inflammatory bowel disease, use of nitrates or calcium channel blockers for hypertension or cardiac conditions. Loss of followup: none 

1. 'Chemical sphincterotomy' with oral nifedipine 20mg twice a day for 6 weeks.2. Lateral sphincterotomy: internal anal sphincter muscle was identified and the muscle proximal to dentate line was lifted with a small pair of artery forceps. The level of internal anal sphincter division was defined accurately before division using diathermy.

Self-reported fecal incontinence, Wexner incontinence scores. Anal manomtery outcomes 

IntOpwitAlloadeconranjus

De Nardi,2006738

RCT to examine the effects of "chemical sphincterotomies" for chronic anal fissure. Duration of followup: 12 months 

30 consecutive patients with chronic posterior anal fissure defined as symptoms lasting for >3 months and the presence of typical features, such as skin tag, indurations of the edges of the fissure, hypertrophic proximal papilla, and exposure of fibers of internal anal sphincter. Exclusion criteria: acute fissure, low resting tone at digital examination, inflammatory bowel disease, incontinence, previous anal surgery, and treatment with oral or transdermal nitrate. Loss of followup: none 

1. 0.2 percent glycerine trinitrate ointment applied three times daily at the anal margin for eight weeks 2. 20 units Botulinum toxin A injection into the internal anal sphincter on each side of the anterior midline 

Self-reported fecal incontinence with Wexner incontinence score questionnaire

IntOpand not repjus

Ron, 2001739

RCT to examine the effects of botulinum toxin type-A (Botox) 

25 patients older than 18 years with history of constipation and symptoms of outlet obstruction for >1 year, nonrelaxing puborectalis muscle on both modalities, who were unable to expel a rectal balloon and who 

1 Local injection of Botox—10 units to each side of the puborectalis 2. Local injection of Botox—20 units to the posterior aspect of 

Self-reported fecal incontinence 

No laballoreprep
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F720 

Study Participants Clinical Interventions Outcomes 

injection to the puborectalis muscle in patients with anismus. Duration of followup: 52 weeks 

failed laxatives and enema therapy. Exclusion criteria: concomitant fecal incontinence, pregnancy. Loss of followup: 4% 

this muscle. jus

Mentes, 2003 740

RCT to examine effects of lateral internal sphincterotomy and injection of botulinum toxin for the treatment of idiopathic anal fissures. Duration of follow up: 1 year 

111 patients with sever chronic anal fissure with the horizontal fibers of the internal anal sphincter visible in its base. Exclusion criteria: concurrent fistula, significant haemorrhoidal diseases, inflammatory bowel disease, anal incontinence, slow transit time constipation, diabetes, alcoholism, drug abuse, anoreceptive intercourse, previous anorectal surgery. Lost of followup: none. 

1. 20 to 30 units (~ 0.3U/kg) of type A botulinum toxin (Botox) injection into the internal anal sphincter. The injection was repeated 2 months later if complete healing was not achieved. 2. Lateral internal anal sphincterotomy. 

Self-reported incidence of anal incontinence using scoring system by Miller (0-18, 18-complete incontinence) 

IntSinwitAllorepconrannot 

Iswariah, 2005741

RCT to examine effects of lateral internal sphincterotomy and injection of botulinum toxin for treatment of idiopathic anal fissures. Duration of followup: 25 weeks 

38 adult patients older than 18 years with chronic idiopathic fissure in and who had failed conservative treatment. Exclusion criteria: prior sphincterotomy or anal dilatation, fissure associated with inflammatory bowel disease, performance of concomitant anal procedure, fecal incontinence, pregnancy or breast-feeding. Loss of followup: 13.6% 

1. Botox, 20 units injected on either side of the fissure into the internal anal sphincter. 2. Sphincterotomy by open or closed technique in the left lateral position using Park’s anal retractor 

Self reported modified Wexner Fecal Continence scoring system 

No labranAlloadeconranSa

Brisinda, 1999742

RCT to examine effects of botulinum toxin and topical nitroglycerin ointment for treatment of chronic anal fissure. Duration of followup: 2 months, 15 months 

50 adults with symptomatic chronic posterior anal fissures. Exclusion criteria: acute fissure, or fissure associated with other conditions (inflammatory bowel diseases, HIV infection, hemorrhoids, fistula in ano, anal abscesses, or anal or perianal cancer), previous surgical procedures in the anal canal. Lost of followup: none 

1. 20 units of botulinum toxin injected into the internal anal sphincter on each side of the anterior midline 2. 0.2 percent nitroglycerin ointment applied twice daily 

Anal manometry outcomes 

IntSingetabnot conranSa
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F721 

Study Participants Clinical Interventions Outcomes 

Siproudhis, 2003 743Placebo-controlled RCT to examine effects of single injection of botulinum toxin in the internal anal sphincter of patients with chronic anal fissure. Duration of followup: 12 weeks. 

44 patients 18-75 years old with chronic anal fissure >1 month, mean value of postdefecation anal pain >30mm on a 100mm visual analogue scale 1 week before inclusion. Exclusion criteria: anal sepsis, inflammatory bowel disease, cancer, trauma, anal stenosis, previous surgery, functional pelvic disorders, use of non steroidal anti-inflammatory and analgesic drugs. Loss of followup: 4.5%. 

1. Single injection of botulinum toxin in the internal anal sphincter, 100 units of Dysport toxin, 250.units/ml. Daily laxatives and suppositories. 2. Single injection of isotonic saline. Daily laxatives and suppositories 

Self-reported incidence of anal incontinence 

No blinranbloconBaadeSa

Hallgren,1994744

Crossover placebo controlled RCT to examine the effects of Loperamide on fecal continence after restorative proctocolectomy. Duration: 7 days 

30 patients operated for ulcerative colitis with endoanal mucosectomy and a hand sewn ileal pouch-anal anastomosis or with abdominal proctocolectomy and stapling of the pouch to the top of the anal canal. Exclusion criteria: not reported.Loss of followup: 6.6% 

1. Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days 2. Placebo with the same frequency. 

Self-reported fecal continence. Anal manometry outcomes 

No blinallorepconrannot 

Sun, 1997745

Placebo controlled crossover RCT to examine the effects of loperamide oxide on anorectal function in patients with chronic diarrhea. Duration: 4 weeks with 1 week run-in and wash out 

11 patients with chronic diarrhea, fecal incontinence >1 time/month, and severe urgency >3 times/week. Exclusion criteria: positive microbiologic analysis for feces, fat, and blood, large-volume diarrhea >500ml/day, anal seepage, use of anti diarrhea medication. Loss of followup: none 

1. Loperamide oxide 4mg twice daily 2. Placebo 

Self-reported fecal incontinence as leakage of several ml of fluid, enough to require cloth change. Self-reported fecal urgency as acute desire to defecate which would result in incontinence if not relieved within 30 seconds. Visual analog scale from 0 (absent) to 100 (extreme). Anal manometry outcomes 

InteRaconBaSa

Kneebone, 2004746Placebo-controlled RCT to examine the effects of oral 

338 males receiving definitive radiotherapy for prostate cancer with prescribed dose >60Gy and the superior limit of the treatment fields situated below the level of the greater sciatic 

1. 3g of oral sucralfate suspension twice daily starting 1 day before RT and continuing every day for 8 weeks 

Self-reported patients' symptoms of fecal incontinence using the Radiation Therapy 

No blingeon
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F722 

Study Participants Clinical Interventions Outcomes 

sucralfate to prevent fecal incontinence in prostate cancer patients treated with radiotherapy. Duration: 8 weeks Duration of followup: 2 years 

notch to ensure that significant portions of small bowel were not irradiated. Exclusion criteria: active gastro-intestinal conditions including acute diverticulitis, Crohn’s disease, or ulcerative colitis, prior colostomy for any reason, significant renal impairment (serum creatinine >0.3 mmol/l). Loss of followup: 11.8%

2. Identical placebo twice daily Oncology Group Grade 

2 or more criteria. Flexible sigmoidoscopy outcomes 

witconBaadeSa

Carapeti, 2000747

Placebo controlled crossover RCT to examine the effects of topical phenylephrine in the treatment of faecal incontinence due to internal sphincter dysfunction. Duration: 4 weeks, washout 1 week 

36 patients with fecal incontinence for solid or liquid stool and ultrasonographically structurally normal anal sphincter muscles. Exclusion criteria: pregnancy, ischemic heart disease, hypertension, aortic aneurysm, treatment with monoamine oxidase inhibitors or tricyclic antidepressants, underlying treatable causes for incontinence such as inflammatory bowel disease or surgically repairable external sphincter.Loss of followup: not reported

1. Topical 10% phenylephrine 0.5 ml applied topically to the anus twice daily for 4 weeks. 2. Identical placebo gel 0.5 ml applied topically to the anus twice daily for 4 weeks. 

Self-reported fecal incontinence score modified from the Wexner scale: 24- worst incontinence; 0-no incontinence scored to analyze the frequency of incontinence for solid or liquid stool or gas, alteration in lifestyle, need to wear a pad, urgency and use of constipating drugs. 

No blinwitranconBaadeSa

Carapeti, 2000 748Placebo controlled crossover RCT to examine the effects of topical phenylephrine gel on fecal incontinence in patients with an ileoanal reservoir pouch. Duration: 4 weeks 

12 patients with fecal incontinence, noninflamed pouch for previous ulcerative colitis of normal size and ultrasonographically structurally normal anal sphincter muscles. Exclusion criteria: pregnancy, ischemic heart diseases, hypertension, aortic aneurism, treatment with monoamine oxidase inhibitors or tricyclic antidepressants. Loss of followup: none 

1. Alpha1-adrenergic agonist phenylephrine, topical 10% 0.5ml application 2 times/day 2. Placebo gel 

Self-reported fecal incontinence symptoms (0-no symptoms to 280) and scores using validated Wexner scale from 0-continence to 24 – complete incontinence. Anorectal manometry outcomes. 

IntDogeAlloadeconranjus

Nessim, 1999749

RCT to examine the effects of medical bowel confinement and regular diet on fecal incontinence after anorectal 

54 patients 23-87 years old after anorectal reconstructive surgery including 32 after sphincteroplasty for fecal incontinence. Exclusion criteria: age younger than 18 years, immunosupression, prior pelvic irradiation, active proctitis, inflammatory bowel disease Loss of followup: none 

1. Medical bowel confinement: clear liquid diet with loperamide 4mg 3 times/day and codeine phosphate 30mg 4 times/day for 3 days. 2. Regular diet beginning the day of surgery 

Self-reported fecal incontinence scores from 1 to 20 in 32 patients treated with sphincteroplasty for fecal incontinence 

No blinranconBaadeSa
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F723 

Study Participants Clinical Interventions Outcomes 

reconstructive surgery. Duration of followup: 13 months Tankova, 2002750

RCT to examine the effects of topical mononitrate hydrogel for the treatment of anal fissure. Duration: 3 weeks. Duration of followup: 3 months 

19 patients with symptomatic chronic anal fissures lasting for >2 months. Exclusion criteria: Anal fissures associated with other conditions (Crohn's disease, human immunodeficiency virus infection, fistula in ano, anal abscess, anal cancer) and previous surgical procedures. Loss of followup: none 

1. Rectal administration of hydrogel containing 0.2% isosorbide-5-mononitrate 2 times/day 2. Placebo gel. 

Self-reported fecal incontinence. Anal manometry outcomes 

IntMaautand RaconBaadeSa

Effects of surgical interventions on fecal incontinence related to obstetric trauma in femalesFernando, 2006751

RCT to examine the effects of primary overlap versus end-to-end repair of the external anal sphincter after acute obstetric trauma. Duration: 12 months 

64 women with third-degree (3b = greater than 50% external anal sphincter thickness, 3c = internal sphincter injury) or fourth-degree (including anorectal epithelium) perineal tears Exclusion criteria: 3a tear (<50% thickness of the external anal sphincter torn) or a previous 3rd or 4th degree perineal tear. 

Loss of followup: 19%, 2 women had left the area and could not be contacted, and 10 declined to complete further questionnaires. 

1. End-to-end technique to repair obstetric anal sphincter: torn ends of the external anal sphincter were approximated and repaired with 2-3 mattress sutures using 3-0 PDS sutures. 2. Overlap technique to repair obstetric anal sphincter: the outer surface of the sphincter was mobilized from the surrounding tissue, the first row of sutures was inserted ~1.5 cm from one side of the torn edge of external anal sphincter and overlapped within 0.5 cm of the other edge of the torn external anal sphincter. 

Self-reported fecal incontinence, urgency, flatus incontinence, and improvement of anal incontinence symptoms scored with Wexner scale from; 24 – complete incontinence to 0 - complete continence. Questionnaires were sent at 6 weeks, and 3, 6, and 12 months after the repair 

Inte(sucomminAlloadeconranjus

Garcia, 2005597RCT to examine the effects of surgical techniques for the primary repair of obstetric anal sphincter lacerations. Duration: 4 months postpartum 

51 women with complete third or fourth degree anal sphincter laceration and who underwent primary repair at the time of vaginal delivery. Exclusion criteria: not reported Loss of followup: 35.6% 

1. End-to-end technique to repair obstetric anal sphincter lacerations: 4 separate sutures of polyglycolic acid to reapproximate the sphincter ends directly. 2. Overlapping repair of obstetric anal sphincter lacerations used 3 sutures of 2-0 PDS to reapproximate the 

Self-reported urinary and anal incontinence graded with the Fecal Incontinence Score (FIS) from 18 - total incontinence >2/week, scores 1-3 incontinence of flatus only. Anal incontinence was 

No blinranconBaadeSa
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F724 

Study Participants Clinical Interventions Outcomes 

sphincter ends in an overlapping fashion. 

defined as a fecal incontinence score of >0 

Williams, 2006752RCT to compare two surgical techniques and two types of suture material for anal sphincter repair after obstetric injury. Duration: 3 months 

150 women with an anal sphincter injury sustained during childbirth. Exclusion criteria not reported. Loss of followup: 20% at 3 months. 

1. End–end repair of the torn anal sphincter with braided polyglactin (Vicryl retains 50% of its strengths at 3weeks, minimal tissue reaction). 2. Overlap repair of the torn anal sphincter with braided polyglactin (Vicryl retains 50% of its strengths at 3 weeks, minimal tissue reaction). 3. End–end repair of the torn anal sphincter with PDS (a monofilament suture with minimal absorption until 90 days, no chronic suture sinuses) 4. Overlap repair of the torn anal sphincter with PDS (amonofilament suture with minimal absorption until 90 days, no chronic suture sinuses). 

Self-reported fecal incontinence using St Mark’s bowel symptom questionnaire and scoring. Anorectal function using endoanal ultrasound. Anal manometry and pudendal nerve terminal latency tests. 

No blinsequsinu8. Aunconranjus

Tjandra, 2003753

RCT to examine the effects of two surgical techniques (direct end-to-end vs. overlapping) of delayed repair of a localized anterior defect of external anal sphincter after an obstetric trauma. Duration of followup: 18 months 

23 women with localized anterior defect of external anal sphincter after an obstetric trauma, normal pudendal nerve terminal motor latency. Exclusion criteria: prolonged pudental nerve terminal motor latency. Loss of followup: none. 

1. Direct end-to-end repair using 2-0 PDS sutures 2. Overlapping sphincter repair with fibro muscular ends using 2-0 PDS sutures 

Self-reported fecal continence using the Cleveland Clinic Continence Score (0-20); 0 - perfect continence. Endoanal ultrasound, anorectal manometry, and neurophysiologic exam outcomes. 

IntSinand not conrannot 

Fitzpatrick, 2000754

RCT to examine the effects of primary anal 

112 primiparous women who sustained a third-degree tear defined as any recognized disruption of the external anal sphincter (partial or complete). 

1. Primary anal sphincter overlap: the sphincter ends in an overlapping fashion. 2. Approximation repair: the torn 

Self-reported fecal incontinence using detailed bowel function questionnaire scored 

All ananot Allo
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F725 

Study Participants Clinical Interventions Outcomes 

sphincter overlap or approximation repair of thirddegree obstetric tears on postpartum incontinence. Duration: 3 months postpartum 

Exclusion criteria: not reported. Loss of followup: 0% 

sphincter ends were grasped by means of an Allis forceps and approximated end to end without tension 

with a modified Wexner score. anal manometry and anal endosonography outcomes 

unconranjus

Effects of clinical interventions to prevent fecal incontinence after obstetric traumaDannecke, 2005590

Followup RCT to examine the effects of restrictive use of mediolateral episiotomy vs. routine episiotomy. Duration: 18 months 

146 primiparous women with an uncomplicated singleton pregnancy >34 weeks of gestation intending a vaginal delivery. Exclusion criteria: previous surgery at the pelvic floor and neurological disorder. Loss of followup: 45% in restrictive policy group, 32% in liberal policy group 

1. Restrictive episiotomy - avoidance of episiotomy (for fetal indications only). 2. Liberal – in addition to fetal indications use episiotomy when a tear is judged to be imminent 

Self-reported presence of urinary and fecal incontinence with standardized questionnaire. Anorectal manometry and urodynamic outcomes. Pelvic floor muscle strength with a vaginal palpation. The effort to contract the levator ani was graded with the Oxford Score (4 - strongest). 

IntSimAlloadeconranjus

Sartore, 2004591

Nonrandomized CT to examine the effect of mediolateral episiotomy on puerperal pelvic floor strength and dysfunction. Duration: 3 months after vaginal delivery 

519 consecutive primiparous women with singleton pregnancies and spontaneous vaginal delivery with the fetal head in occiput anterior position, residents of Trieste. Exclusion criteria: Not delivered in the lithotomy position, cesarean delivery, third and fourth-degree perineal lacerations, preterm, breech, and operative delivery, anal and urinary incontinence that pre-existed vaginal delivery, and history of vaginal or anal surgery. 

1. Mediolateral episiotomy. 2. No episiotomy 

Stress urinary incontinence - observation of involuntary loss of urine synchronous with coughing (+ stress test) with comfortably full bladder. Selfreported urge incontinence - loss of urine associated with strong desire to void. Self-reported anal incontinence – loss of flatus, liquid, or solid stool. Pelvic floor muscle strength scored from 0 to 5. Vaginal manometry: 

No labcomneorat
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F726 

Study Participants Clinical Interventions Outcomes 

abnormal perineometric values <12 cm of water. Urine stream interruption test: abnormal any urine stream interruption test scores >5 seconds. 

Hannah, 2002592

Term Breech Trial, RCT to examine the effects of planned cesarean section on incontinence 3 months postpartum. Duration: 3 months 

1,159 women with singleton live fetus in a frank or complete breech presentation at term (37 weeks’ gestation). Exclusion criteria: Fetopelvic disproportion, fetus weight >4000g, hyperextension of the fetal head, lethal anomaly or a condition that 

might cause a mechanical problem at delivery, and contraindication to labor or vaginal delivery. Loss of followup: 16.5% 

1. Planned vaginal birth group, management was expectant until 

spontaneous labor began, unless an indication to induce labor 

(e.g., post term pregnancy) 2. Planned cesarean delivery (e.g., footling breech presentation) scheduled for 38 or more weeks' gestation. If the woman was in labor at the time of randomization, the caesarean section was undertaken as soon as possible. Immediately before caesarean section, the fetal presentation was reassessed and if cephalic, a vaginal birth was planned. 

Self-reported stress urinary incontinence and fecal or flatus incontinence within the 

previous 7 days. Perception of incontinence: no problem at all, a little problem, or a big 

problem. 

IntCestrsizconBaadeSa

Hannah, 2004593

Followup the Term Breech Trial, RCT to examine the effects of planned cesarean section on incontinence 2 years postpartum. Duration: 2 years 

917 of 1,159 women with singleton live fetus in a frank or complete breech presentation at term (37 weeks’ gestation). Exclusion criteria: Fetopelvic disproportion, fetus weight >4,000g, hyperextension of the fetal head, lethal anomaly or a condition that 

might cause a mechanical problem at delivery, and contraindication to labor or vaginal delivery. Loss of followup: 20.9% in planned Cesarean groups and 19.6% in vaginal birth group. 

1. Planned vaginal birth group, management was expectant until 

spontaneous labor began, unless an indication to induce labor (e.g., 

post term pregnancy) 2. Planned cesarean delivery (e.g., footling breech presentation) scheduled for 38 or more weeks' gestation. If the woman was in labor at the time of randomization, the caesarean section was undertaken as soon as possible. Immediately before caesarean section, the fetal presentation was reassessed and if cephalic, a vaginal birth was planned. 

Self-reported stress urinary incontinence and fecal or flatus incontinence within the 

previous over the previous 3 to 6 months. Perception of incontinence: no problem at all, a little problem, or a big 

problem. 

IntCestrsizconBaadeSa
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F727 

Study Participants Clinical Interventions Outcomes 

Fitzpatrick, 2002755

RCT to examine the effects of delayed vs. immediate pushing in second stage of labor with epidural analgesia on postpartum faecal continence. Duration: 3 months 

178 primiparae in either spontaneous or induced labor with a singleton fetus, cephalic presentation between 37 and 42 weeks of gestation with effective epidural analgesia in situ. Exclusion criteria: diabetes, irritable bowel syndrome or other bowel or neurological disorder Loss of followup: none 

1. Immediate pushing 2. 60-minute delay, prior to the commencement of active pushing. If delivery was not imminent after 60 minutes pushing, a decision was made regarding the need for instrumental or caesarean delivery. 

Self-reported FI using bowel function questionnaire With modified continence score from 0 - complete continence, to 20 – complete incontinence. Anal manometry outcomes. Anal ultrasound to evaluate potential structural damage to the anal sphincters. 

All IntSingeof Alloadeconranjus

Johanson, 1999596

Followup RCT to examine the effects of delivery by forceps or vacuum extractor on maternal and child outcomes. Duration: 5 years postpartum. 

607 women requiring assisted vaginal delivery. Exclusion criteria: 47% of participants form the original RCT were not contacted for unclear reasons. Loss of followup: 26.2% non responders to the survey 5 years postpartum. 

1. Delivery with vacuum extractor. 2. Forceps delivery. 

Self-reported fecal and urinary incontinence 5 years postpartum 

No labproAllounconranjus

Fitzpatrick, 2003756

RCT to examine the effects of forceps or vacuum assisted vaginal delivery on anal sphincter function in standardized management of labor. Duration: 12 weeks 

130 primiparous women in either spontaneous or induced labor with a singleton fetus, cephalic presentation, between 37 and 42 weeks of gestation and required instrumental assistance with delivery. Exclusion criteria: diabetes, irritable bowel syndrome or other bowel or neurological disorders Loss of followup: 16 failed vacuum-forceps 

1. Vacuum assisted delivery 2. Low-cavity, non-rotational forceps assisted delivery 

Self-reported fecal continence scored from 0 - complete continence, to 20 - complete incontinence. Fecal urgency - unable to defer defecation for >5 minutes. Anal manometry outcomes. Endoanal ultrasound outcomes. 

IntCoranbaAllounconranjus

Sultan, 1999757

RCT to examine the effect of forceps and vacuum delivery on anal sphincter trauma 5 years postpartum. Duration: 5 years postpartum 

44 from 313 contacted participants in Keele University Multicenter Assisted Delivery Trial (607 women were randomized in the original trial) Exclusion criteria: unclear why only 313 from 607 participants were contacted for a survey; 44 only agree to have anal endosonography and manometry 5 years postpartum. 

1. Delivery with vacuum extractor 2. Forceps delivery. 

Anal endosonography outcomes. Anal manometry outcomes. 

IntRanot condatranjus
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F728 

Study Participants Clinical Interventions Outcomes 

Effects of surgical interventions to reduce fecal incontinence in femalesFaltin, 2005758RCT to examine whether diagnosis of sphincter tears followed by immediate surgical repair reduces the occurrence of incontinence. Duration: 3 months and 1 year 

752 nulliparous women older than 18 years with no scheduled cesarean delivery with second-degree perineal tear (spontaneous or after episiotomy). Exclusion criteria: anal sphincter ruptures (third- or fourth-degree perineal tear, International Classification of Diseases, 10th Revision), Cesarean delivery, intact perineum or minimal perineal tear ruptures (first-degree perineal tear). Loss of followup: 0.8% 

1. Clinical and ultrasound examination of the anal sphincter immediately after 

vaginal delivery 2. Clinical examination alone 

Self-reported fecal incontinence, need to wear a pad, and lifestyle alterations caused by fecal incontinence using the Wexner scale grading (0-absent; 4- daily). 

IntCoranand ordadeconranjus

Deen, 1994759

RCT to examine the effects of abdominal resection rectopexy or perineal rectosigmoidectomy and pelvic floor repair in elderly female patients with full-thickness rectal prolapse and faecal incontinence. Duration of followup: 17 months 

20 elderly female patients with full-thickness 

rectal prolapse and fecal incontinence. Exclusion criteria: not reported. Loss of followup: none 

1. Abdominal resection rectopexy and pelvic floor repair. 2. Perineal rectosigmoidectomy and pelvic floor repair. 

Self-reported fecal incontinence graded from A (fully continent) to D. anal manometry outcomes. 

No laballorepconrannot 

Sayfan, 1990760

Non randomized controlled CT to examine the effects of sutured posterior abdominal rectopexy with sigmoidectomy or Marlex rectopexy on fecal incontinence in patients with rectal prolapse. Duration of followup: 2 weeks 

29 women with full-thickness rectal prolapse. Exclusion criteria: not reported. Loss of followup: none. 

1. Marlex mesh posterior rectopexy alone. 2. Sigmoidectomy combined with a sutured posterior rectopexy 

Self-reported fecal incontinence, anal manomtery outcomes and rectal emptying during proctography. 

IntOprannot jus
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F729 

Study Participants Clinical Interventions Outcomes 

Yoshioka, 1999761

RCT to examine the effects of total pelvic floor repair with gluteus maximus transposition for women with post obstetric fecal incontinence. Duration of followup: 18 months 

24 women with post obstetric neuropathic fecal incontinence. Exclusion criteria: comorbidity (diabetes), endosonographic sphincter defect, previous anal surgery. Loss of followup: not reported 

1. Gluteus maximus transposition (without electrical stimulation). 2. Total pelvic floor postanal repair with anterior levatoroplasty 

20 point clinical incontinence score. -failing to achieve full continence -fecal urgency secondary outcome measures: -post-operative complications -adverse functional effects -physiological outcomes 

IntPeranconBaadeSa

Deen, 1993762

RCT to examine total pelvic floor repair with anterior levatorplasty and sphincter plication alone and postanal repair alone. Duration: 6 months 

36 women 28-75 years with neuropathic fecal incontinence confirmed by manometry with >4 incontinent episodes/month. Exclusion criteria: isolated anal sphincter defect, diabetes mellitus. Loss of followup:53% 

1. Total pelvic floor repair 2. Anterior levatorplasty and sphincter plication alone 3. Postanal repair alone 4. Control: 18 females undergoing herniorrhaphy and cholecystectomy 

Self-reported fecal continence. Manometric and radiologic outcomes. 

No labranconBaSa

Davis, 2004763

RCT to examine the effects of adjuvant biofeedback following anal sphincter repair on fecal incontinence. Duration of biofeedback: 6 weeks Duration of followup: 3 months and 1 year 

38 females with fecal incontinence who failed other conservative treatments, with persistent leakage of liquid or solid stool over at least the previous 12 months, with external anal sphincter defect identifiable on endoanal ultrasound. Exclusion criteria: Coexistent rectocele, full thickness rectal prolapse, congenital abnormalities, non-obstetric trauma to the sphincter complex, inflammatory bowel disease or significant, women under the age of 18 years, planning pregnancy or who suspected pregnancy. Loss of followup: 5.3% 

1. Anterior overlapping sphincter repair using interrupted nonabsorbable sutures and levatorplasty using absorbable sutures. 2. Anterior overlapping sphincter repair plus visual or auditory biofeedback with dual-balloon pressure system during pelvic floor exercise 2 times/day. Three types of exercises: ‘maximal’ -maximal squeeze for as long as possible up to 10 seconds; ‘submaximal’ - halfway squeeze held for up to 5 seconds; or series of repetitive fast squeeze and relax contractions. 

Self-reported fecal incontinence symptoms with 3-point scale of ‘improved,’ ‘remained the same,’ or ‘got worse,’ change in continence score ranging from 0 to 20 (0 - no incontinence to 20 - complete incontinence), and anorectal outcomes. 

IntRagenuconBaadeSa

Deen, 1995764

RCT to examine the effects of 

33 women with neuropathic fecal incontinence with a history of prolonged or difficult vaginal delivery, >6 fecal accidents/month, using pad 

1. Adjuvant internal anal sphincter plication in pelvic floor repair 

Self-reported fecal incontinence scores from 1 - satisfactory to 

IntOpwit
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F730 

Study Participants Clinical Interventions Outcomes 

adjuvant internal anal sphincter plication in women with neuropathic fecal incontinence. Duration of followup: 1 year. 

for fecal incontinence. Exclusion criteria: external sphincter defect, diabetes mellitus, rectal prolapse. Loss of followup: none 

2. Pelvic floor repair alone 7 – poor. Anorectal 

manometry outcomes 

Allorepconranjus

Davis, 2004763

RCT to examine the effects of adjuvant biofeedback following sphincter surgery. Duration of followup: 12 months 

47 consecutive female patients with defect of external anal sphincter identifiable on endoanal ultrasound and fecal incontinence who failed to control symptoms of persistent leakage of liquid or solid stool over at least the previous 12 months. Exclusion criteria: coexistent rectocele, full thickness rectal prolapse, congenital abnormalities, non-obstetric trauma to the sphincter complex, inflammatory bowel disease or significant neuropathy, women under the age of 18 years, planning pregnancy or who suspected pregnancy. Loss of followup:18% 

1. Direct sphincter repair and levatorplasty with pelvic floor muscle exercise training with maximal or submaximal squeeze for 10 seconds 10 times day in different positions. Biofeedback therapy 3 months after surgery using dual-balloon pressure system with color led visual or auditory signals of sphincter pressure as feedback. 2. Direct sphincter repair and levatorplasty 

Self-reported fecal continence using fecal incontinence scale with continence score (0 - no incontinence to 20 - complete incontinence). Endoanal ultrasonography outcomes. 

No labcomranconBaadeSa

Van Tets, 1998765

RCT to examine the effects of postanal and total pelvic floor repair for female neurogenic incontinence. Duration of followup: 12 weeks 

Type D incontinence (no control of solid stool by Parks and Browning). Exclusion criteria: sphincter defects. Loss of follow up: not reported 

1. Postanal repair with levator ani and plicated of the external anal sphincter. 2. Total pelvic floor repair with a combination of postanal repair, anterior Ievatorptasty, and anterior sphincter plication 

Self-reported fecal incontinence 

IntOpdraconBaadeSa

Thakar, 2002599

RCT to examine the effects of total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases. Duration: 1 year 

279 women referred for hysterectomy because of benign disease; most of the women were premenopausal. Exclusion criteria: age >60 years, suspected cancer, a body weight that exceeded 100kg, previous pelvic surgery, known endometriosis, abnormal cervical smears, symptomatic uterine prolapse, and symptomatic urinary incontinence for which the patient might seek expert medical advice. Loss of followup: 16% in total and 12% in subtotal abdominal hysterectomy groups. 

1. Subtotal hysterectomy 2. Total hysterectomy 

Self-reported urinary incontinence using standardized Questionnaire. Stress incontinence scored from 0 - none to 4 - always. Twin-channel subtracted cystometrography and uroflowmetry outcomes. 

No cysblincomAllounconranjus
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F731 

Study Participants Clinical Interventions Outcomes 

Effects of surgical interventions to reduce fecal incontinence in malesPeeters, 2006766

RCT to examine the effects of three-dimensional conformal radiotherapy for prostate cancer. Duration of followup: 44 months 

641 patients with localized adenocarcinoma of the prostate. Exclusion criteria: not reported Loss of followup: 0.6%. 

1. Three-dimensional conformal radiotherapy 68Gy 2. Three-dimensional conformal radiotherapy 78Gy 

Fecal incontinence as use of incontinence pads for rectal loss of blood, mucus, or stools (requiring the use of pads more than twice a week) reported using Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer questionnaire. 

No labby aggroconBaadeSa

Fransson, 2001686

RCT to examine the effects of radiotherapy for localized prostate carcinoma. Duration of followup: 30-40 months 

166 patients with localized prostate carcinoma cytologically or histologically verified as T1aT2, G1-G2, pN0, and M0. Exclusion criteria: expected survival <10 years. Loss of followup: 35%. 

1. Radiotherapy with a total dose of 4.8Gy (range, 62.3–70.0Gy) given for 5 days a week, 2 grays (Gy) per fraction. 2. Active surveillance 

Self-reported urinary and fecal incontinence using validated symptom specific self assessment questionnaire, QUFW94 with values between 0 and 10; 0 - “no problem/very good function” and 10 - “many problems/very bad function.” 

No laballorepconrannot 

Little, 2003676

Followup RCT to examine the effects of radiotherapy for prostate cancer on urinary incontinence and bowel function. Duration of followup: 3 years 

301 patients: 3 with histologically confirmed adenocarcinoma of the prostate and no metastatic disease treated with a four-field box technique to a dose of 46Gy. Exclusion criteria: not reported Response rate 70%. 

1. Radiation with a four-field box technique to a dose of 70Gy arm 2. Radiation with threedimensional conformal techniques to generate a sixfield boost plan of a total dose of 78Gy 

Self-reported bladder, bowel and sexual function (Fowler) 

No laballorepconrannot 

Effects of bowel management in patients with spinal cord injury and symptoms of neurogenic bowel dysfunctionChristensen, 2006767RCT to examine the effects of 

87 patients 18 years or older after spinal cord injury at any level at least 3 months after injury and at least one of the following symptoms of neurogenic bowel dysfunction: 1) spending 

1. Transanal irrigation with integrated system of coated rectal balloon catheter, control unit including a manual pump, 

Cleveland Clinic constipation scoring system (0-30, 30 = severe symptoms). St 

IntCoranAllo
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F732 

Study Participants Clinical Interventions Outcomes 

transanal irrigation on fecal incontinence in patients with spinal cord injuries. Duration: 10 weeks 

>30 minutes attempting to defecate each day or every second day, 2) episodes of fecal incontinence >1 per month, 3) symptoms reflecting autonomic dysreflexia before or during defecation, and 4) abdominal discomfort before or during defecation. Exclusion criteria: coexisting major unsolved physical problems due to the injury, performance of transanal irrigation on a regular basis, evidence of bowel obstruction or inflammatory bowel disease, history of cerebral palsy or cerebral apoplexy, multiple sclerosis, diabetic polyneuropathy, previous abdominal or perineal surgery (excluding minor surgery such as appendectomy or hemorrhoidectomy), pregnancy or lactation, evidence of spinal shock, mental instability, treatment with more than 5mg/day prednisolone, and implant for sacral nerve stimulation.Loss of followup: 6.8% 

and a water container with the volume increased to 1,500ml or reduced gradually to 250ml. 2. Conservative bowel management with scheduled bowel care at least every 2 days, modulated diet, fluids, and regular physical activity and use of laxatives or constipating medicine. 

Mark's fecal incontinence grading system (0-24, 24 = severe symptoms) Neurogenic Bowel Dysfunction Score (0-no symptoms, 47 = severe symptoms). The modified American Society of Colorectal Surgeon fecal incontinence scores (0-4, 4 = high quality of life) 

adeconranjus

Effects of surgical interventions on fecal incontinences in adults with hemorrhoid diseaseHetzer, 2002768RCT to examine the effects of stapled hemorrhoidectomy and excision hemorrhoidectomy on fecal incontinence. Duration of followup: 12 months 

40 patients with second- and third-degree hemorrhoid disease. Exclusion criteria: not reported Loss of followup: none 

1. Stapled hemorrhoidectomy (Longo technique) with circular anal dilatator introduced to reduce the prolapse of the anoderm and parts of the anal mucous membrane. 2. Excision hemorrhoidectomy (Ferguson technique). 

Self-reported fecal incontinence 

IntOpand not conrannot 

Konsten, 2000769

RCT to examine the effects of anal dilation and hemorrhoidectomy for haemorrhoidal disease on fecal incontinence. Duration of followup: 1 year. 

138 patients with second-degree and thirddegree hemorrhoids. Exclusion criteria : not reported Loss of followup: 14%, 14 patients died. 

1. Hemorrhoidectomy with no retractor (Miller method). 2. Hemorrhoidectomy with forced anal dilation and after treatment for 6 months (original Lord's procedure. 3. Hemorrhoidectomy with forced anal dilation. 

Self-reported fecal incontinence 

No laballorepconrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F733 

Study Participants Clinical Interventions Outcomes 

Jayne, 2002770

RCT to examine the effects of open diathermy haemorrhoidectomy and a new technique of haemorrhoidectomy using the Ligasure device suited to day-case surgery on fecal incontinence. Duration of followup: 3 months 

40 patients with grade III or IV hemorrhoids. Exclusion criteria: use of regular anticoagulants, immunosuppressant or analgesics, American Society of Anesthesiologists grade III and IV risk, pregnancy, and the inability to give written informed consent. Loss of followup: none 

1. Ligasure haemorrhoidectomy applying repeated diathermy forceps across the hemorrhoid with associated skin tag. Completion of coagulation was signaled by the feedback sensors, and haemorrhoidal tissue was excised along the line of coagulum. 2. Open diathermy haemorrhoidectomy 

Self-reported fecal incontinence. 

No blinranAlloadeconranjus

Galizia, 2000771

RCT to examine the effects of adding a lateral internal sphincterotomy to haemorrhoidectomy Duration of followup: 24 months 

48 consecutive patients with severe prolapsed piles suitable for surgical haemorrhoidectomy. Exclusion criteria: younger than 30 years or over 50 years, associated anorectal diseases such as anal scars, fissures, fistulas in ano, proctitis, or thrombosed hemorrhoids. Loss of followup: none. 

1. Complete excision of three hemorrhoids (Milligan-Morgan technique) and lateral internal sphincterotomy up to the dentate line, in left haemorrhoidectomy wound. 2. Complete excision of three hemorrhoids (Milligan-Morgan technique) 

Self-reported fecal incontinence. Anal manometry outcomes. 

No labranAlloaderepjus

Lawes, 2004772

Followup RCT to examine the effects of Ligasure haemorrhoidectomy on fecal incontinence in patients with prolapsing hemorrhoids. Duration of followup: 12months 

34 patients with prolapsing hemorrhoids. Exclusion criteria: not reported Loss of followup: 11.7%. 

1. Ligasure haemorrhoidectomy with controlled quantity of bipolar diathermy current to tissue ensuring the complete coagulation of blood vessels 2. Standard diathermy haemorrhoidectomy 

Self-reported fecal incontinence using validated continence scoring system, the Continence Grading Scale 

No laballoreprepjus

Filingeri, 2004773

RCT to examine the effects of submucosal hemorrhoidectomy with radiofrequency 

102 patients with fourth-degree hemorrhoids. Exclusion criteria: presence of previous proctologic surgery or associated proctologic diseases, pregnancy, scores III or IV on the ASA score of the American Society of Anesthesiologists. Loss of followup: 7.8% 

1. Submucosal hemorrhoidectomy with radiofrequency bistoury. 2. Conventional Parks' hemorrhoidectomy 

Self-reported fecal continence 

No blinranAlloadeconran
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F734 

Study Participants Clinical Interventions Outcomes 

bistoury or conventional Parks' haemorrhoidectomy on fecal incontinence. Duration of followup: 6 months 

jus

Johannsson, 2006774RCT to examine the effects of open (Milligan-Morgan) and closed (Ferguson) haemorrhoidectomy on fecal incontinence. Duration of followup: 1 year 

225 patients older than 18 years attended the clinic for haemorrhoidectomy. Exclusion criteria: history of anal incontinence. Loss of followup: 6.2% 

1. Open (Milligan-Morgan) haemorrhoidectomy 2. Closed (Ferguson) haemorrhoidectomy with wounds sutures without tension 

Self-reported anal incontinence using validated questions and an Miller incontinence scores 

No labby conBaadeSa

Khan, 2001775

RCT to examine the effects of closed excisional hemorrhoidectomy and the Harmonic Scalpel technique on fecal incontinence. Duration of followup: 6 weeks 

30 patients with Grade 2 and 3 symptomatic hemorrhoids. Exclusion criteria: not reported Loss of followup: not reported 

1. Excisional Hemorrhoidectomy with the ultrasonically activated scalpel (Harmonic Scalpel). 2. Closed excisional hemorrhoidectomy assisted by electrocautery 

Self-reported fecal incontinence, and quality of life using the Short Form-36 survey 

IntOpand not repjus

van Tets, 1997776

RCT to examine effects of the Parks' anal retractor on anal sphincter function during closed hemorrhoidectomy Duration of followup: 12 weeks 

40 patients with symptomatic third-degree hemorrhoids with normal continence. Exclusion criteria: not reported. Loss of followup: none. 

1. Closed hemorrhoidectomy performed intra-anally using the Parks' anal retractor 2. Closed hemorrhoidectomy performed perineally without the use of a retractor 

Anal manometry outcomes. 

IntOpand not conrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F735 

Study Participants Clinical Interventions Outcomes 

Ho, 2000777

RCT to examine effects of stapled or conventional open diathermy hemorrhoidectomy on fecal incontinence in adults. Duration of followup: 3 months 

119 consecutive patients with prolapsed irreducible hemorrhoids. Exclusion criteria: previous perianal surgery, acute thrombosis of internal hemorrhoids, bleeding disorders. Loss of followup: not reported 

1.Conventional open diathermy hemorrhoidectomy. 2.Stapled hemorrhoidectomy 

Self-reported fecal incontinence and quality of life outcomes. Anal manometry outcomes. Endoanal ultrasound outcomes. 

IntSindraAlloadeconrannot 

Effects of the clinical interventions in patients with rectal diseases to reduce risk of fecal incontinenceSchouten, 1991778

RCT to examine the effects of fistulectomy in patients with anorectal abscess. Duration of followup: 42 months 

70 patients with anorectal abscess. Exclusion criteria: recurrent abscess. Loss of followup: 5.7% 

1. Incision, drainage and fistulectomy with primary partial internal sphincterotomy. 2. Incision and drainage alone with secondary partial internal sphincterectomy 

Self-reported anal continence 

No laballoreprepjus

Singer, 2005779

RCT to examine the effects of Tisseel-VH fibrin sealant in combination with intra-adhesive cefoxitin, surgical closure of primary opening, or both modifications on fecal incontinence in patients with chronic fistula-ano. Duration of followup: 12 months 

Patients with fistula-in-ano for at least 3 months. Exclusion criteria: not reported. Loss of followup: none 

1. Tisseel-VH fibrin sealant intra-adhesive cefoxitin 100mg. 2. Tisseel-VH fibrin sealant surgical closure of primary opening. 3. Tisseel-VH fibrin sealant intra-adhesive cefoxitin 100mg surgical closure of primary opening 

Self-reported fecal incontinence. 

No labranAlloadeconranjus

Libertiny, 2002780

RCT to examine the effects of glyceryl trinitrate or lateral 

70 patients with chronic anal fissure for >2 months, with the presence of ulcerated induration, and the presence of internal sphincter fibers at the base of the fissure, who failed to respond to treatment with stool 

1. Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day for 8 weeks. 2. Lateral sphincterotomy 

Self-reported fecal incontinence. 

NolabselAllorep
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F736 

Study Participants Clinical Interventions Outcomes 

sphincterotomy on fecal incontinence in patients with chronic anal fissure. Duration of followup: 24 months 

softeners and topical ointments. Exclusion criteria: acute fissures, postpartum stage, incontinence, previous history of anorectal surgery Loss of followup: not reported 

rep

Mishra, 2005781

RCT to examine the effects of glyceryl trinitrate or lateral sphincterotomy on FI in patients with for chronic anal fissure. Duration of followup: 6 weeks 

40 consecutive patients with primary idiopathic chronic anal fissure with symptoms (pain, bleeding) lasting for more than 6 weeks, fibers of internal anal sphincter visible at the floor of the fissure, sentinel pile, and induration of the edges. Exclusion criteria: secondary fissures, systemic diseases (diabetes mellitus, jaundice, collagen diseases), pregnancy, or those being treated with nitrates. Loss of followup: not reported 

1. Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day 2. Lateral sphincterotomy 

Self-reported fecal incontinence 

No labran(baweconBaadeSa

Oettle, 1997782

RCT to examine the effects of glyceryl trinitrate or lateral sphincterotomy on FI in patients with chronic anal fissure. Duration of followup: 22 months 

24 consecutive patients with chronic anal fissure. Exclusion criteria: Crohn’s disease, tuberculosis, AIDS, anal abscess or fistula. Loss of followup: 0% 

1. Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day. 2. Lateral sphincterotomy 

Self-reported fecal incontinence 

IntRanuAlloreprep

Richard, 2000783RCT to examine the effects of topical nitroglycerin or internal sphincterotomy on fecal incontinence in patients with chronic anal fissure. Duration of followup: 6 months 

90 patients with symptomatic chronic anal fissures (fibrosis at the base of fissure, visible internal sphincter, hypertrophied anal papilla proximal to fissure, sentinel pile distal to fissure). Exclusion criteria: refusals of Internal sphincterotomy, healing of fissure before surgery, fissure was not observed at surgery, sepsis, Crohn’s disease, AIDS, practicing anal intercourse, contraindication to nitrates. Loss of followup: 8.8% 

1. Application of 0.25% nitroglycerin twice per day to perianal area 3 times/day 2. Internal sphincterotomy 

Self-reported fecal incontinence using Continence Index by Jorge and Wexner. 

No labgepestrconBaadeSa
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F737 

Study Participants Clinical Interventions Outcomes 

Evans, 2001784

RCT to examine the effects of glyceryl trinitrate or lateral sphincterotomy on fecal incontinence in patients with chronic anal fissure. Duration 8 weeks. Duration of followup:12 months 

65 patients with symptoms of chronic anal fissure (symptoms >2 weeks). Exclusion criteria: inflammatory bowel disease, AIDS, previous fecal incontinence, sphincter injury or surgery, medical conditions that contraindicated general anesthesia, use of nitrates. Loss of followup:7.7 % 

1. Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day for 8 weeks. 2. Lateral sphincterotomy 

Self-reported minor fecal incontinence. 

No labAlloaderep

Zimmerman, 2003785RCT to examine the effects of two different types of anal retractors on fecal continence after fistula repair. Duration of followup: 12 weeks 

30 patients with perianal fistula. Exclusion criteria: fistulotomy. Loss of followup: none. 

1. Parks retractor during fistula repair. 2. Scott retractor during fistula repair 

Self-reported fecal continence using Rockwood fecal continence Severity Index. Anal manometry outcomes. 

IntOpand not conranjus

Ho, 2005786

RCT to examine the effects of dermal island flap anoplasty on fecal incontinence in patients with transsphincteric fistulain-ano. Duration of followup: 16 weeks 

20 patients with fistula-in-ano confirmed by endoanal ultrasound. Exclusion criteria: not reported. Loss of followup: none. 

1. Dermal island flap anoplasty with cutaneous advancement flap into the rectum 2. Conventional treatment: lay open fistulotomy or seton insertion 

Self-reported fecal incontinence scores. 

IntOpand not conranjus

Clinical interventions in patients with rectal cancerPeeters, 2005674

RCT to examine the effects of preoperative shortterm radiotherapy in patients treated with total 

1,861 patients with histologically confirmed adenocarcinoma of the rectum with inferior margin of the tumor had <15 cm from the anal verge and below the level of S1 and S2. Exclusion criteria: distant metastases, fixed tumors, locally treated (transanal resected) tumors 

1. Radiotherapy with total dose of 25Gy administered in 5 fractions over 5 to 7 days before total mesorectal excision. 2. Total mesorectal excision 

Self-reported urinary and fecal incontinence with 4-point scale from “no, never” to “sometimes” (<1/week), “often” (>1/ week but not every 

No laballorepconrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F738 

Study Participants Clinical Interventions Outcomes 

mesorectal excision. Duration of followup: 5 years 

Loss of followup: 32%, 597responded to questionnaire. 

day), and “yes, always” (every day) for timedependent symptoms and from “no, not at all” to “a little,” “pretty much,” and “very seriously” for timeindependent symptoms. 

Dahlberg, 1998787

Followup RCT to examine effects of preoperative highdose radiotherapy on long-term bowel function in patients with rectal cancer. Duration of followup: 5 years 

400 patients younger than 80 years with respectable rectal cancer participated in nationwide Swedish Rectal Cancer Trial. 171 patients survived after a minimum of five year responded to the questionnaire. Exclusion criteria: postoperative stomas and dementia. Loss of followup: 57% from the initial trial, 16% among survivors. 

1. Preoperative high-dose radiotherapy with 25Gy given in 5 fractions for 5-7 days followed by anterior resection of rectal cancer. 2. Anterior resection of rectal cancer alone 

Self-reported defecation frequency, emptying difficulties, urgency, and incontinence 

No laballorepBaadeSa

Pollack, 2006675RCT to examine the effects of rectal cancer surgery with or without preoperative radiotherapy on incontinence. Duration of follow up:15 years 

1,406 patients with biopsy-proven adenocarcinoma of the rectum, resectable for cure by an abdominal procedure who participated in the Stockholm I and II trials.252 alive 15 years after surgery surveyedExclusion criteria: distant metastases, locally advanced cancer or previous irradiation to the pelvis, local excision; mental or physical condition that did not allow to participate in the survey.Loss of follow up: 90% (139 patients available 

for follow-up and willing to participate).

1.Abdominal rectal resection with preoperative radiotherapy in a dose of 25 (5 × 5) Gy using a two field technique (The Stockholm I trial) or four-field box technique (The Stockholm I trial II). 2. Abdominal rectal resection without preoperative radiotherapy

Self reported fecal and urinary incontinence using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) 

No laballorepconrannot FroBacena bran

Allgayer, 2005788

Controlled CT to examine the effects of pelvic floor exercise/ biofeedback training combined with irradiation on fecal incontinence after surgery for colorectal cancer. Duration of 

90 patients with colorectal cancer, lower anterior resection as the standard surgical procedure; a UICC II/III tumor stage; macroscopically and histologically tumor-free resection margins; normal laboratory tests including carcinoembryonic antigen (CEA) and a normal abdominal ultrasound/CT on admission. Exclusion criteria: impaired general health conditions (Karnofsky index <80), age >75 years, a second malignancy or other relevant adverse clinical conditions such as advanced 

1. Intensive daily pelvic floor exercise under the supervision of therapist (30-40 minutes) for 3 weeks in routine rehabilitation programs with biofeedback intra-anal electromyogram electrode device. Postoperative irradiation (total dose 50.4 ±/2.0 Gy) applied in split doses (1.8Gy, 5//week). 2. Intensive daily pelvic floor exercise under the supervision 

Self-reported severity of fecal incontinence using Modified Cleveland Incontinence Score (MCIS) questionnaire 16-point scale: <6.0 total incontinence with complete inability to retain solid stools; 7.0-/12.0- partial incontinence with 

No labsigbasrep
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F739 

Study Participants Clinical Interventions Outcomes 

followup: 3 weeks and one year. 

heart failure (NYHA III/IV), pulmonary diseases, metabolic diseases, poorly controlled diabetes (Hba1c >/7.7%), neurologic diseases and/or language barriers. Loss of followup: 34.7% 

of therapist (30-40 minutes) for 3 weeks in routine rehabilitation programs With biofeedback intra-anal electromyogram electrode device. 

incontinence for liquid stools; and >14.0 almost normal continence. The major criteria included stool frequency (number of daily evacuations), stool consistence, urgency (time to reach a toilet in minutes, seconds or immediately), discrimination between air, liquid and/or solid stool, spoiling to underwear and concomitant antidiarrheal medication and/or bulk-forming agents. Each item graded from 0 to 3 by the patient and by a trained nurse/ physician and subsequently controlled by an independent observer. 

Lundby, 2005789

15933797 RCT to examine the effects of adjuvant postoperative radiotherapy for rectal cancer on fecal incontinence. Duration of follow up: 15-20 years 

494 patients with Dukes B or C rectal carcinoma who were surveyed 15-20 years after surgery. Exclusion criteria: not reported Loss of follow up:81% 

1.Postoperative radiotherapy after anterior resection. 2.Anterior resection alone 

Self-reported fecal incontinence. 

No laballorepconranSajus

Effects of the surgical interventions on fecal incontinence in patients with rectal prolapseLuukkonen, 1992790RCT to examine effects of 

30 consecutive patients with a full-thickness circumferential rectal prolapse. Exclusion criteria: not reported. Loss of followup: 3.3% 

1. Posterior sutured abdominal rectopexy combined with sigmoidectomy complete rectal prolapse and end-to-end 

Self-reported anal continence graded from 0 to 3: normal (grade 0), incontinent 

No labranAllo
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F740 

Study Participants Clinical Interventions Outcomes 

abdominal rectopexy and sigmoid resection with polyglycolic acid mesh rectopexy without sigmoidectomy for complete rectal prolapse. Duration of followup: 6 months 

anastomosis made with a circular stapler. 2.Polyglycolic acid mesh rectopexy without sigmoidectomy for complete rectal prolapse anterior rectal wall free 

for flatus (grade 1), incontinent for liquid stool (grade 2), incontinent for solid stool (grade 3). Anal manometry outcomes 

aderepjus

Racalbuto, 2004791

RCT to examine the effects of haemorrhoidal stapler prolapsectomy or Milligan-Morgan hemorrhoidectomy on fecal incontinence. Duration of followup: 48 months 

100 patients with 3rd and 4th degree hemorrhoids. Exclusion criteria: thrombosed hemorrhoids, partial prolapse (only one nodule), perianal fistulas, presence of chronic associated fissures. Loss of followup: not reported 

1. Stapled prolapsectomy using longo circular stapler.2. Traditional Milligan-Morgan Hemorrhoidectomy with exeresis of the haemorrhoidal piles upon low ligature of each vascular pedicle

Self-reported fecal incontinence using Continence Grading Scale with Wexner scores. Anal manomtery outcomes.

InteOpand reprepjus

Novell, 1994792

RCT to examine the effects of Ivalon sponge versus sutured rectopexy for fullthickness rectal prolapse. Duration of followup: 47 months 

63 patients with full thickness rectal prolapse and coexistent fecal incontinence. Exclusion criteria: not reported. Loss of followup: 12 died from causes unrelated to surgery - 19% 

1. Ivalon sponge with sutured rectangle of sponge placed along the length of the sacrum. 2. Sutured rectopexy with sutured rectangle of sponge or sutures alone placed along the length of the sacrum 

Self reported fecal incontinence as fecal soiling or using a pad 

No labranAllorepconrannot 

Solomon, 2002793

RCT to examine effects of laparoscopic and open abdominal rectopexy in patients with full thickness rectal 

40 patients with full thickness rectal prolapse with or without fecal incontinence. Exclusion criteria: concomitant gynecological procedures, previous rectopexy, large irreducible prolapse. Loss of followup: 2.5% 

1. Laparoscopic rectopexy 2. Open abdominal rectopexy 

Self-reported fecal incontinence scores with visual analog scale 

No blinrepcondatranjus
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F741 

Study Participants Clinical Interventions Outcomes 

prolapse. Duration of followup: 24 months Galili, 1997794

RCT to examine the effects of polyglycolic acid and polypropylene mesh for rectopexy in the treatment of rectal prolapse. Duration of followup: 3.6 years 

37 consecutive patients with complete rectal prolapse. Exclusion criteria: not reported. Loss of followup: none 

1. Posterior abdominal rectopexy with non-absorbable mesh (Polypropylene, Prolene, Ethicon Ltd). 2. Posterior abdominal rectopexy with absorbable mesh (Polyglycolic acid, Dexon, Davis & Geck) 

Self-reported impact on quality of life in scale from 0 to 10. Social activity as 0 -inability to leave home; 1- unrestricted social life. Fecal incontinence as 0 -complete incontinence, 0.5 - incontinence for loose stool only, 1 - complete continence. 

InteOpand reprepjus

Boccasanta, 2006795RCT to examine the effects of Altemeier's procedure with levatorplasty with handwritten and stapled anastomosis in patients with full thickness rectal prolapse and fecal incontinence. Duration of followup: 28 months 

40 patients (55 females; mean age, 70.9 ±

11.3 years) with full thickness rectal prolapse, rectal procidentia >5cm; fecal incontinence 

with score >10. Exclusion criteria: associated colorectal diseases including cancer, rectal procidentia <5cm; fecal incontinence score <10; absolute contraindications to surgery; mental disorders; inflammatory bowel disease; polyps. Loss of followup: none 

1. Altemeier's procedure with levatorplasty, monopolar electrocautery and hand sewn anastomosis. 2. Altemeier's procedure with levatorplasty using harmonic scalpel and circular stapler 

Self-reported fecal continence using a validated scoring system (Wexner score, ranging from 0 - full continence to 20 – complete incontinence). Anal manometry and electromyogram outcomes. 

InteSingenwitconBasadeSa

Boccasanta, 1998796RCT to examine the effects of laparoscopic rectopexy and open technique in the treatment of complete rectal prolapse. 

21 patients with complete full thickness rectal prolapse with variable degree of fecal incontinence aged between 22-76 years. Exclusion criteria: not reported. Loss of followup: none. 

1. Laparoscopic stapled Well’s rectopexy, perineal physiotherapy, external electric stimulation, and perineal biofeedback. 2. Well's rectopexy by the open technique without division of lateral rectal ligaments, perineal physiotherapy, external electric stimulation, and perineal 

Self-reported fecal incontinence scores from 0 - complete continence to 6 - complete incontinence. Dynamic defecography, anorectal manometry, and anal electromyography 

No laballorepconrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F742 

Study Participants Clinical Interventions Outcomes 

Duration of followup: 25.7 - 29.5 months. 

biofeedback outcomes. 

Effects of the surgical interventions on anal sphincter to prevent incidence and progression of fecal incontinence in adultsWiley, 2004797

RCT to examine the effects of open and closed internal sphincterotomy on fecal incontinence in patients with chronic anal fissure. Duration of followup: 52 weeks 

79 patients with chronic idiopathic fissure-inano (defined as fissure-in-ano with >6 weeks symptom duration) in whom conservative treatment had failed, suitable for lateral sphincterotomy. Exclusion criteria: previous sphincterotomy or anal dilation, fissure associated with inflammatory bowel disease, suspicion of malignant fissure or ulcer, concomitant procedure (i.e., hemorrhoidectomy) to be 

performed at the time of sphincterotomy (excision of skin tags was permitted), and anesthetic requirements, which included spinal or caudal blockade. Loss of followup: 3.7% 

1. Closed lateral internal sphincterotomy (Hoffman and Goligher) using a short stab incision and blind division of the internal sphincter guided by the surgeon finger. 2. Open lateral sphincterotomy (Parks) via a 1cm radial incision with division of the internal sphincter under direct vision. 

Self-reported fecal incontinence with standardized questionnaires (modified Wexner score): score range of 0 to 20, 0 - complete or normal continence 

No labAlloadeconranjus

Parellada, 2004798

RCT to examine the effects of lateral internal sphincterotomy with local 0.2% isosorbide dinitrate on fecal incontinence in patients with chronic anal fissure. Duration of followup: 24 months 

63 patients with chronic anal fissure (anal pain at defecation for at least 2 months) on proctologic examination with observation of sphincter fibers at the base of the fissure independent of the presence of the sentinel pile or hypertrophic papilla who failed conservative treatments with a high-fiber diet, bulking agents, and warm sit baths. Exclusion criteria: not reported. Loss of followup: 14% 

1. Surgical: open lateral internal spincterotomy and mucose closure with chromic catgut. 2. Chemical: local 0.2% isosorbide dinitrate - pea-size quantity applied manually at the entrance of the anus, 3 times/day immediately after a warm sit bath, for 6 weeks. 

Self-reported fecal incontinence. Anal manometry outcomes. 

No labrantrethe conBaadeSa

Wong, 2002799

Not randomized not controlled multicenter trial to examine the effects of Acticon trade mark artificial bowel sphincter for fecal incontinence. 

112 patients older than 18 year, with a fecal incontinence for >6 months and score of 88 or greater (scale, 1-120), who failed surgical treatment, with life expectancy >2 years. Exclusion criteria: adverse comorbities, fecal incontinence scores <88, Crohn’s disease, irritable bowel syndrome as only cause of fecal incontinence, active pelvic sepsis, pregnancy, history of pelvic radiation, anal 

Implantation of Acticon trade mark artificial bowel sphincter - solid silicone elastomer device. 

Self-reported fecal incontinence using Fecal Incontinence Scoring System (FISS), from 0 - complete continence to 120 - complete incontinence. 

Notriaouttre
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F743 

Study Participants Clinical Interventions Outcomes 

Duration of followup: 12 months 

receptive intercourse. Loss of followup: 2.6% 

Arroyo , 2005800RCT to examine the effects of close lateral internal sphincterotomy and botulinum toxin sphincterotomy for chronic anal fissure. Duration of followup: 2 months and 1- 3 years 

80 patients with chronic anal fissure (presence of fibrous induration or exposed internal sphincter fibers) after at least 6 weeks of conservative treatments. Exclusion criteria: associated anal diseases (stenosis, abscess, fistula, hemorrhoids), comorbidities (inflammatory bowel disease, AIDS, tuberculosis, sexually transmitted diseases), anticoagulants, and pregnancy. Loss of followup: none 

1. Close lateral internal sphincterotomy 2. Chemical sphincterotomy with 25 units botulinum toxin injected into the internal sphincter 

Self-reported fecal incontinence using the Cleveland Clinic Scoring System (0 - perfect continence to 20 - complete incontinence) 

IntCoranconBaadeSa

Zbar, 2003801

RCT to examine the effects of conventional cutting vs. internal anal sphincterpreserving seton for high transsphincteric fistula. Duration of followup: 12-13 months 

34 patients with cryptogenic high transsphincteric fistulas. Exclusion criteria: not reported. Loss of followup: none. 

1. Modified cutting seton, which repaired the internal anal sphincter muscle and re-routed the seton through the intersphincteric space. 2. Conventional cutting seton 

Self-reported fecal continence using Pescatori’s continence Scale. Anal manometry outcomes. 

IntOpwitAllorepconrannot 

Osterberg, 2004802

RCT to examine the effects of levatorplasty and anal plug electrostimulation of the pelvic floor in idiopathic faecal incontinence. Duration of followup: 12 months 

70 patients with disabling fecal incontinence of idiopathic (neurogenic) origin, persistent after dietary advice and a standardized treatment with bulking agents attempted for at least 2 months. Exclusion criteria: endosonographic anal sphincter defect, rectal prolapse or intra-anal intussusception, previous anorectal surgery other than haemorrhoidectomy. Loss of followup: 15.7% 

1. Anterior levatorplasty with mobilization of external sphincter. 2. Anal (and vaginal in women) plug electrostimulation of the pelvic floor with stimulation frequency was 25Hz and the duration 1.5 seconds, with a pulse-train interval of 3 seconds. 

Self-reported anal incontinence, pad use, stool frequency using standard bowel questionnaire to calculate Miller’s incontinence score (0 - total continence to 18 - maximum incontinence). Anorectal manometry outcomes. 

No labranbaspreconBaadeSa
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F744 

Study Participants Clinical Interventions Outcomes 

Tjandra, 2004803

RCT to examine the effects of injectable silicone biomaterial, PTP to augment the internal anal sphincter. Duration of followup: 3 months 

82 patients (64 females; median age, 66 years) with severe fecal incontinence and a low anal resting pressure caused by internal anal sphincter dysfunction, who failed treatment with bulking or constipating agents and pelvic floor physiotherapy. Exclusion criteria: pregnancy, active perianal sepsis, unresected anorectal cancer, and immunosuppression. Loss of followup: 14.6% at 3 months 

1. PTP injection into intersphincteric space and internal anal sphincter with guidance by endoanal ultrasound using 25 gauge hypodermic needles inserted to provide guidance to the position of intersphincteric space and the depth of insertion. 2. PTP injection into intersphincteric space and internal anal sphincter without guidance by endoanal ultrasound 

Self-reported fecal Wexner continence score (0 - perfect continence; 20 - complete incontinence), visual analog scale (10 being best) for global quality of life, fecal incontinence quality of life scales. 

IntOpand not conrannot 

O'Brien, 2004804

RCT to examine the effects of an artificial bowel sphincter (Acticon Neosphincter) on fecal continence in severely incontinent adults. Duration of followup: 6 months 

14 patients with severe fecal incontinence (the Cleveland Clinic Scoring System >15), mentally able to consent. Exclusion criteria: history of previous sphincter repair, chronic inflammation in perianal region, use of immunosuppressive drugs, inflammatory bowel disease, high anesthetic risk. Loss of followup: none 

1. Placement of the artificial bowel sphincter activated at 6 weeks after surgery. 2. Usual supportive care: physiotherapy, pelvic floor exercise, dietary advice. 

Self-reported fecal Incontinence score using the Cleveland Clinic Scoring System (0 - perfect continence to 20 - complete incontinence). American Medical Systems quality of life questionnaire specialized on fecal incontinence 

IntOpgeAllorepconranjus

Muscle Transfer Procedures on FI Effects of the surgical interventions (diversion) on fecal incontinence in adults with cancerSeow-Choen, 1995805RCT to examine the effects of ultralow anterior resection with a J colonic pouch and straight coloanal anastomosis in patients with rectal cancer. Duration of followup after closure of ileostomy: 12 months 

40 patients with low rectal cancer and median distance from the lower edge of the tumor to the anal verge of 5cm. Exclusion criteria not reported. Loss of followup: 5% 

1. Ultra-low anterior resection with total mesorectal excision and 8cm J colonic pouch-anal anastomosis (median distance of anastomosis from the anal verge 3cm). 2. Ultra-low anterior resection with total mesorectal excision and straight coloanal anastomosis (median distance of anastomosis from the anal verge 3.25cm). 

Self-reported bowel urgency, fecal incontinence, pad use for fecal incontinence. 

No labnot conBasadeSam
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F745 

Study Participants Clinical Interventions Outcomes 

Ho, 2001806

RCT to examine the effects of colonic J-pouch and straight coloanal anastomosis after ultra-low anterior resection of rectal cancer. Duration of followup: 2 years 

40 patients with adenocarcinoma of the mid and lower rectum. Exclusion criteria: extensive local disease, which would preclude ultra-low anterior resection. Loss of followup: 17% 

1. Standardized ultra-low anterior resection with straight coloanal anastomosis, the descending colon was anastomosed to the anorectal stump. 2. Standardized ultra-low anterior resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6cm in length 

Self-reported fecal incontinence using validated Wexner scale from 0 - continence to 24 - complete incontinence. Anal manometry outcomes. 

No blinranAlloadeconrannot 

Soliani,1992807

RCT to examine the effects of Conseal Colostomy Plug, a new device for the regulation of continence in patients with colostomies. Duration 2 weeks 

57 patients with left terminal colostomies at least 6 months after neoplastic or inflammatory diseases, trained for selfirrigation. Exclusion criteria: stomal pathology, short transit intestinal syndrome, not self independent, unreliable for correct colostomy handling. Loss of followup: none 

1. Conseal Colostomy Plug fit with a two-piece Conseal system. 2. Conseal Colostomy Plug fit with a one-piece Conseal system 

Self-reported fecal incontinence as modification in continence time 

No laballorepconrannot 

Hallbook, 1996808

RCT to examine the effects of a low anterior resection with either straight or colonic J pouch anastomosis in patients with rectal cancer. Duration of followup after closure of ileostomy: 1 year 

100 patients with rectal adenocarcinoma, lower margin not more than 12cm from the anal verge with possible curative sphinctersaving resection. Exclusion criteria: not reported. Loss of followup: 3% 

1. Low anterior resection with total mesorectal excision with straight anastomosis 6 to 8cm in length. 2. Low anterior resection with total mesorectal excision colonic J pouch anastomosis 6 to 8cm in length. 

Anastomotic leakage: abscess on CT scan or ultrasound; discharge of pus either per anum or through a fistula; and necessity of laparotomy or a transanal drainage procedure. Selfreported bowel function using questionnaire: Frequency of bowel movements per night. Degree of urgency: Ability to defer defecation for 30 minutes: always, often, sometimes, never. Composite score of grade and frequency of 

No blinperrancenconBasadeSam
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F746 

Study Participants Clinical Interventions Outcomes 

fecal incontinence (Miller scale). Ability to evacuate the bowel in <15 minutes: always, often, sometimes, never. Sensation of incomplete evacuation: never, sometimes, often, always. Impact on overall well-being: not at all, a little, quite a bit, very much. 

Ho, 2002809

RCT to examine the effects of Jpouch and coloplasty pouch for low rectal cancer. Duration of followup: 1 year. 

88 patients with mid- and low rectal adenocarcinoma. Exclusion criteria: extensive local disease, which would preclude ultralow anterior resection. Lost of followup: 23%, 7 deaths from chest infection and residual cancer 

1. Standardized total mesorectal excision with at least 2cm of distal tumor clearance. J-pouch was constructed from descending colon 6cm in length using an Autosuture ILA 75 linear cutting stapler. 2. Standardized total mesorectal excision with at least 2cm of distal tumor clearance. Coloplasty pouch was anastomosed to stapled anorectal stump. 

Self-reported fecal continence score with validated Fecal Incontinence Quality of Life Scale, anorectal manometry, and endoanal ultrasound. 

InteRacomAllorepconranjust

Machado, 2005810

RCT to examine the effects of colonic J-pouch or a side-to-end anastomosis after low anterior resection for rectal cancer. Duration of followup: 2 years 

71 patients with rectal cancer. Exclusion criteria: not reported. Loss of followup: none. 

1. Low anterior resection and total mesorectal excision with a colonic J-pouch anastomosis. 2. Low anterior resection and total mesorectal excision with a colonic J-pouch or a side-to-end anastomosis. 

Self-reported fecal incontinence using with scores from 0 to 18 (total incontinence). Bowel rank scores: number of bowel movements, incontinence scores, ability to defer defecation for 30 minutes and empty bowel for 15 minutes. Anorectal manometry outcomes 

InteRaconBasadeSam

Laurent, 2005811

RCT to examine the effects of staples or hand 

37 patients with rectal adenocarcinoma requiring total mesorectal excision. Exclusion criteria: distant metastases. Loss of followup: 2.7% 

1. Total mesorectal excision and hand sewn colonic J-pouch-anal anastomosis (6cm) 2. Total mesorectal excision and 

Self-reported continence to gas, liquids, and solid stools Cleveland Clinic 

No labopecom
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F747 

Study Participants Clinical Interventions Outcomes 

sewn colonic Jpouch-anal anastomosis for rectal cancer. Duration of followup: 2 years 

stapled colonic J-pouch-anal anastomosis (6cm) using PI-30 stapling instrument 

Fecal Incontinence Score Scale 

tabnot conrannot 

Lazorthes, 1997812

RCT to examine the effects of small and large colonic J-pouch following coloanal anastomosis on fecal incontinence in patients with rectal carcinoma. Duration of followup: 12, and 24 months after colostomy closure. 

59 consecutive patients with rectal cancers 4 to 8cm from the anal verge. Exclusion criteria: inadequate bowel length, thickened mesentery. Loss of followup: 34% 

1. Complete rectal excision with coloanal anastomosis 6cm Jpouch group 2. Complete rectal excision with coloanal anastomosis 10cm Jpouch group 

Self-reported bowel urgency and fecal continence 

No laballoadeconranjust

McKee, 1992813

RCT to examine the effects of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Duration of followup: 20 months 

18 patients with full thickness prolapse of the rectum. Exclusion criteria: not reported. Loss of followup: not reported 

1. Abdominal rectopexy without sigmoidectomy 2. Abdominal rectopexy with sigmoidectomy of redundant sigmoid colon and end-to-end anastomosis of colon and rectum made in pelvic brim 

Fecal incontinence using saline solution infusion test 

No laballoreprepjust

Furst, 2003814

RCT to examine the effects of Colonic J-pouch and coloplasty in patients with resected distal rectal cancer. Duration of followup after closure of ileostomy: 6 months 

40 patients with distal rectal cancer (<12cm from the anal verge) after low rectal resection and coloanal anastomosis. Exclusion criteria: preoperative incontinence, inflammatory bowel diseases, adenocarcinoma of proximal rectum (>12cm above the anocutaneous line). Loss of followup: 25% 

1. 5cm colonic J-pouch constructed with a linear stapler 2. 8cm coloplasty pouch sutures horizontally with minimal extension effect. 

Self-reported stool frequency. Anorectal manometry outcomes. 

No laballorepconrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F748 

Study Participants Clinical Interventions Outcomes 

Hasegawa, 2000815RCT to examine the effects of fecal diversion after sphincter repair on fecal incontinence. Duration of followup: 13 months 

27 patients with fecal incontinence requiring sphincter repair due to localized sphincter damage. Exclusion criteria: not reported. Loss of followup: none 

1. Fecal diversion with defunctioning stoma (closed at 4 months after surgery) for sphincter repair with standard overlapping technique 2. Sphincter repair with standard overlapping technique with no stoma 

Self-reported fecal Incontinence score using the Cleveland Clinic Scoring System (0 - perfect continence to 20 - complete incontinence). Incontinence episodes as never; rarely if<1/month; sometime if <1/week; usually if >1/week; always if>1/day. Anal manometry outcomes. 

InteOpand repconranjust

Sailer, 2002816

RCT to examine the effects of straight and pouch coloanal reconstruction. Duration of followup: 3 months, 1 year 

64 patients undergo low anterior rectal resection for primary cancer of the lower and middle third of the rectum. Exclusion criteria: manifest or latent fecal incontinence. Loss of followup: 39%, 11 patients died. 

1. Total mesorectal excision and straight anastomosis with descending colon anastomosed in end-to-end fashion to the anal canal. 2. Total mesorectal excision and coloanal J pouch anastomosis by folding the descending colon to the form of a `J', 5 ± 6cm in length. 

Self-reported fecal incontinence using Gastrointestinal Quality of Life Index (0-4 scale for 36 items with total 144 scores for nest outcome) European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30) (0-100 scores for the best outcome) and disease-specific (EORTC QLQ-CR38) scales: 0-36 (perfect continence) 

InteRagenAlloadejust

Ho, 2002817

RCT to examine the effects of colonic Jpouch and straight coloanal anastomosis after ultra-low anterior resection of rectal cancer. Duration of followup: 1 year 

12 patients with mean age 61.5 years with adenocarcinoma of the mid and lower rectum. Exclusion criteria: not reported. Loss of followup: none 

1. Standardized ultra-low anterior resection with straight coloanal anastomosis, the descending colon was anastomosed to the anorectal stump. 2. Standardized ultra-low anterior resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6cm in length 

Self-reported fecal incontinence using bowel questionnaire Anal manometry outcomes. Scintigraphy with technetium TC 99m tin-colloid liquid test meal/I-131 microcapsule 

No blinallorepconrannot 
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F749 

Study Participants Clinical Interventions Outcomes 

Furst, 2002818

RCT to examine the effects of short colonic J-pouch and straight coloanal anastomosis for low rectal cancer. Duration of followup: 6 months. 

74 consecutive patients (55 males) with rectal cancer in the lower and middle third of the rectum (<12cm above anocutaneuous line), local curative resection with preservation of sphincter, normal baseline continence. Exclusion criteria: inflammatory bowel disease, adenocarcinoma of proximal rectum (>12cm above anocutaneuous line). Loss of followup:16%, 6 deaths 

1. The standardized total mesorectal excision with preaortal lymph node dissection, autonomic nerve preservation, and short (5cm) colonic J-pouch anastomosis. 2. The standardized total mesorectal excision with preaortal lymph node dissection, autonomic nerve preservation, and straight coloanal anastomosis. 

Self report fecal incontinence using standardized questionnaire (European Organization for Research and Treatment of Cancer, EORTC-QLQ-C30). Anorectal manometry outcomes 

No blinindconBasadeSam

Jiang 2005819

RCT to examine the effects of side-to-end or colonic J-pouch group on fecal incontinence in patients with rectal cancer. Duration of follow up: 2 years 

56 consecutive patients with middle-to-low rectal cancer eligible for local curative resection with possible sphincter preservation, and normal continence preoperatively, Exclusion criteria: emergency admission. Loss of follow up: 14.3%

1.Side-to-end anastomosis after low anterior resection. 

2.Colonic J-pouch reconstruction after low anterior resection 

Self-reported fecal incontinence. Anal manometry outcomes. Continence was recorded as Grade 1 (perfect continence), Grade 2 (incontinence of flatus), Grade 3 (occasional minor soiling), Grade 4 (frequent major soiling), and Grade 5 (total incontinence).

No Ranumtabnot BasadeSamjust

Surgical interventions in patients with chronic ulcerative colitisReilly, 1997820RCT to examine the effects of staples or hand sewn techniques for excision of anal mucosa during ileas pouch-anal anastomosis. Duration of followup: 6 months after closure of the temporary stoma. 

41 patients with chronic ulcerative colitis. Exclusion criteria: not reported. Loss of followup: 22% 

1. Abdominal colectomy excising anal transition zone and hand sewing the pouch to the anal canal (Ileal Pouch-Anal Anastomosis). 2. Abdominal colectomy preserving anal transition zone and double stapling the pouch to the anal canal (Ileal PouchAnal Anastomosis) 

Quality of life scores: 1 -severely restricted performance to 5 - improved performance. Anorectal manometry, scintigraphic outcomes and pudendal nerve terminal motor latency 

IntRaconBaadeSa

Johnston, 1996821

RCT to examine the effects of 

60 patients with ulcerative colitis. Exclusion criteria: not reported. Loss of followup: 5% 

1-2. Duplicated (J) pelvic ileal reservoirs in restorative proctocolectomy constructed 

Self-reported faecal leakage, anal soreness, the ability to 

No blinallo
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F750 

Study Participants Clinical Interventions Outcomes 

duplicated and quadruplicated pelvic ileal reservoirs in restorative proctocolectomy for ulcerative colitis. Duration of followup after operation or closure of the defunctioning ileostomy: 1 year 

with either 30 or 40cm of ileum 3-4.Quadruplicated (W) reservoir pelvic ileal reservoirs in restorative proctocolectomy, constructed with either 30 or 40cm of ileum 

defer defecation. Anorectal manometry outcomes. 

repconrannot 

Selvaggi, 2000822

RCT to examine the effects of Jpouch and Wpouch configurations for ulcerative colitis. Duration of followup after ileostomy closure: 1 year 

24 patients with ileal pouch-anal anastomosis for ulcerative colitis. Exclusion criteria: not reported. Loss of followup: none 

1. Ileal pouch-anal anastomosis including total colectomy, total rectal excision, and two-limb J reservoir. 2. Ileal pouch-anal anastomosis including total colectomy, total rectal excision, and four-limb W reservoir 

Self-reported bowel function and fecal incontinence scores with Wexner scale from 0-continence to 24 - complete incontinence. Anorectal manometry outcomes. 

IntSinand not conrannot 

Oresland,1988823

RCT to examine the effects of balloon dilatation of the pouch and sphincter biofeedback training in patients with an ileo-pouch anal anastomosis. Duration: 8 weeks Duration of followup after closure of ileostomy: 1 year 

40 patients with ulcerative proctocolitis 4 weeks after ileo-pouch anal anastomosis with J pouch extended to pelvis and sutured to pectinate line. Exclusion criteria: not reported. Loss of followup: 5%. 

1. Anal balloon dilatation with step-wise increasing pressure (5-80cm H20), distention ~ 60 seconds for 50-60 minutes. 2. Sphincter training with visual feedback for 50-60 minutes/day. 

Resting anal pressure, self-reported number of bowel evacuations. 

No laballorepconrannot 

Hahnloser, 2007824

Retrospective analysis to analyze 

1,885 patients with preoperative diagnosis of chronic ulcerative colitis operated with Ileal pouch-anal anastomosis – 1,824 J pouch, 44 

1. Stage: abdominal colectomy, construction of ileal reservoir -J, S, or W pouch. Completion by 

Self-reported fecal incontinence during the day and night as never, 

Timprofro
F151a. Effects of clinical interventions on fecal incontinence in community dwelling adults (continued) 

F751 

Study Participants Clinical Interventions Outcomes 

the effects of Ileal pouch-anal anastomosis for ulcerative colitis on fecal incontinence. Duration of followup: 11 years. 

S pouch, and 17 W pouch. A diverting ileostomy was performed in 98·4% of patients (30% one-stage procedure). Loss of followup: response rates to the questionnaires by 1, 5, 10, 15, and 20 years were 80, 72, 73, 64, and 54%. 

excision of anal transition zone and hand sewing the pouch to the dentate line area, or by preserving anal transition zone and double -stapling the pouch to the dentate line. 2. Stage: closure of the diverting stoma accomplished 2-3 months later. 

occasional (1-2 episodes/ week), or frequent (>2 episodes per week). 

estKacurthe adj

Diversion in patients with rectal prolapseMcKee, 1992813

RCT to examine the effects of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Duration of followup: 20 months 

18 patients with full thickness prolapse of the rectum. Exclusion criteria: not reported. Loss of followup: not reported 

1. Abdominal rectopexy without sigmoidectomy. 2. Abdominal rectopexy with sigmoidectomy of redundant sigmoid colon and end-to-end anastomosis of colon and rectum made in pelvic brim 

Fecal incontinence using saline solution infusion test 

No laballoreprepjus

Diversion in patients with sphincter damageHasegawa, 2000815RCT to examine the effects of fecal diversion after sphincter repair on fecal incontinence. Duration of followup: 13 months 

27 patients with fecal incontinence requiring sphincter repair due to localized sphincter damage. Exclusion criteria: not reported. Loss of followup: none 

1. Fecal diversion with defunctioning stoma (closed at 4 months after surgery) for sphincter repair with standard overlapping technique. 2. Sphincter repair with standard overlapping technique with no stoma 

Self-reported fecal Incontinence score using the Cleveland Clinic Scoring System (0 - perfect continence to 20 - complete incontinence). Incontinence episodes as never; rarely if<1/month; sometime if <1/week; usually if >1/week; always if>1/day. Anal manometry outcomes. 

IntOpand not conranjus
F752 

Table F152. Comparative effectiveness of conservative management of fecal incontinence in residents of nursing homes (seve

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference, (95%CI) 

Schnelle, 2002459N = 190 84% female 

Integrated incontinence care and exercise every 2 hours 5 days a week including fluid prompting, prompted toileting, and regular wet checks, arm raise and arm curl exercises 

Usual care Fecal 

incontinence frequency, % of wet checks 

3.0 ± 8.0 7.0 ±10.0 -0.44 (-0.73;-0.15) 

Percent wet checks/total checks 

Schnelle, 17.8 ± 13.0 34.5 ± 16.8 -1.1 (-1.5; -0.7) 1989457N = 126 75% female 

Prompted voiding treatment: check for incontinence, asking for needed toileting assistance, prompted voiding, and socially reinforced for appropriate toileting 

Usual care 

Percent appropriate toileting 

59.4 ± 26.7 16.8 ± 22.0 1.7 (1.3; 2.2) 

Wet checks/total checks 

25.0 ± 50.0 50.0 ± 28.0 -0.6 (-1.0; -0.2) 

Wet stool checks/total checks 

0.0 ± 44.7 1.0 ± 22.0 0.0 (-0.4; 0.4) 

Change after treatments in wet checks/ total checks 

 17.0 (-83.9; 49.9) 

Ouslander, 2005458N = 107 10% female 

Functional Incidental Training: prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered 4 times per day, 5 days per week 

Usual care 

Change after treatments in wet stool checks/total checks 

 0.0 (-46.0; 446.0) 

Bold - significant difference in outcomes at 95%confidence level
F753 

Table F153. Comparative effectiveness of pharmacological intervention on progression of fecal incontinence in residents of lon

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STE 

After Control 

Treatment 

M

Episodes of fecal incontinence/ patient/day: loss of feces 

0.9 ± 0.4 0.8 ± 0.4 

Episodes of fecal incontinence per patient/day: loss of feces 

0.4 ± 0.4 0.4 ± 0.5 

Chassagne, 2000720N = 178 82% female 

Single osmotic laxative -30g lactulose 

Osmotic agent 30g lactulose with a rectal stimulant (glycerine suppository) and weekly tap-water enemas 

Number of cloth changes/day due to fecal incontinence 

2.9 ± 0.6 2.8 ± 0.7 
F754 

Table F154. Comparative effectiveness of individualized evidence-based conservative management on self-reported severity of patients after stroke 

Author 

Sample Outcome 

Number of Cases 

After Active 

Treatment 

Number of Cases 

After Control 

Treatment 

Rate (%) Af

Active Treatm

One or more episodes of FI per week 

Harari, 2004 3 3 4.10 

721

N = 146 (Active = 73; Control = 73) 40% female Straining on >1 in 4 bowel 

movements 

13 6 17.80 
F755 

Table F155. Comparative effectiveness of individualized evidence-based conservative management on quality of life 

Author 

Sample Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference Stand

Erro

Visual analog scale (0 = “no problem at all” to 100 = “terrible problem”) 

Harari, 2004 33.60 ± 30.9 32.00 ± 27.60 0.05 0.17 

721

N=146 (Active = 73; Control = 73) 40% female 

Visual analogue scale (0 = “no control” to 100 = “perfect control”) 

77.90 ± 24.70 73.90 ± 28.30 0.15 0.17 
F756 

Table F156. Relative risk of fecal incontinence outcomes after individualized evidence-based conservative management

Author Outcome Relative Risk (95% CI 

Harari, One or more episodes of FI per week 1.13 (0.1; 8.9) 2004721 Straining on >1 in 4 bowel movements 1.51 (0.5; 4.9) 
F757 

Table F157. Comparative effectiveness of dietary interventions on progression of fecal incontinence in adults (event rate) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Bliss, 2001722N = 42 80% female 

Usual diet supplemented with 25g of Metamucil, 7.1g of psyllium/day 

Usual diet supplemented with 0.25g of pectin/d as a placebo 

% of incontinent stools 

2 7 17.0 50.0 0.3 (0.1; 1.2) 
F758 

Table F158. Comparative effectiveness of dietary interventions on progression of fecal incontinence in adults (severity measur

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean Difference 

(95% CI) 

Stool weight, g/day 

198.2 ± 6.9 139.0 ± 5.4 9.59 (6.77; 12.41) 

Total stool solids, g/day 

34.1 ± 11.5 31.6 ± 11.5 0.22 (-0.55; 0.99) 

% water content 

78.8 ± 4.7 77.0 ± 1.9 0.50 (-0.28; 1.28) 

% water insoluble solids 

25.3 ± 7.9 22.9 ± 7.9 0.30 (-0.47; 1.08) 

WHC/g water insoluble solids 

3.0 ± 0.4 2.3 ± 0.4 1.75 (0.84; 2.66) 

Usual diet supplemented with 25g of Metamucil, 7.1g of psyllium/day 

Total WHC 46.6 ± 9.0 37.6 ± 9.0 1.00 (0.18; 1.82) Stool weight, g/day 

159.0 ± 5.0 139.0 ± 5.4 3.83 (2.50; 5.16) 

Total stool solids, g/day 

35.6 ± 11.5 31.6 ± 11.5 0.35 (-0.43; 1.12) 

% water content 

75.8 ± 4.7 77.0 ± 1.1 -0.35 (-1.13; 0.42) 

% water insoluble solids 

25.1 ± 7.9 22.9 ± 7.9 0.28 (-0.49; 1.05) 

WHC/g water insoluble solids 

2.6 ± 0.4 2.3 ± 0.4 0.75 (-0.05; 1.55) 

Bliss, 2001722

N = 42 80% female 

Usual diet supplemented with 25g of gum arabic/day 

Usual diet supplemented with 0.25g of pectin/d as a placebo 

Total WHC 43.4 ± 9.0 37.6 ± 9.0 0.64 (-0.15; 1.43) 

WHC = Water holding capacity; Bold- significant difference in outcomes at 95% confidence level 
F759 

Table F159. Comparative effectiveness of conservative management programs on postnatal fecal incontinence in females 

Author 

Sample 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rat

After 

Trea

Glazener, Any fecal incontinence (to motions) 12 25 42001483N=747 100% female 

371 376 

Severe fecal incontinence (sometimes, often, or always) 

5 12 1

Fecal incontinence six years after index delivery 

Glazener, 32 32 2005484N=747 100% female 

371 376 

Severe fecal incontinence six years after index delivery 

15 8 
F760 

Table F160. Relative risk of fecal incontinence outcomes, number needed to treat to prevent one event, and number of avoided 1,000 treated after conservative management programs on postnatal fecal incontinence in females 

Author Outcome Relative Risk (95% CI) Number Needed to Treat (95% CI) Number 

Events/

(9

Glazener, Any fecal incontinence (to motions) 0.49 (0.25; 0.95) 16 (13; 206) 62001483 Severe fecal incontinence (sometimes, often, or always) 0.42 (0.15; 1.19) Glazener, Fecal incontinence six years after index delivery 1.0 (0.6; 1.6) 2005484 Severe fecal incontinence six years after index delivery 1.9 (0.8; 4.4) Bold- significant difference in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome in 1 patioutcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F761 

Table F161. Comparative effectiveness self administered perineal massage on prevention of fecal incontinence in females 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Fecal continence in women with no previous vaginal birth 

502 499 96.8 96.9 1.0 (1.0; 1.0) 

Fecal incontinence >1/day in women with no previous vaginal birth 

2 4 0.4 0.7 0.5 (0.1; 2.7) 

Fecal continence in women with previous vaginal birth 

242 237 98.4 95.8 1.0 (1.0; 1.1) 

Labrecque, 2000482Sample: 1034 Active: 519 Control: 515 Women with previous vaginal birth: 493 Active: 246 Control: 247 

Self administered perineal massage 

Usual obstetric care 

Fecal incontinence >1/day in women with previous vaginal birth 

4 10 1.6 4.2 0.4 (0.1; 1.3) 
F762 

Table F162. Comparative effectiveness of behavioral interventions on prevention of fecal incontinence in females (cases of con

Author 

Sample 

Active 

Treatment 

Control 

Treatment 

Number 

of Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Number N

to Tre

(95% 

Fynes, 1999723

N = 40 100% female 

Augmented biofeedback training of pelvic floor with audiovisual feedback and electric stimulation of slow and fast twitch fibers 

Sensory biofeedback training with a vaginal perineometer and standard Kegel pelvic floor exercise 

15 7 75.0 36.8 2.0 (1.1; 3.9) 3 (1;3

Bold- significant difference in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome in 1 patioutcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F763 

Table F163. Comparative effectiveness of behavioral interventions on instrumental outcomes in females 

Author 

Sample Active Treatment Control Treatment Outcomes Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differen

(95%CI) 

Mean maximum resting pressure 

54.0 ± 8.0 32.0 ± 16.8 1.69 (0.95; 2.4

Mean maximum squeeze pressure 

86.0 ± 12.0 51.0 ± 29.6 1.56 (0.84; 2.2

Squeeze increment 

30.0 ± 12.0 24.0 ± 4.2 0.66 (0.01; 1.3

Fynes, 1999723N = 40 100% female 

Augmented biofeedback training of pelvic floor with audiovisual feedback and electric stimulation of slow and fast twitch fibers for 12 weeks 

Sensory biofeedback training with a vaginal perineometer and standard Kegel pelvic floor exercise for 12 weeks Vector symmetry index 0.5 ± 0.2 0.5 ± 0.2 0.00 (-0.63; 0.6

Bold- significant difference in outcomes at 95%confidence level 
F764 

Table F164. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in females (eve

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number of 

Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

(95% 

Ilnyckyj, 2005724N = 23 100% female 

Education and explanation and instruction in pelvic floor muscle strengthening exercises with max possible squeeze duration for 5 repetitions spaced by a 20 second pause, 6 times/day. 

Education and visual and verbal biofeedback therapy using a radial catheter with a latex balloon 

Selfreported success in bowel control: complete continence in bowel controlcured 

5 6 45.5 50.0 0.9 (0.4
F765 

Table F165. Comparative effectiveness of behavioral intervention on prevention of fecal incontinence in adults (cases of contin

Author 

Sample Active Treatment Control Treatment 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95%CI) 

Hospital-based computer-assisted sphincter pressure biofeedback 

2 0 5.0 0.1 3.8 (0.2; 76.9) 

Standard care with 9 40–60-minute sessions to advise on diet, fluids intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

 0.1 0.1 

Norton, 2003729

N = 171 92% female 

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training 

4 0 10.0 0.1 8.0 (0.4; 143.0)
F766 

Table F166. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence adults (events 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

% improvement in Pascatori scores for fecal incontinence 

14 53 26.0 29.0 0.9 (0.5; 1.5) 

% improvement in St Mark scores for fecal incontinence 

21 79 39.0 43.0 0.9 (0.6; 1.3) 

% improvement in resting pressure 

2 15 3.0 8.0 0.4 (0.1; 1.9) 

% improvement in maximum pressure 

7 28 12.0 15.0 0.8 (0.4; 1.8) 

Marked Improvement in fecal incontinence 

12 50 22.0 27.0 0.8 (0.5; 1.4) 

Improved fecal incontinence 

21 54 39.0 29.0 1.3 (0.9; 2.0) 

No change in fecal incontinence 

19 80 35.0 43.0 0.8 (0.5; 1.2) 

Byrne, 2005726N = 239 90% female 

Initial face-toface assessment and treatment with transanal manometry and ultrasound biofeedback, followed by three treatments conducted via telephone and a final face-toface assessment. 

Standard treatment with 5 faceto-face treatment sessions with manometry and ultrasound 

Worse fecal incontinence 

2 2 4.0 1.0 3.4 (0.5; 23.3)
Table F166. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence adults (events 

F767 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95%CI) 

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

Standard care with 9 40–60-minute sessions to advise on diet, fluids intake, bowel training 

Self-reported improvement in fecal incontinence 

23 20 55.0 55.0 1.0 (0.7; 1.5) 

Hospital-based computerassisted sphincter pressure biofeedback 

27 20 55.0 55.0 1.0 (0.7; 1.5) 

Norton, 2003729N = 171 92% female 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training 

Self-reported improvement in fecal incontinence 

19 20 45.0 55.0 0.8 (0.5; 1.3) 
F768 

Table F167. Clinical behavioral interventions that resulted in improvement in fecal incontinence in more than 40% of subjects 

Author 

Sample Treatment 

Byrne, 2005726

N = 239 90% female 

Standard treatment with 5 face-to-face treatment sessions with manometry and ultrasound 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes Hospital-based computer-assisted sphincter pressure biofeedback 

Norton, 2003729

N = 171 92% female 

40–60-minute sessions to advise on diet, fluid intake, bowel training 

Education and explanation and instruction in pelvic floor muscle strengthening exercises with maximum possible squeeze duration for 5 repetitions spaced by a 20 second pause, 6 times/day 

Ilnyckyj, 2005 

724

N = 23 100% female Education and visual and verbal biofeedback therapy using a radial catheter with a latex balloon 
F769 

Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seveinstrumental outcomes) 

Author 

Sample Active Treatment Control Treatment Outcomes Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Differen

(95% CI) 

St Mark scores of quantitative fecal incontinence (0-10): socializing, shopping, outdoor activities 

6.8 ± 3.8 9.0 ± 2.7 -0.67 (-0.93; -0

Pescatori scores of quantitative fecal incontinence (0-10): socializing, shopping, outdoor activities 

4.0 ± 1.6 4.9 ± 2.2 -0.47 (-0.72; -0

St Mark scores of quantitative fecal incontinence (0-10): personal and psychological 

5.7 ± 3.6 7.6 ± 2.6 -0.61 (-0.86; -0

Pescatori scores of quantitative fecal incontinence (0-10): personal and psychological 

4.0 ± 1.6 4.6 ± 0.9 -0.46 (-0.72; -0

St Mark scores of quantitative fecal incontinence (0-10): travel 

8.0 ± 3.3 9.2 ± 2.1 -0.43 (-0.69; -0

Pescatori scores of quantitative fecal incontinence (0-10): travel 

4.6 ± 1.5 6.0 ± 1.5 -0.93 (-1.20; -0

St Mark scores of quantitative fecal incontinence (0-10): exercise 

7.7 ± 3.4 9.3 ± 2.7 -0.52 (-0.78; -0

Byrne, 2002725

N = 120 91% female 

Pelvic floor exercises and biofeedback 

Baseline data 

Pescatori scores of quantitative fecal incontinence (0-10): exercise 

4.3 ± 1.5 4.7 ± 1.0 -0.31 (-0.57; -0
Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seve

instrumental outcomes) (continued) 

F770 

Author 

Sample Active Treatment Control Treatment Outcomes Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean Differen

(95% CI) 

St Mark scores of quantitative fecal incontinence (0-10): family and relationship 

8.0 

± 3.5 9.3 

± 2.2 -0.44 (-0.70; -0

Pescatori scores of quantitative fecal incontinence (0-10): family and relationship 

4.5 

± 1.2 4.7 

± 0.7 -0.20 (-0.46; 0

St Mark scores of quantitative fecal incontinence (0-10): job and work 

6.3 

± 2.8 7.3 

± 2.8 -0.36 (-0.61; -0

Pescatori scores of quantitative fecal incontinence (0-10): job and work 

4.3 

± 1.1 4.6 

± 0.9 -0.30 (-0.55; -0

Pescatori fecal incontinence scores (0-6) 

4.0 

± 0.7 4.0 

± 0.7 0.00 (-0.44; 0.

St Mark fecal incontinence scores (0-13) 

7.0 

± 1.3 8.0 

± 1.3 -0.75 (-1.20; -0

Self-rated fecal incontinence (0-10) 

3.6 

± 1.1 3.5 

± 1.5 0.08 (-0.36; 0.

Investigator rated fecal incontinence (0-10) 

3.7 

± 2.1 4.5 

± 1.9 -0.41 (-0.85; 0

Rest pressure, mm/Hg 44.0 

± 8.7 48.0 

± 6.0 -0.54 (-0.98; -0

Squeeze pressure, mm/Hg 

95.0 

± 17.3 90.0 

± 20.0 0.27 (-0.17; 0.

Isotonic fatigue time sec 

27.0 

± 10.0 15.0 

± 10.7 1.16 (0.69; 1.6

Biofeedback with transanal ultrasound 

Isometric fatigue contractions (n) 

9.0 

± 2.7 8.0 

± 1.3 0.48 (0.03; 0.9

Pescatori fecal incontinence scores (0-6) 

4.0 

± 0.7 4.0 

± 0.7 0.00 (-0.44; 0.

Solomon, 2003727N = 120 89% female 

Biofeedback with anal manometry 

Pelvic floor exercises with feedback from digital examination alone 

St Mark fecal incontinence scores (0-13) 

6.0 

± 2.7 8.0 

± 1.3 -0.96 ( -1.42; -0
Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seve

instrumental outcomes) (continued) 

F771 

Author 

Sample Active Treatment Control Treatment Outcomes Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean Differen

(95% CI) 

Self rated fecal incontinence (0-10) 

4.0 

± 1.2 3.5 

± 1.5 0.37 (-0.07; 0.

Investigator rated fecal incontinence (0-10) 

3.7 

± 2.5 4.5 

± 1.9 -0.36 (-0.80; 0

Rest pressure, mm/Hg 45.0 

± 6.7 48.0 

± 6.0 -0.47 (-0.92; -0

Squeeze pressure, mm/Hg 

78.0 

± 18.7 90.0 

± 20.0 -0.62 (-1.07; -0

Isotonic fatigue time sec 

21.0 

± 6.7 15.0 

± 10.7 0.67 (0.22; 1.

Isometric fatigue contractions (n) 

8.0 

± 1.3 8.0 

± 1.3 0.00 (-0.4; 0.4

Pescatori fecal incontinence score (0 as continent - 6) 

3.6 

± 1.8 3.0 

± 1.4 0.34 (-0.26; 0.

St Mark Hospital Fecal incontinence score (0 as continent - 13) 

5.1 

± 3.7 3.8 

± 2.2 0.40 (-0.20; 1.

Pager, 2002728

N = 83 89% female 

Pelvic floor exercises with feedback from digital examination alone every day or 2-3 times/week. 

45 minute sessions of sphincter exercises with biofeedback (instrumental or digital examination) 

Self-reported fecal continence (0 as continent - 10) 

3.3 

± 2.6 2.9 

± 2.4 0.18 (-0.42; 0.

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

Norton, 6.0 

± 2.2 6.0 

± 2.2 0 (-0.44; 0.44

2003729N = 171 92% female 

Hospital-based computer-assisted sphincter pressure biofeedback 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training 

Rating of bowel control (0–10 scale) 

6.0 

± 3.7 6.0 

± 2.2 0 (-0.43; 0.43
Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seve

instrumental outcomes) (continued) 

F772 

Author 

Sample Active Treatment Control Treatment Outcomes Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean Differen

(95% CI) 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

7.0 

± 1.9 6.0 

± 2.2 0.49 (0.05; 0.9

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

0.1 

± 2.2 1.0 

± 1.5 -0.47 (-0.92; -0

Hospital-based computer-assisted sphincter pressure biofeedback 

0.0 

± 2.2 1.0 

± 1.5 -0.52 (-0.95; -0

Standard care with 9 40–60-minute sessions to advise on diet, fluids intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

Diary fecal accidents per week 

0.1 

± 1.5 1.0 

± 1.5 -0.61 (-1.06; -0

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

Diary pads/week for fecal incontinence 

0.1 

± 0.7 1.0 

± 1.5 -0.78 (-1.24; -0
Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seve

instrumental outcomes) (continued) 

F773 

Author 

Sample Active Treatment Control Treatment Outcomes Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean Differen

(95% CI) 

Hospital-based computer-assisted sphincter pressure biofeedback 

0.1 

± 1.5 1.0 

± 1.5 -0.61 (-1.04; -0

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

0.1 

± 0.1 1.0 

± 1.5 -0.89 (-1.35; -0

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

14.0 

± 8.1 13.0 

± 4.8 0.15 (-0.30; 0.

Hospital-based computer-assisted sphincter pressure biofeedback 

13.0 

± 5.2 13.0 

± 4.8 0.00 (-0.43; 0.

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

Fecal continence score

11.0 

± 4.4 13.0 

± 4.8 -0.43 (-0.88; 0
Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seve

instrumental outcomes) (continued) 

F774 

Author 

Sample Active Treatment Control Treatment Outcomes Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean Differen

(95% CI) 

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

54.0 

± 33.3 50.0 

± 13.3 0.15 (-0.29; 0.

Hospital-based computer-assisted sphincter pressure biofeedback 

66.0 

± 26.7 50.0 

± 13.3 0.73 (0.29; 1.

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

Resting pressure: cm H2O 

49.0 

± 31.9 50.0 

± 13.3 -0.04 (-0.48; 0

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

37.0 

± 29.6 71.0 

± 49.6 -0.84 (-1.31; -0

Hospital-based computer-assisted sphincter pressure biofeedback 

Squeeze increment: cm H2O 

30.0 

± 31.9 71.0 

± 49.6 -1.01 (-1.47; -0
Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seve

instrumental outcomes) (continued) 

F775 

Author 

Sample Active Treatment Control Treatment Outcomes Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean Differen

(95% CI) 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

60.0 

± 76.3 71.0 -0.17 (-0.61; 0

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

35.0 

± 37.0 35.0 

± 51.9 0 (-0.44; 0.44

Hospital-based computer-assisted sphincter pressure biofeedback 

30.0 

± 33.3 35.0 

± 51.9 -0.12 (-0.55; 0

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

5-second squeeze increment 

37.0 

± 32.6 35.0 

± 51.9 0.05 (-0.39; 0.

Mean resting pressure, mm/Hg 

48.0 

± 64.9 44.0 

± 50.5 0.07 (-0.70; 0.

Highest resting pressure. mm/Hg 

69.0 

± 90.1 65.0 

± 64.9 0.05 (-0.72; 0.

Mean squeezing pressure, mm/Hg 

86.0 

± 194.7 110.0 

±

180.3 

-0.13 (-0.90; 0

Jorge, 1994730

N = 28 39% female 

Pelvic floor exercise program with 10 second contractions for 5 minutes 5 times/day before surgery 

Regular care before surgery 

Highest squeezing pressure, mm/Hg 

118.0 

± 54.0 145.0 

± 50.0 -0.52 (-1.30; 0
Table F168. Comparative effectiveness of behavioral interventions to prevent progression of fecal incontinence in adults (seve

instrumental outcomes) (continued) 

F776 

Author 

Sample Active Treatment Control Treatment Outcomes Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean Differen

(95% CI) 

Incontinence scores 2.0 

± 1.2 2.8 

± 1.6 -0.57 (-1.35; 0

Fecal incontinence episodes/week 

0.9 

± 1.1 2.3 

± 2.1 -0.86 (-1.68; -0

Urgency episodes/week 

2.2 

± 5.0 3.9 

± 4.5 -0.35 (-1.15; 0

Sensory threshold (ml) 6.6 

± 7.6 19.5 

± 24.6 -0.72 (-1.53; 0

Miner, 1990731

N = 25 68% female 

Pelvic floor exercise with active sensory retraining (3 20-minute sessions) to perceive small rectal volumes of air into the rectal balloon 

Pelvic floor exercise retraining with no instruction on how to improve performance. Sensory delay 

(seconds) 

0 3.7 

± 1.3 

Bold- significant difference in outcomes at 95%confidence level 
F777 

Table F169. Comparative effectiveness of behavioral interventions on objective instrumental outcomes, only significant differe

Author Treatment Control Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

M

Diffe

(95% 

Hospital-based computer-assisted sphincter pressure biofeedback 

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training 

Squeeze increment: cm H2O 

30.0 ± 31.9 71.0 ± 49.6 -1.01 

0.

Norton, 2003729

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

Standard care with 9 40–60 minute sessions to advise on diet, fluid intake, bowel training 

Squeeze increment: cm H2O 

37.0 ± 29.6 71.0 ± 49.6 -0.84 

0.

Biofeedback with transanal ultrasound 

Pelvic floor exercises with feedback from digital examination alone 

Rest pressure, mm/Hg 

44.0 ± 8.7 48.0 ± 6.0 -0.54 

0.

Rest pressure, mm/Hg 

45.0 ± 6.7 48.0 ± 6.0 -0.47 

0.

Solomon, 2003727

Biofeedback with anal manometry 

Pelvic floor exercises with feedback from digital examination alone Squeeze pressure, 

mm/Hg 

78.0 ± 18.7 90.0 ± 20.0 -0.62 

0.

Norton, 2003729 Hospital-based computer-assisted 

sphincter pressure biofeedback 

Standard care with 9 40–60 minute sessions to advise on diet, fluid intake, bowel training 

Resting pressure: cm/H2O 

66.0 ± 26.7 50.0 ± 13.3 0.73 (0.

Augmented biofeedback training of pelvic floor with audiovisual feedback and electric stimulation of slow and fast twitch fibers 

Sensory biofeedback training with a vaginal perineometer and standard Kegel pelvic floor exercise for 12 weeks 

Fynes, 1999 Squeeze increment 30.0 ± 12.0 24.0 ± 4.2 0.66 (0.

723

Augmented biofeedback training of pelvic floor with audiovisual feedback and electric stimulation of slow and fast twitch fibers for 12 weeks 

Sensory biofeedback training with a vaginal perineometer and standard Kegel pelvic floor exercise for 12 weeks 

Mean maximum squeeze pressure 

86.0 ± 12.0 51.0 ± 29.6 1.56 (0.
Table F169. Comparative effectiveness of behavioral interventions on objective instrumental outcomes, only significant differe

F778 

Author Treatment Control Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

M

Diffe

(95% 

Solomon, 2003727

Biofeedback with anal manometry 

Pelvic floor exercises with feedback from digital examination alone 

Isotonic fatigue time seconds 

21.0 ± 6.7 15.0 ± 10.7 0.67 (0.

Fynes, 1999723 Augmented 

biofeedback training of pelvic floor with audiovisual feedback and electric stimulation of slow and fast twitch fibers for 12 weeks 

Sensory biofeedback training with a vaginal perineometer and standard Kegel pelvic floor exercise for 12 weeks 

Mean maximum resting pressure 

54.0 ± 8.0 32.0 ± 16.8 1.69 (0.

Isometric fatigue contractions (n) 

Solomon, 9.0 ± 2.7 8.0 ± 1.3 0.48 (0.2003727

Biofeedback with transanal ultrasound 

Pelvic floor exercises with feedback from digital examination alone Isotonic fatigue 

time seconds 

27.0 ± 10.0 15.0 ± 10.7 1.16 (0.

Norton, 2003729

Standard care with 9 40–60 minute sessions to advise on diet, fluid intake, bowel training plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

Standard care with 9 40–60 minute sessions to advise on diet, fluid intake, bowel training 

Rating of bowel control (0–10 scale) 

7.0 ± 1.9 6.0 ± 2.2 0.49 (0.

Bold- significant difference in outcomes at 95%confidence level 
F779 

Table F170. Clinical behavioral interventions that resulted in more than 40% difference in outcome levels compared to standard 

Active Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

% Differenc

(9

Standard care with 9 40–60 minute sessions to advise on diet, fluid intake, bowel training, plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

0.1 ± 0.1 -89.2 (-1

Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

0.1 ± 0.7 -78.4 (-1

Standard care with 9 40–60-minute sessions to advise on diet, fluid intake, bowel training, plus instruction on sphincter exercises with at least 50 maximal voluntary sustained sphincter contractions and 50 fast-twitch contractions per day 

0.1 ± 1.5 -60.8 (-1

Hospital-based computer-assisted sphincter pressure biofeedback 

Diary record of pads per week for fecal incontinence 

0.1 ± 1.5 -60.8 (-1

Hospital-based computer-assisted sphincter pressure biofeedback 0.0 ± 2.2 -51.6 (Hospital biofeedback plus the use of a home electromyelogram biofeedback device once daily for 20 minutes 

Diary record of fecal accidents per week 0.1 ± 2.2 -47.1 (

Bold- significant difference in outcomes at 95%confidence level
F780 

Table F171. Comparative effectiveness of electrical stimulation on fecal incontinence in adults (events) 

Author 

Sample Active Treatment Control Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After Active 

Treatment 

Norton, 2006732

N = 90 100% female 

Active anal stimulation at 35Hz and 40 minutes per day 

Sham anal stimulation at 1Hz 

Cured from fecal incontinence 

1 0 2.5 

Stamp, 2001574

N = 1,340 100% female 

Massage and stretching of the perineum during the second stage of labor with a water soluble lubricant 

Usual care Fecal 

incontinence 3 months postpartum 

36 35 5.1 

Significant improvement in fecal incontinence 

Norton, 2006 5 7 10.0 

732

N = 90 90% female 

Active anal stimulation at 35Hz and 40 minutes per day 

Sham anal stimulation at 1Hz 

Small improvement in fecal incontinence 

17 14 36.0 

Leroi, 2005733N = 34 91% female 

Active sacral nerve continuous stimulation with pulse width of 210 microseconds, frequency 14 pulses/second, and amplitude adapted to the patient’s perception of perineal and anal sphincter muscle contraction. 

Sham sacral nerve stimulation with lead turned off 

Improvement in fecal incontinence 

30 6 89.0 

Endo-anal electrical stimulation using a home-based unit 

Endo-anal hospitalsupervised electrical stimulation 

Fecal incontinence much better

Healy, 2006 17 20 60.00 

735

N = 58 100% female 

Endo-anal electrical stimulation using a home-based unit 

Endo-anal hospitalsupervised electrical stimulation 

Cured fecal incontinence

1 0 5.00 
F781 

Table F172. Relative effectiveness and attributable events of electrical stimulation on fecal incontinence in adults 

Author 

Sample Active Treatment Control Treatment Outcome Relative Risk (95% CI) Number Needed to Treat (95% CI) 

Numb

attribu

Events/

Treat

(95% 

Norton, 2006732N = 90 100% female 

Active anal stimulation at 35Hz and 40 minutes per day 

Sham anal stimulation at 1 Hz 

Cured from fecal incontinence 

2.8 (0.1; 65.8) 

Stamp, 2001574N = 1,340 100% female 

Massage and stretching of the perineum during the second stage of labour with a water soluble lubricant 

Usual care Fecal 

incontinence 3 months postpartum 

0.9 (0.6; 1.4) 

Significant improvement in fecal incontinence 

Norton, 0.7 (0.2; 1.9) 2006732N = 90 90% female 

Active anal stimulation at 35Hz and 40 minutes per day 

Sham anal stimulation at 1Hz 

Small improvement in fecal incontinence 

1.1 (0.6; 2.0) 

Leroi, 2005733N = 34 91% female 

Active sacral nerve continuous stimulation with pulse width of 210 microseconds, frequency 14 pulses/second, and amplitude adapted to the patient’s perception of perineal and anal sphincter muscle contraction. 

Sham sacral nerve stimulation with lead turned off 

Improvement in fecal incontinence 

5.0 (2.4; 10.4) 1 (1; 4) 720 (237; 

Endo-anal electrical stimulation using a homebased unit 

Endo-anal hospitalsupervised electrical stimulation 

Fecal incontinence much better 

Healy, 0.85 (0.57; 1.26)2006735N = 58 100% female Folloup: 3 

Endo-anal electrical stimulation using a homebased unit 

Endo-anal hospitalsupervised electrical stimulation 

Cured fecal incontinence 

3.00 (0.13; 70.74)

Bold- significant difference in outcomes at 95%confidence level; A - Number of avoided; E - number of excessive events per 1000 treate
F782 

Table F173. The effect of electrical stimulation on quality of life of fecal incontinence in adults 

Author 

Sample Active Treatment Control Treatment Outcome Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) 

Bowel movements/week 

10.2 ± 10.5 12.7 ± 4.2 -0.3 (-0.8; 0.2) 

Fecal Incontinent episodes/week 

0.7 ± 2.9 1.7 ± 6.2 -0.2 (-0.7; 0.3) 

Fecal urgency episodes/week 

1.0 ± 10.0 4.5 ± 3.7 -0.5 (-0.9; 0.0) 

Delay to postpone defecation 

1.8 ± 0.8 1.0 ± 1.3 0.7 (0.2; 1.2) 

Leroi, 2005733N = 34 91% female 

Active sacral nerve continuous stimulation with pulse width of 210 microseconds, frequency 14 pulses/second, and amplitude adapted to the patient’s perception of perineal and anal sphincter muscle contraction. 

Sham sacral nerve stimulation with lead turned off 

Cleveland Clinic score 

8.0 ± 4.7 15.0 ± 0.0 

Mahony, 2005736N = 60 100% female 

Intra-anal electromyographic biofeedback with electrical stimulation of the anal sphincter weekly for 12 weeks 

Standard intraanal electromyographic biofeedback training of the pelvic floor 

Median scores of fecal incontinence 

2.0 ± 6.4 2.0 ± 6.4 0.0 (-0.5; 0.5) 

Satisfaction with bowel habits 

Chang, 48.3 ± 34.1 59.0 ± 28.8 -0.3 (-1.2; 0.5) 2003734N = 22 50% female 

External electrical stimulation therapy using an anal plug with pulse generator in the anal canal once a day for 20 minutes over 10–12 sessions with pulse width of 360–960 μs, a 

frequency of 2–110Hz, and an amplitude of 30–35 V. 

Biofeedback therapy using the EMG system. The visual feedback observing changes in pressure activity on a monitor screen during rise in rectal pressure synchronized with anal relaxation for 60–90 mutes in over 10–14 sessions. 

Incomplete evacuation score: 0-10 (0=absent, 10 = very severe) 

4.2 ± 3.0 4.5 ± 3.3 -0.1 (-0.9; 0.7) 

Bold- significant difference in outcomes at 95%confidence level 
F783 

Table F174. Effects of electrical stimulation on progression of fecal incontinence in adults (anal manometry outcomes) 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean 

Differen

(95% C

Anal manometry: resting pressure 

49.0 ± 18.0 38.5 ± 18.0 0.6 (0.2; 1

Anal manometry: squeeze pressure increment 

50.0 ± 15.2 36.5 ± 5.1 1.2 (0.7; 1

Norton,2006732

N = 90 90% female 

Active anal stimulation at 35 Hz and 40 minutes per day 

Sham anal stimulation at 1 Hz 

Cough pressure increment 

56.0 ± 22.9 40.5 ± 7.7 0.9 (0.5; 1

Maximum resting pressure (cm/H2O) 

50.0 ± 70.0 50.0 ± 32.0 0.0 (-0.5; 

Maximum squeeze pressure increment (cmH2O) 

53.0 ± 182.0 54.0 ± 37.3 0.0 (-0.5; 

Leroi, 2005733

N = 34 91% female 

Active sacral nerve continuous stimulation with pulse width of 210 microseconds, frequency 14 pulses/sec, and amplitude adapted to the patient’s perception of perineal and anal sphincter muscle contraction 

Sham sacral nerve stimulation with lead turned off 

Squeeze pressure duration (seconds) 

18.0 ± 49.3 40.0 ± 0.0 

Median resting pressure (mm/Hg) 

Mahony, 30.0 ± 28.8 31.0 ± 26.4 0.0 (-0.6; 2004736N = 60 100% female 

Intra-anal electromyographic biofeedback with electrical stimulation of the anal sphincter weekly for 12 weeks 

Standard intra-anal electromyographic biofeedback training of the pelvic floor 

Median squeeze pressure (mm/Hg) 

47.0 ± 35.2 59.0 ± 40.8 -0.3 (-0.9; 

Mean anal resting pressure 

58.2 ± 16.5 69.5 ± 46.4 -0.3 (-1.2; 

Maximal anal squeezing pressure 

176.4 ± 50.3 177.2 ± 42.7 0.0 (-0.9; 

Anal residual pressure 

63.6 ± 45.9 38.0 ± 21.5 0.7 (-0.2; 

Rectal pressure 38.0 ± 21.5 58.5 ± 24.8 -0.9 (-1.8; Rectal sensory threshold volumes (ml): first perception 

10.0 ± 0.0 10.0 ± 0.0 

Rectal sensory threshold volumes (ml): desire to defecate 

70.0 ± 29.9 99.0 ± 31.7 -0.9 (-1.8; 

Chang, 2003734N = 22 50% female 

External electrical stimulation therapy using an anal plug with pulse generator in the anal canal once a day for 20 min over 10–12 sessions with pulse width of 360–960 μs, a frequency of 2–110Hz, and an amplitude of 30–35V 

Biofeedback therapy using the EMG system. The visual feedback observing changes in pressure activity on a monitor screen during rise in rectal pressure synchronized with anal relaxation for 60–90 minutes over 10–14 sessions. 

Rectal sensory 135. ± 47.9 160.0 ± 44.9 -0.5 (-1.4; 
Table F174. Effects of electrical stimulation on progression of fecal incontinence in adults (anal manometry outcomes) (continu

F784 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean 

Differen

(95% C

threshold volumes (ml): urge to defecate Rectal sensory threshold volumes (ml): maximal tolerated volume 

174.0 ± 58.5 205.0 ± 60.9 -0.5 (-1.4; 

Bold- significant difference in outcomes at 95%confidence level 
F785 

Table F175. Comparative effectiveness of Botulinum toxin on fecal incontinence (events rate) 

Author 

Sample Active Control Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Ratio (%) 

After Active 

Treatment 

Ratio (%

After 

Control 

Treatmen

Mentes, 2003740N = 111 68% female 

20 to 30 U (~ 0.3 U/kg) of type A botulinum toxin (Botox) injection into the internal anal sphincter. The injection was repeated 2 months later if complete healing was not achieved. 

Lateral internal anal sphincterotomy 

Self-reported incidence of fecal incontinence 

5 0 8 0 

Ron, 2001739

N = 25 60% female 

Local injection of Botox-10 units to each side of the puborectalis 

Local injection of Botox-20 units to the posterior aspect of this muscle. 

Self-reported fecal continence 

15 11 100 100 
F786 

Table F176. Comparative effectiveness of pharmacological interventions on progression of fecal incontinence (severity measu

outcomes) 

Author 

Sample Active Treatments Control Treatments Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Iswariah, 2005741N = 44 58% female 

Botox, 20 units injected on either side of the fissure into the internal anal sphincter. 

Sphincterotomy by open or closed technique in the left lateral position using Park’s anal retractor 

Self-reported modified Wexner Fecal Continence scoring system 

0.2 ± 1.2 0.0 ± 0.0 

Resting anal pressure 

Brisinda, 64.2 ± 14.9 71.9 ± 17.0 1999742N = 50 50% female 

20 U of Botulinum toxin injected into the internal anal sphincter on each side of the anterior midline 

0.2% nitroglycerin ointment applied twice daily Maximal Voluntary 

pressure 

83.3 ± 25.2 86.5 ± 31.3 

Nessim, 1999749N = 54 85% female 

Medical bowel confinement: clear liquid diet with loperamide 4mg 3 times/day and codeine phosphate 30 mg 4 times/day for 3 days. 

Regular diet beginning the day of surgery 

Fecal incontinence scores (1-20) 

6.0 ± 9.3 5.0 ± 4.7 

Fecal urgency in 40.0 ± 35.0 70.0 ± 25.0 Visual analog scale from 0 (absent) to 100 (extreme). 

26.0 ± 36.0 43.0 ± 37.0 

Maximal anal pressure, cm H20 

76.0 ± 40.0 69.0 ± 35.0 

minimum basal pressure, cm H20 

58.0 ± 28.0 48.0 ± 28.0 

Squeeze increment, cm H20 

107.0 ± 66.0 104.0 ± 61.0 

Sun, 1997745

N = 11 73% female 

Loperamide oxide 4mg twice daily 

Placebo 

Total squeeze pressure, cm H20 

163.0 ± 86.0 155.0 ± 85.0 

Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days in hand sewn ileal pouch-anal anastomosis 

Placebo with the same frequency in hand sewn ileal pouch-anal anastomosis 

Maximal squeeze pressure 

Hallgren, 240.0 ± 21.9 245.0 ± 24.9 1994744N = 30 27% female 

Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days after abdominal proctocolectomy and stapling of the pouch to the top of the anal canal 

Placebo with the same frequency after abdominal proctocolectomy and stapling of the pouch to the top of the anal canal 

Maximal squeeze pressure 

210.0 ± 31.7 165.0 ± 56.2 
Table F176. Comparative effectiveness of pharmacological interventions on progression of fecal incontinence (severity measu

outcomes) (continued) 

F787 

Author 

Sample Active Treatments Control Treatments Outcome 

Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After Control 

Treatment 

Fecal continence scores, Wexner 

0.4 

± 2.6 0.2 

± 0.7 

Mean resting anal pressure, mm/Hg 

42.7 

± 43.5 43.4 

± 27.7 

Ho, 2005737

N = 89 83% female 

Chemical sphincterotomy with oral nifedipine 20mg twice a day for 6 weeks. 

Lateral sphincterotomy 

Mean squeeze pressure, mm/Hg 

162.1 

± 123.6 199.8 

± 178.7 

Tankova, 2002750N = 19 58% female 

Rectal administration of hydrogel containing 0.2% isosorbide-5-mononitrate 2 times/day 

Placebo gel. Resting anal 

pressure 

27.9 

± 4.0 34.5 

± 6.5 

Fecal Incontinence score (0-continence to 24 – complete incontinence) 

9.0 

± 3.0 20.0 

± 1.0 

Fecal incontinence symptom score (0-no symptoms to 280) 

117.0 

± 36.0 208.0 

± 31.0 

Max resting pressure mm H20 

91.0 

± 7.0 78.0 

± 17.0 

Carapeti, 2000748N = 12 58% female 

Alpha1-adrenergic agonist phenylephrine, topical 10 percent 0.5ml application 2 times/day 

Placebo gel 

Max resting pressure mm H20 

86.0 

± 27.0 71.0 

± 9.0 

Self-reported fecal incontinence score Wexner scale: 24- worst incontinence; active-placebo 

12.5 

± 3.4 12.6 

± 4.2 

maximum resting anal pressure, H20; active-placebo 

65.0 

± 21.0 54.0 

± 21.0 

Self-reported fecal incontinence score Wexner scale: 24- worst incontinence; active-placebo 

13.0 

± 4.7 13.4 

± 4.7 

Carapeti, 2000747N = 36 61% female 

Topical 10 % phenylephrine 0.5ml applied topically to the anus twice daily for 4 weeks 

Identical placebo gel 0.5ml applied topically to the anus twice daily for 4 weeks 

maximum resting anal pressure, H20; active-placebo 

55.0 

± 16.0 61.0 

± 18.0 

Bold- significant difference in outcomes at 95%confidence level 
F788 

Table F177. Comparative effectiveness of Loperamide vs. placebo on fecal incontinence (events rate) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases After 

Active 

Treatment 

Number of 

Cases After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate 

After Co

Treatm

Fecal leak/soiling day time 

1 3 7 20 

Fecal leak/soiling night time 

1 5 7 34 

Use of pad for fecal incontinence daytime 

1 1 7 7 

Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days in hand sewn ileal pouch-anal anastomosis 

Placebo with the same frequency in hand sewn ileal pouch-anal anastomosis 

Use of pad for fecal incontinence night time 

1 2 7 14 

Fecal leak/soiling day time 

2 5 15 31 

Fecal leak/soiling night time 

0 7 0 46 

Use of pad for fecal incontinence daytime 

0 2 0 15 

Hallgren, 1994744N = 30 27% female 

Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days after abdominal proctocolectomy and stapling of the pouch to the top of the anal canal 

Placebo with the same frequency after abdominal proctocolectomy and stapling of the pouch to the top of the anal canal Use of pad for fecal 

incontinence night time 

0 5 0 31 
F789 

Table F178. Comparative effectiveness of pharmacological interventions on fecal incontinence (events rate) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CL)

N

Anal fissure healing 

Tankova, 8 2 80.0 22.0 4 ( 1; 13) 2002750N = 19 58% female 

Rectal administration of hydrogel containing 0.2% isosorbide-5-mononitrate 2 times/day 

Placebo gel 

Self-reported fecal continence 

10 9 100.0 100.0 

De Nardi, 2006738N = 30 43% female 

"Chemical sphincterotomy" with 0.2 percent glycerine trinitrate ointment applied three times daily at the anal margin for 8 weeks 

"Chemical sphincterotomy" with 20 units Botulinum toxin A injection into the internal anal sphincter on each side of the anterior midline 

Self-reported fecal continence 

15 15 100.0 100.0 

Fecal incontinence (Grade 1 or worse) 

51 55 33.0 33.0 1 ( 1; 1) 

Fecal incontinence (any/3 months) 

16 20 10.3 12.1 1 (0; 2) 

Kneebone, 2004746N = 338 0% female 

3g of oral sucralfate suspension twice daily starting 1 day before RT and continuing every day for 8 weeks 

Identical placebo twice daily 

Incidence of any fecal incontinence 

17 27 11.0 16.0 1 (0; 1) 

Carapeti, 2000747N = 36 61% female 

Topical 10% phenylephrine 0.5 ml applied topically to the anus twice daily for 4 weeks 

Identical placebo gel 0.5 ml applied topically to the anus twice daily for 4 weeks 

Improvement in fecal incontinence symptoms >75% 

6 2 33.3 11.1 3 (1; 13) 

Bold- significant differences in outcomes at 95% confidence level; A - Number of avoided; E - number of excessive events per 1000 trea
F790 

Table F179. Medications that resulted in fecal continence in more than 50% of subjects 

Author 

Sample Definition of Continence Treatment % 

Fecal continence with Grade <1 3g of oral sucralfate suspension twice daily starting 1 

day before RT and continuing every day for 8 weeks 

Absence of any fecal incontinence at 2 years 3g of oral sucralfate suspension twice daily starting 1 

day before RT and continuing every day for 8 weeks 

Kneebone, 2004746N = 338 0% female 

Absence of any fecal incontinence at 3 months 3g of oral sucralfate suspension twice daily starting 1 

day before RT and continuing every day for 8 weeks Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days after abdominal proctocolectomy and stapling of the pouch to the top of the anal canal 

No fecal leak/soiling in day time 

Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 

times/day for 7 days in hand sewn ileal pouch-anal anastomosis 

Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days in hand sewn ileal pouch-anal anastomosis 

Hallgren, 1994 744N = 30 27% female 

No fecal leak/soiling night time 

Loperamide hydrochloride (Imodium) 2mg 2 capsules 3 times/day for 7 days after abdominal proctocolectomy and stapling of the pouch to the top of the anal canal 

Mentes, 2003740

N = 111 68% female 

Fecal continence 20 to 30 units (~0.3 U/kg) of type A Botulinum toxin 

(Botox) injection into the internal anal sphincter. The injection was repeated 2 months later if complete healing was not achieved 

"Chemical sphincterotomy" with 0.2% glycerine trinitrate ointment applied three times daily at the anal margin for 8 weeks 

De Nardi, 2006 

738

N = 30 43% female 

Fecal continence 

"Chemical sphincterotomy" with 20 units Botulinum toxin A injection into the internal anal sphincter on each side of the anterior midline 
F791 

Table F180. Medications that changed self-reported scores of fecal incontinence by more than 20% compared to the control int

Author 

Sample Active Treatment Control Treatment Outcome Mean ± After Active Treatment Mean ± After Control Treatment Mean Differenc

(95% CI) 

Carapeti, 2000748N = 12 58% female 

Alpha1-adrenergic agonist phenylephrine, topical 10% 0.5ml application 2 times/day 

Placebo gel Fecal 

incontinence score (0-continence to 24 – complete incontinence) 

9.0 ± 3.0 20.0 ± 1.0 -4.6 (-6.9; -2.3

Ho, 2005737

N = 89 83% female 

Chemical sphincterotomy with oral nifedipine 20 mg twice a day for 6 weeks 

Lateral sphincterotomy 

Fecal continence scores, Wexner 

0.4 ± 2.6 0.2 ±0.7 0.1 (-0.3; 0.5) 

Iswariah, 2005741N = 44 58% female 

Botox, 20 units injected on either side of the fissure into the internal anal sphincter 

Sphincterotomy by open or closed technique in the left lateral position using Park’s anal retractor 

Self-reported modified Wexner fecal continence scoring system 

0.2 ± 1.2 0.0 ± 0.0 0.2 (-0.4; 0.9) 

Bold- significant difference in outcomes at 95%confidence level 
F792 

Table F181. Comparative effectiveness of end-to-end technique vs. overlapping repair of obstetric anal sphincter lacerations (c

Author 

Sample Outcome 

Number 

of Cases 

AfterActive 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Number Needed 

to Treat 

(95% CI) 

Self reported anal incontinence 4 months postpartum 

5 6 33.0 55.0 0.7 (0.2; 1.8) 

Self-reported flatus only incontinence 4 months postpartum 

4 3 27.0 27.0 1.0 (0.3;4.1) 

Garcia, 2005597N = 41 

Self-reported stool incontinence 4 months postpartum 

1 3 4.3 16.7 0.3 (0.0; 2.3) 

Defects on Internal sphincter 

Williams, 4 2 7.1 3.6 2.0 (0.4; 10.5) 2006752N = 150 Defects on 

external sphincter 

11 8 19.6 14.3 1.4 (0.6; 3.2) 

Fecal incontinence at 12 months postpartum 

6 0 24.0 13.0 (0.8; 221.5) 

Fecal urgency at 12 months postpartum 

8 1 32.0 3.7 8.0 (1.1; 60.3) 4 (0; 443) 

Flatus incontinence at 12 months postpartum 

4 4 16.0 14.9 1.0 (0.3; 3.7) 

Fecal incontinence 6 months postpartum 

6 0 21.4 0.0 13.0 (0.8; 221.5) 

Fernando, 2006751N = 64 

Fecal urgency 6 months postpartum 

9 2 32.1 7.1 4.5 (1.1; 19.2) 4 (2; 262) 
Table F181. Comparative effectiveness of end-to-end technique vs. overlapping repair of obstetric anal sphincter lacerations (c

(continued) 

F793 

Author 

Sample Outcome 

Number 

of Cases 

AfterActive 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Number Needed 

to Treat 

(95% CI) 

Flatus incontinence 6 months postpartum 

4 7 14.3 25.0 0.6 (0.2; 1.8) 9 (5; -5) 

Cured of anal Incontinence from 6 weeks to 12 months 

4 7 16.0 25.9 0.6 (0.2; 1.8) 10 (5; -5) 

Tjandra, 2003753N = 23 

Self-reported fecal incontinence "Success" 

9 8 75 72.7 1.0 (0.6; 1.7) 

Bold - significant difference in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome in 1 patoutcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F794 

Table F182. Comparative effectiveness of different techniques to repair anal sphincter (clinical events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CL)

Self-reported symptoms of fecal incontinence 

33 27 58.0 49.0 1.2 (0.9; 1.7) 

Continence score >10 

5 2 9.0 4.0 2.5 (0.5; 12.4)

Fecal urgency <5 minutes 

17 11 30.0 20.0 1.5 (0.8; 3.0) 

Scar only in endoanal ultrasonography

4 6 7.0 11.0 0.6 (0.2; 2.2) 

Defect ≤1 

quadrant, external anal sphincter 

50 43 88.0 78.0 1.1 (0.9; 1.3) 

Fitzpatrick, 2000754N = 112 

Approximation repair: end to end 

Primary anal sphincter overlap 

Defect >1 quadrant, external anal sphincter 

3 6 5.0 11.0 0.5 (0.1; 1.8) 
F795 

Table F183. Comparative effectiveness of different techniques to repair anal sphincter (instrumental outcomes) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcomes 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean Difference 

(95% CI) 

Median continence score 

2.0 ± 8.0 0.0 ± 8.7 0.2 (-0.1; 0.6) 

Resting pressure (mm/Hg) 

42.0 ± 30.0 49.0 ± 34.0 -0.2 (-0.6; 0.2) 

Squeeze pressure (mm/Hg) 

66.0 ± 34.7 74.0 ± 37.3 -0.2 (-0.6; 0.1) 

Squeeze increment (mm/Hg) 

20.0 ± 44.0 25.0 ± 34.0 -0.1 (-0.5; 0.2) 

Fitzpatrick, 2000754N = 112 

Approximation repair: end to end 

Primary anal sphincter overlap 

Vector symmetry index 

0.6 ± 0.2 0.7 ± 0.1 -0.4 (-0.7; 0.0) 
F796 

Table F184. Comparative effectiveness of end-to-end technique vs. overlapping repair of obstetric anal sphincter lacerations (s

instrumental outcomes) 

Outcomes Mean ± STD After Active Treatment Mean ± STD After Control Treatment Mean Difference (95% CI) % Change fr

(95% 

Continence score at 3 months752 0.0 ± 9.3 0.0 ± 9.3 0.0 ( -0.4; 0.4) Resting pressure752 44.0 ± 31.3 47.0 ± 28.7 -0.1 (-0.5; 0.3) -0.2 (-1Increment squeeze pressure752 30.0 ± 26.7 29.0 ± 35.3 0.0 (-0.3; 0.4) 0.1 (-1.Pudendal nerve motor latency - right752 1.9 ± 0.4 1.9 ± 0.3 -0.1 (-0.5; 0.3) -4.6 (-24Pudendal nerve motor latency - left752 2.0 ± 0.5 1.9 ± 0.3 0.1 (-0.3; 0.4) 2.7 (-16.Cleveland Clinic Continence Score753 3.0 ± 4.7 3.0 ± 4.0 0.0 (-0.8; 0.8) 0.0 (-27.Mean Resting pressure - mm/Hg753 45.0 ± 23.3 50.0 ± 20.7 -0.2 (-1.0; 0.6) -0.5 (-2Max squeeze pressure753 125.0 ± 40.0 130.0 ± 16.0 -0.2 (-1.0; 0.7) -0.1 (-0
F797 

Table F185. Comparative effectiveness of clinical interventions to reduce fecal incontinence after obstetric trauma (clinical events

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Dannecke, 2005590N = 146 

Restrictive episiotomy 

Liberal episiotomy 

Self-reported fecal incontinence 18 months postpartum 

6 10 19.0 24.0 0.7 (0.2; 1.7) 

Fecal incontinence is not a problem at all 2 years postpartum 

3 2 27.3 22.2 1.5 (0.3; 9.0) 

Fecal incontinence is a big problem 2 years postpartum 

1 3 9.1 33.3 0.3 (0.0; 3.2) 

Hannah, 2004593N = 2,088 

Planned cesarean delivery 

Planned vaginal birth 

Self-reported flatus incontinence 2 years postpartum 

60 53 13.1 11.5 1.1 (0.8; 1.6) 

Self-reported fecal incontinence 3 months postpartum 

Hannah, 5 9 0.8 1.5 0.6 (0.2; 1.7) 2002 592

N = 2,088 

Planned cesarean delivery 

Planned vaginal birth 

Self-reported flatus incontinence 3 months postpartum 

66 59 10.7 9.7 1.1 (0.8; 1.6) 

Self-reported fecal incontinence 3 months postpartum 

Fitzpatrick, 23 33 26.0 38.0 0.7 (0.4; 1.1) 2002755N = 178 

Immediate pushing 

60 minute delay prior to the commencement of active pushing. 

% of normal ultrasound 

14 19 40.0 49.0 0.7 (0.4; 1.3) 
Table F185. Comparative effectiveness of clinical interventions to reduce fecal incontinence after obstetric trauma (clinical eve

F798 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

<1 quad external anal sphincter defect 3 months postpartum ultrasound 

19 20 54.0 51.0 0.9 (0.5; 1.6) 

>1 quad EAS defect 3 months postpartum ultrasound 

2 0 6.0 0.0 4.9 (0.2; 100.4)

Self-reported frequent fecal incontinence 

Johanson, 1 1 0.3 0.3 1.1 (0.1; 16.7) 1999596N = 607 

Delivery with vacuum extractor 

Forceps delivery 

Self-reported fecal incontinence, sometimes 

28 16 9.5 5.1 1.8 (1.0; 3.3) 

Fecal urgency <5 minutes 

21 19 30.4 31.1 1.0 (0.6; 1.6) 

Abnormal endoanal ultrasound 

34 34 49.3 55.7 1.0 (0.7; 1.4) 

Fitzpatrick, 2003756N = 130 

Vacuum assisted delivery 

Low-cavity, non-rotational forceps assisted delivery 

Abnormal endoanal ultrasound: >1 quadrant defect 

2 2 2.9 3.3 0.5 (0.1; 3.7) 

Anal sphincter defects 

Sultan, 13 14 48.0 82.0 1.7 (1.0; 3.1) 1998757N = 44 

Delivery with vacuum extractor 

Forceps delivery. 

Anal incontinence 

7 3 26.0 18.0 3.5 (1.0; 12.2) 

Defects on Internal sphincter 

Wiilliams, 6 0 10.7 0.0 13.0 (0.7; 225.42006752N = 150 

Suture material vicryl 

Suture material PDS 

Defects on external sphincter 

12 7 21.4 12.5 1.7 (0.7; 4.0) 
Table F185. Comparative effectiveness of clinical interventions to reduce fecal incontinence after obstetric trauma (clinical eve

F799 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative Risk 

(95% CI) 

Sartore, 2004591N = 519 

Mediolateral episiotomy 

No episiotomy % with selfreported anal 

incontinence 

7 5 2.8 1.9 1.47 (0.46; 5) 
F800 

Table F186. Comparative effectiveness of clinical interventions to reduce fecal incontinence after obstetric trauma (severity me

outcomes)

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean Difference 

(95% CI) 

Anal canal functional length (rest), mm/Hg 

50.0 ± 12.0 50.0 ± 10.0 0.0 (-0.3; 0.3) 

Anal canal functional length (contraction), mm/Hg) 

42.0 ± 12.0 45.0 ± 13.0 -0.2 (-0.6; 0.1) 

Anal maximum pressure (rest), mm/Hg 

113. 0 ±

35.0 

121.0 ± 35.0 -0.2 (-0.6; 0.1) 

Dannecke, 2005590N = 176 

Restrictive episiotomy 

Liberal episiotomy 

Anal maximum pressure (contraction), mm/Hg 

143.0 ± 43.0 166.0 ± 56.0 -0.5 (-0.8; -0.1) 

Fecal continence scores (median) 3 months postpartum 

3.0 ± 3.3 4.0 ± 3.3 -0.3 (-0.6; 0.0) 

Squeeze pressure (mm/Hg) 

93.0 ± 84.7 100.0 ± 49.3 -0.1 (-0.4; 0.2) 

Resting pressure (mm/Hg) 

62.0 ± 50.7 64.0 ± 50.7 0.0 (-0.3; 0.3) 

Squeeze Increment (mm/Hg) 

27.0 ± 69.3 31.0 ± 61.3 -0.1 (-0.4; 0.2) 

Fitzpatrick, 2002755N = 178 

Immediate pushing 

60 minute delay, prior to the commencement of active pushing. 

Vector symmetry index 

0.7 ± 0.2 0.7 ± 0.2 -0.1 (-0.4; 0.2) 

Fecal incontinence scores 

3.0 ± 6.0 3.0 ± 5.3 0.0 (-0.3; 0.3) 

Resting pressure (mm/Hg) 

63.0 ± 38.7 54.0 ± 41.3 0.2 (-0.1; 0.6) 

Squeeze pressure (mm/Hg) 

96.0 ± 57.3 86.0 ± 44.0 0.2 (-0.2; 0.5) 

Squeeze increment (mm/Hg) 

25.0 ± 77.3 27.0 ± 42.7 0.0 (-0.4; 0.3) 

Fitzpatrick, 2003756N = 130 

Vacuum assisted delivery 

Low cavity, non-rotational forceps assisted delivery 

Vector symmetry index 

0.7 ± 0.1 0.7 ± 0.1 0.0 (-0.3; 0.3) 

Maximum resting pressure (mm/Hg) 

Sultan, 1998 55.0 ± 15.0 60.0 ± 15.0 -0.3 (-0.9; 0.3) 

757

N = 44 

Delivery with vacuum extractor 

Forceps delivery 

Maximum squeeze pressure (mm/Hg) 

38.0 ± 14.0 53.0 ± 24.0 -0.8 (-1.5; -0.2) 
Table F186. Comparative effectiveness of clinical interventions to reduce fecal incontinence after obstetric trauma (severity me

outcomes) (continued) 

F801 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean Difference 

(95% CI) 

Continence score at 3 months 

0.0 ± 9.3 0.0 ± 6.7 0.0 (-0.4; 0.4) 

Resting pressure 43.0 ± 27.3 48.0 ± 28.7 -0.2 (-0.5; 0.2) Increment squeeze pressure 

23.0 ± 31.3 30.0 ± 34.7 -0.2 (-0.6; 0.2) 

Pudendal nerve motor latency, right 

1.9 ± 0.4 1.9 ± 0.3 -0.2 (-0.5; 0.2) 

Williams, 2006752N = 150 

Suture material vicryl 

Suture material PDS 

Pudendal nerve motor latency, left 

1.9 ± 0.4 2.0 ± 0.5 -0.1 (-0.4; 0.3) 

Bold- significant differences in outcomes at 95% confidence level
F802 

Table F187. Comparative effectiveness of surgical interventions on fecal incontinence in females (events) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

(95% C

Self-reported fecal incontinence 3 months postpartum (Wexner scores >0) 

120 114 33.0 32.1 1.1 (0.9; 

Self-reported fecal incontinence 1 year postpartum (Wexner scores >0) 

86 91 25.1 26.6 0.9 (0.7; 

Self-reported daily flatus incontinence 3 months postpartum 

7 15 1.9 4.2 0.5 (0.2; 

Self-reported daily flatus incontinence 1 year postpartum 

2 3 0.6 0.9 0.7 (0.1; 

Daily fecal urgency 3 months postpartum 

4 3 1.1 0.9 1.3 (0.3; 

Faltin, 2005758N = 752 

Clinical and ultrasound examination of the anal sphincter 

Clinical examination alone 

Daily fecal urgency 1 year postpartum 

2 1 0.6 0.3 2.0 (0.2; 

Thakar, 2002599N = 279 

Subtotal hysterectomy 

Total hysterectomy

Incontinence in flatus 12 months after operation 

2 2 1.5 1.4 1.1 (0.2: 
F803 

Table F188. Comparative effectiveness of surgical interventions on fecal continence in females (events) 

Author 

Sample Active Control Outcome 

Number of 

Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relat

(95

Deen, 1994759N = 20 

Abdominal resection rectopexy and pelvic floor repair 

Perineal rectosigmoidectomy and pelvic floor repair. 

Self-reported fecal continence (cured) 

4 4 40.0 40.0 1.0 ( 

Sayfan, 1990760N = 29 

Marlex mesh posterior rectopexy alone 

Sigmoidectomy combined with a sutured posterior rectopexy 

Self-reported restored fecal continence 

9 6 56.3 46.2 1.2 (

Postanal repair alone 

Deen, 4 4 33.3 33.3 1.0 (1993762N = 36 Total pelvic 

floor repair 

Anterior levatorplasty and sphincter plication alone 

Self-reported fecal continence 9 4 75.0 33.3 2.3 (Complete fecal continence at 12 months 

Davis, 1 1 5.0 5.6 0.9 (02004763N = 38 

Anterior overlapping sphincter repair using interrupted nonabsorbable sutures and levatorplasty using absorbable sutures. 

Anterior overlapping sphincter repair plus visual or auditory biofeedback with dual-balloon pressure system during pelvic floor exercise 2 times/day 

Proportion of patients with composite fecal continence scores >9 with fecal continence score <9 (0 - no incontinence to 20 - complete incontinence) 

10 13 47.8 71.4 0.7 (

Van Tets, 1998765N=20 

Postanal repair with levator ani and plicated of the external anal sphincter 

Total pelvic floor repair with a combination of postanal repair, anterior Ievatorptasty, and anterior sphincter plication 

Complete incontinence, continuing fecal leakage 

6 6 54.5 66.7 0.8(
F804 

Table F189. Comparative effectiveness of surgical interventions of progression of fecal incontinence in females (events) 

Author 

Sample Active Control Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

N

(

Number of patients with no improvement in fecal urgency 

Yoshioka, 3 5 25.0 41.7 0.6 (0.2; 2.0) 1999761N = 24 

Gluteus maximus transposition (without electrical stimulation) 

Total pelvic floor repair 

Number of patients failing to achieve full continence 

4 5 33.3 41.7 0.8 (0.3; 2.3) 

Self-reported severe fecal incontinence 3 months postpartum (Wexner scores >4) 

12 31 3.3 8.7 0.4 (0.2; 0.7) 19 

Self-reported severe fecal incontinence 1 year postpartum (Wexner scores >4) 

11 23 3.2 6.7 0.5 (0.2; 1.0) 29 

Daily lifestyle alteration due to fecal incontinence 3 months postpartum 

2 5 0.5 1.4 0.4 (0.1; 2.0) 

Faltin, 2005758

N = 752 

Clinical and ultrasound examination of the anal sphincter 

Clinical examination alone 

Daily lifestyle alteration due to fecal incontinence 1 year postpartum 

3 6 0.9 1.8 0.5 (0.1; 2.0) 
Table F189. Comparative effectiveness of surgical interventions of progression of fecal incontinence in females (events) contin

F805 

Author 

Sample Active Control Outcome 

Number 

of 

Active 

Cases 

Number 

of 

Control 

Cases 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

N

N

(

Postanal repair alone 

Manometry: presence of reactoanal inhibitory reflex 

Deen, 1993 11 10 91.7 83.3 1.1 (0.8; 1.5) 762

N = 24 

Total pelvic floor repair 

Anterior levatorplasty and sphincter plication alone Manometry: 

presence of reactoanal inhibitory reflex 

12 10 100.0 83.3 1.2 (0.9; 1.6) 

Davis, 2004763

N = 38 

Anterior overlapping sphincter repair using interrupted nonabsorbable sutures and levatorplasty using absorbable sutures. 

Anterior overlapping sphincter repair plus visual or auditory biofeedback with dualballoon pressure system during pelvic floor exercise 2 times/day 

Symptomatic improvement in fecal incontinence 

13 17 64.7 92.8 0.7 (0.5; 1.0) 4 

Bold- significant difference in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome in 1 patioutcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the contro

the active group); A - avoided; E - excessive events 
F806 

Table F190. Comparative effectiveness of surgical interventions on self-reported severity of fecal incontinence in females 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Yoshioka, 1999761N = 24 

Gluteus maximus transposition (without electrical stimulation) 

Total pelvic floor repair 

Fecal Incontinence score 

7.7 ± 6.1 6.6 ± 4.5 0.2 (-0.6; 1.0) 

Anterior overlapping sphincter repair using interrupted nonabsorbable sutures and levatorplasty using absorbable sutures. 

Anterior overlapping sphincter repair plus visual or auditory biofeedback with dual-balloon pressure system during pelvic floor exercise 2 times/day 

Continence Grading Scale Score (0 - no incontinence to 20 - complete incontinence) 

9.7 ± 4.7 8.4 ± 5.1 0.3 (-0.4; 0.9) 

Continence Grading Scale Score (n) 

8.4 ± 5.1 9.7 ± 4.7 -0.3 (-0.9; 0.4) 

Patient satisfaction visual analogue score (n) 

6.3 ± 3.4 6.4 ± 3.4 0.0 (-0.6; 0.6) 

Quality of life scores, lifestyle 

3.4 ± 0.8 2.8 ± 0.9 0.7 (0.0; 1.3) 

Fecal continence scores (range: 0-20) 

7.4 ± 4.6 9.1 ± 4.9 -0.4 (-1.0; 0.3) 

Davis, 2004763

N = 38 

Direct sphincter repair and levatorplasty with pelvic floor muscle exercise training and biofeedback therapy 

Direct sphincter repair and levatorplasty 

Patient satisfaction visual analogue scores range: 0-10) 

8.0 ± 2.5 6.4 ± 2.9 0.6 (-0.1; 1.2) 
F807 

Table F191. Comparative effectiveness of surgical interventions on progression of fecal incontinence (instrumental outcomes) 

Author Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean Differ

(95% C

Maximum resting pressure, cm/H20 

Deen, 63.3 ± 28.7 51.2 ± 29.6 0.4 (-0.5; 11994759N = 20 

Abdominal resection rectopexy and pelvic floor repair 

Perineal rectosigmoidectomy and pelvic floor repair. Maximum squeeze 

pressure, cm/H20 

97.6 ± 29.1 103.0 ± 49.2 -0.1 (-1.0; 

Resting anal pressure, H20 

69.0 ± 23.3 86.0 ± 32.7 -0.6 (-1.4; 

Maximal squeeze pressure, c/ H2O 

134. 0 ± 86.7 137.0 ± 112.0 0.0 (-0.8; 0

Sayfan, 1990760N = 29 

Marlex mesh posterior rectopexy alone 

Sigmoidectomy combined with a sutured posterior rectopexy 

Rectal emptying 58.0 ± 17.3 41.0 ± 19.3 0.9 (0.2; 1Change from baseline in length of high pressure zone ,cm 

-2.6 ± 0.9 -2.0 ± 0.7 -0.7 (-1.6; 

Change from baseline in maximum squeeze pressure ,cm/H2O 

-92.7 ± 25.8 -94.5 ± 50.3 0.0 (-0.8; 0

Mucosal electro sensitivity ,mA 

10.8 ± 5.8 12.7 ± 5.9 -0.3 (-1.1; 

Yoshioka, 1999761N = 24 

Gluteus maximus transposition (without electrical stimulation) 

Total pelvic floor repair 

Change in maximum resting anal pressure, cm/H2O 

-60.3 ± 16.5 -63.4 ± 32.2 0.1 (-0.7; 0

Deen, 1993762N = 24 

Total pelvic floor repair 

Anterior levatorplasty and sphincter plication alone 

Manometry: maximum squeeze pressure, cm/H20 

131.0 ± 10.0 141.0 ± 17.0 -0.7 (-1.5; 

Resting anal pressures mean ,cm H2O 

Davis, 65.9 ± 19.5 77.3 ± 14.8 -0.7 (-1.3; 2004763N = 38 

Anterior overlapping sphincter repair using interrupted non-absorbable sutures and levatorplasty using absorbable sutures. 

Anterior overlapping sphincter repair plus visual or auditory biofeedback with dual-balloon pressure system during pelvic floor exercise 2 times/day 

Squeeze anal pressures, mean ,cm/H2O 

105.4 ± 34.7 129.5 ± 32.1 -0.7 (-1.4; -

Maximum resting pressure, cm/H20 

63.2 ± 18.5 86.9 ± 31.5 -0.9 (-1.7; -

Maximum squeezing pressure. cm/H20 

92.0 ± 72.0 140.0 ± 98.0 -0.6 (-1.3; 

Improvement in anal mucosal electro sensitivity 

2.2 ± 8.7 0.5 ± 6.6 0.2 (-0.5; 0

Deen, 1995764N = 33 

Adjuvant internal anal sphincter plication in pelvic floor repair 

Pelvic floor repair alone 

Rectal capacity 189.0 ± 38.7 207.2 ± 60.5 -0.4 (-1.1; 
Table F191. Comparative effectiveness of surgical interventions on progression of fecal incontinence (instrumental outcomes) 

F808 

Author Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean Differ

(95% C

Resting anal pressures, mean, cm/H2O 

Davis, 77.3 ± 14.8 65.9 ± 19.5 0.7 (0.0; 12004763N = 38 

Direct sphincter repair and levatorplasty with pelvic floor muscle exercise training and biofeedback therapy 

Direct sphincter repair and levatorplasty. 

Squeeze anal pressures, mean, cm/H2O 

129.5 ± 32.1 105.4 ± 34.7 0.7 (0.1; 1

Bold- significant difference in outcomes at 95%confidence level 
F809 

Table F192. Comparative effectiveness of radiotherapy for prostate cancer on fecal incontinence 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment 

Relative 

Risk 

(95% CI) 

Fecal incontinence as use of incontinence pads for rectal loss of blood, mucus, or stools (requiring the use of pads more than twice a week) at 4 years 

Peeters, 21 40 6.5 12.2 0.5 (0.3; 0.9) 2006766N = 669 

Threedimensional conformal radiotherapy 68Gy 

Threedimensional conformal radiotherapy 78Gy 

Incontinence pad use at 5 years 

40 51 12.3 15.5 0.9 (0.7; 1.1) 

Fransson, 2001686N = 166 

Radiotherapy with a total dose of 4.8 Gy (range, 62.3–70.0 Gy) given for 5 days a week, 2 grays (Gy)/fraction. 

Active surveillance 

Use of sanitary shields for stool leakage 

5 2 8.6 4.1 2.1 (0.4; 

10.2) 

Little, 2003676

N = 301 

Radiation with a fourfield box technique to a dose of 70Gy arm 

Radiation with threedimensional conformal techniques to generate a six-field boost plan of a total dose of 78Gy 

Selfreported fecal continence 

89 91 82.4 88.3 0.9 (0.8; 1.0) 

Bold- significant difference in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome in 1 pat

outcome in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the controthe active group ; A - avoided; E - excessive events 
F810 

Table F193. The changes in self-reported fecal incontinence after radiotherapy of prostate cancer in 166 males compared to ac

Sample Active treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

% C

(

Fransson, 2001686 Radiotherapy with a total dose of 4.8Gy (range, 62.3–70.0Gy) 

given for 5 days a week, 2grays (Gy) per fraction. 

Self-reported stool leakage 0 - “no problem/ very good function” and 10 - “many problems/very bad function” 

0.8 ± 1.5 0.3 ± 1.3 0.3 (0.0; 0.7) 115.9 
F811 

Table F194. Bowel management in 87 patients with spinal cord injury (29% females) and symptoms of neurogenic bowel dysfu

Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

% Change from 

Control 

(95% CI) 

Cleveland Clinic constipation scoring system 10.3 ± 4.4 13.2 ± 3.4 -0.7 (-1.2; -0.3) -5.6 (-8.9; -2.3St Mark’s fecal incontinence grading system 5 ± 4.6 7.3 ± 4.0 -0.5 (-1.0; -0.1) -7.3 (-13.2; -1.5Neurogenic bowel dysfunction score 10.4 ± 6.8 13.3 ± 6.4 -0.4 (-0.9; 0.0) -3.3 (-6.5; -0.1American Society of Colon and Rectal Surgeons fecal incontinence score 

3 ± 0.7 2.8 ± 0.8 0.3 (-0.2; 0.7) 9.5 (-5.6; 24.6

Influence of fecal incontinence on daily activities 4.5 ± 3.2 4.1 ± 2.8 0.1 (-0.3; 0.6) 3.3 (-7.0; 13.5Number of episodes where due to fecal incontinence it was necessary to change clothes 

0.3 ± 0.6 0.3 ± 0.7 0.0 (-0.4; 0.4) 0.0 (-140.2; 140

Bold - significant differences in outcomes at 95%confidence level
F812 

Table F195. Comparative effectiveness of surgical interventions on fecal incontinence in patients with hemorrhoid disease (eve

Author 

Sample Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%

After 

Contr

Treatm

Galizia, 2000771

N = 42 48% female 

Complete excision of three hemorrhoids (Milligan-Morgan technique) and lateral internal sphincterotomy up to the dentate line, in left haemorrhoidectomy wound. 

Complete excision of three hemorrhoids (Milligan-Morgan technique) 

Self-reported fecal incontinence 

1 0 4.5 0.1 

Self-reported fecal incontinence to liquid 

Hemorrhoidectomy 1 1 2.5 3.0 with no retractor (Miller method) 

Hemorrhoidectomy with forced anal dilation. 

Self-reported fecal incontinence to solid stool 

4 8 10.0 18.0 

Self-reported fecal incontinence to liquid 

4 1 10.0 3.0 

Konsten, 2000769

N = 118 42% female 

Hemorrhoidectomy with forced anal dilation and after treatment for 6 month original Lord's procedure. 

Hemorrhoidectomy with forced anal dilation. 

Self-reported fecal incontinence to solid stool 

6 8 15.0 18.0 

Hetzer, 2002768N = 40 28% female 

Stapled hemorrhoidectomy (Longo technique) with circular anal dilatator introduced to reduce the prolapse of the anoderm and parts of the anal mucous membrane. 

Excision hemorrhoidectomy (Ferguson technique). 

Self reported fecal continence 

20 20 100.0 100.0 
Table F195. Comparative effectiveness of surgical interventions on fecal incontinence in patients with hemorrhoid disease (eve

F813 

Author 

Sample Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%

After 

Contr

Treatm

Jayne, 2002770

N = 40 47% female 

Ligasure haemorrhoidectomy applying repeated diathermy forceps across the hemorrhoid with associated skin tag. Completion of coagulation was signaled by the feedback sensors, and haemorrhoidal tissue was excised along the line of coagulum. 

Open diathermy haemorrhoidectomy 

Self-reported fecal incontinence fecal continence 

20 20 100.0 100.0 

Filingeri, 2004773

N = 102 53% female 

Submucosal hemorrhoidectomy with radiofrequency bistoury 

Conventional Parks' hemorrhoidectomy 

Self-reported fecal continence 

51 51 100.0 100.0 

Self-reported fecal continence 

Lawes, 2004 12 11 66.7 68.8 

772

N = 34 50% female 

Ligasure haemorrhoidectomy with controlled quantity of bipolar diathermy current to tissue ensuring the complete coagulation of blood vessels 

Standard diathermy haemorrhoidectomy 

Self-reported incontinence to liquid 

0 1 0.0 6.3 

Fecal incontinenceloose feces 

Johannsson, 8 1 7.0 0.9 2006774N = 250 54% female 

Open (MilliganMorgan) haemorrhoidectomy 

Closed (Ferguson) haemorrhoidectomy with wounds sutures without tension 

Fecal incontinencesolid feces 

1 0 0.9 0.0 

Khan, 2001775

N = 30 37% female 

Excisional Hemorrhoidectomy with the ultrasonically activated scalpel (Harmonic Scalpel) 

Closed excisional hemorrhoidectomy assisted by electrocautery 

Self-reported fecal continence 

14 16 100 100 

Ho, 2000777

N=119 52% female 

Conventional open diathermy hemorrhoidectomy 

Stapled hemorrhoidectomy 

Incontinence to liquids and gas 

2 0 3.2 0.1 
F814 

Table F196. Comparative effectiveness of surgical interventions on progression of fecal incontinence in patients with hemorrh

Author 

Sample Active Treatment Control Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rat

A

Co

Trea

Galizia, 2000771

N = 42 48% female 

Complete excision of three hemorrhoids (Milligan-Morgan technique) and lateral internal sphincterotomy up to the dentate line, in left haemorrhoidectomy wound. 

Complete excision of three hemorrhoids (Milligan-Morgan technique) 

Rectoanal inhibitory reflex, presence 

22 20 100.0 10

Jayne, 2002770

N = 40 47% female 

Ligasure haemorrhoidectomy applying repeated diathermy forceps across the hemorrhoid with associated skin tag. Completion of coagulation was signaled by the feedback sensors, and haemorrhoidal tissue was excised along the line of coagulum. 

Open diathermy haemorrhoidectomy 

Self-reported increase in fecal incontinence 

3 5 15.0 2

Johannsson, 2006774N = 250 54% female 

Open (MilliganMorgan) haemorrhoidectomy 

Closed (Ferguson) haemorrhoidectomy with wounds sutures without tension 

Self-reported improvement in anal continence 

29 26 25.2 2
F815 

Table F197. Comparative effectiveness of surgical interventions on fecal incontinence in patients with hemorrhoid disease (selscores and instrumental outcomes) 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Khan, 2001775

N = 30 37% female 

Excisional hemorrhoidectomy with the ultrasonically activated scalpel (Harmonic Scalpel) 

Closed excisional hemorrhoidectomy assisted by electrocautery 

Self-reported general health (SF-36) 

79.0 ± 18.7 74.0 ± 16.0 0.3 (-0.4; 1.0) 

Resting pressures (mm/Hg): maximal

89.0 ± 11.3 139.4 ± 19.7 -3.2 (-4.1; -2.3) 

Resting pressures (mm/Hg): mean 

46.1 ± 8.0 71.1 ± 10.3 -2.7 (-3.6; -1.9) 

Squeeze pressures (mm/Hg): maximal

217.5 ± 50.7 267.0 ± 55.5 -0.9 (-1.6; -0.3) 

Galizia, 2000771N = 42 48% female 

Complete excision of three hemorrhoids (Milligan-Morgan technique) and lateral internal sphincterotomy up to the dentate line, in left haemorrhoidectomy wound. 

Complete excision of three hemorrhoids (Milligan-Morgan technique) 

Squeeze pressures (mm/Hg): mean 

96.2 ± 29.1 120.8 ± 37.1 -0.7 (-1.4; -0.1) 

Resting anal pressure 

van Tets, 84.0 ± 30.0 93.0 ± 36.2 -0.3 (-0.9; 0.4) 1997776N = 40 50% female 

Closed hemorrhoidectomy performed intra-anally using the Parks' anal retractor 

Closed hemorrhoidectomy performed perineally without the use of a retractor 

Squeeze pressure 

90.0 ± 54.1 102.0 ± 67.5 -0.2 (-0.8; 0.4) 

Johannsson, 2006774N = 250 54% female 

Open (MilliganMorgan) haemorrhoidectomy 

Closed (Ferguson) haemorrhoidectomy with wounds sutures without tension 

Miller scores 1.6 ± 8.3 1.0 ± 7.3 0.1 (-0.2; 0.3) Mean anal resting pressure (mm/Hg) 

52.7±63.0 59.9 ± 36.2 -0.1(-0.5 0.2) 

Max anal resting pressure, mm/Hg 

181.2±246.5 222.9 ±1 67.6 -0.2(-0.6 ;0.2) 

Internal sphincter thickness, mm 

2.2 ± 1.6 2.6 ± 2.3 -0.2(-0.6; 0.2) 

Ho, 2000777

N=119 52% females 

Conventional open diathermy hemorrhoidectomy 

Stapled hemorrhoidectomy 

External sphincter thickness, mm 

10.7 ± 4.7 11.0 ± 3.0 -0.1(-0.4; 0.3) 

Bold- significant difference in outcomes at 95%confidence level 
F816 

Table F198. Comparative effectiveness of clinical interventions in patients with colo-rectal diseases to reduce risk of fecal incontin

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relat 

ive Risk 

(95% CI) 

Recurrence or persistence rate of fistula 

Schouten, 1 14 2.9 40.6 0.1 (0.0; 0.5) 1991778

N = 70 83% female 

Incision, drainage and fistulectomy with primary partial internal sphincterectomy 

Incision and drainage alone with secondary partial internal sphincterectomy 

Anal function disturbances: control of flatus and soiling at 1 year 

14 7 39.4 21.4 1.9 (0.9; 4.1) 

Tisseel-VH fibrin sealant intra-adhesive cefoxitin 100mg surgical closure of primary opening 

Singer, 2005 24 26 100.0 100.0 779

N = 75 32% female 

Tisseel-VH fibrin sealant surgical closure of primary opening 

Tisseel-VH fibrin sealant intra-adhesive cefoxitin 100mg 

Selfreported fecal continence 

25 26 100.0 100.0 

Libertiny, 2002780

N = 82 48% female 

Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day for 8 weeks. 

Lateral sphincterotomy 

Selfreported flatus incontinence 

0 1 0.1 2.8 0.3 (0.0; 7.9) 
Table F198. Comparative effectiveness of clinical interventions in patients with colo-rectal diseases to reduce risk of fecal incontin

F817 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relat 

ive Risk 

(95% CI) 

Mishra, 2005781

N = 40 50% female 

Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day 

Lateral sphincterotomy 

Selfreported flatus incontinence 

0 3 0.1 15.0 0.1 (0.0; 2.6) 

Oettle, 1997782

N = 24 50% female 

Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day 

Lateral sphincterotomy 

Selfreported fecal continence 

12 12 100.0 100.0 

Application of 0.25 percent nitroglycerin tid to perianal area 

Internal sphincterotomy 

Selfreported minor fecal incontinence 

Richard, 7 3 15.9 7.9 2.0 (0.6; 7.3) 2000783

N = 82 55% female 

Application of 0.25 percent nitroglycerin tid to perianal area 3 times/day 

Internal sphincterotomy 

Selfreported fecal continence 

27 30 61.4 78.9 0.8 (0.6; 1.0) 

Evans, 2001784

N = 65 65% female 

Glyceryl trinitrate application 0.2% paste to perianal area 3 times/day for 8 weeks. 

Lateral sphincterotomy next available operating list 

Selfreported minor FI 

0 2 0.1 6.5 0.2 (0.0; 3.7) 

FI during a day 

190 111 62.0 38.0 1.6 (1.4; 1.9) 

FI during a night 

98 49 32.0 17.0 1.9 (1.4; 2.6) 

Use of pads for Fecal Incontinence 

171 96 56.0 33.0 1.7 (1.4; 2.1) 

Peeters, 2005674

N = 597 38% female 

Radiotherapy with total dose of 25Gy administered in 5 fractions over 5 to 7 days before total mesorectal excision 

Total mesorectal excision 

Complete fecal continent (FI at baseline) 

116 180 38.0 62.0 0.6 (0.5; 0.7) 
Table F198. Comparative effectiveness of clinical interventions in patients with colo-rectal diseases to reduce risk of fecal incontin

F818 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relat 

ive Risk 

(95% CI) 

Always fecal continent (FI at baseline) 

43 15 14.0 5.0 2.7 (1.5; 4.8) 

Selfreported fecal incontinence 

12 11 57.0 26.0 2.2 (1.2; 4.2) 

Selfreported gas incontinence 

15 20 71.0 46.0 1.5 

(1.0; 2.3) 

Selfreported soiling 

8 7 38.0 16.0 2.3 (1.0; 5.6) 

Peeters, 2005674

N = 64 50% female 

Radiotherapy with total dose of 25Gy was administered with 5Gy fractions to rectum, perirectal tissues, anal sphincters, and regional lymph nodes before low anterior resection of rectal cancer 

Low anterior resection of rectal cancer without pre operative radiotherapy. 

Rectoanal inhibitory reflex. 

17 36 81.0 83.7 1.0 (0.8; 1.2) 

Fecal urgency, toilet dependence 

25 5 30.0 6.0 5.2 (2.1; 12.9) 

Bowel empting difficulties 

44 31 52.0 36.0 1.5 

(1.0; 2.1) 

Incontinence of gas 

57 44 68.0 51.0 1.3 

 (1.0; 1.7) 

Incontinence of loose stool 

42 21 50.0 24.0 2.1 (1.3; 3.2) 

Incontinence of solid stool 

12 3 14.0 3.0 4.1 (1.2; 14.2) 

Fecal nocturnal leakage 

12 7 14.0 8.0 1.8 (0.7; 4.3) 

Dahlberg, 1998787

N = 171 51% female 

Preoperative high-dose radiotherapy with 25Gy given in 5 fractions for 5-7 days followed by anterior resection of rectal cancer 

Anterior resection of rectal cancer alone 

Use of pad for FI 

41 19 49.0 22.0 2.2 (1.4; 3.5) 
Table F198. Comparative effectiveness of clinical interventions in patients with colo-rectal diseases to reduce risk of fecal incontin

F819 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number 

of Cases 

After 

Active 

Treatment 

Number 

of Cases 

After 

Control 

Treatment 

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relat 

ive Risk 

(95% CI) 

Ability to release flatus without stool 

73 82 87.0 94.0 0.9 (0.8; 1.0) 

Excellent operation with respect to bowel function 

12 28 14.0 32.0 0.4 (0.2; 0.8) 

Restriction in social life because of fecal incontinence 

25 9 30.0 10.0 2.9 (1.4; 5.8) 

Loose or liquid stool 

9 3 3.7 1.2 3.1 (0.8; 11.2) 

Fecal incontinence 

9 1 3.7 0.4 9.2 (1.2; 72.2) 

Lundby, 2005789N=494 Postoperative radiotherapy 

after anterior resection 

Anterior resection alone 

Use of pad for fecal incontinence 

7 0 2.9 0.0 15.4 

(0.9; 267.6) 

Pollack, 2006675

N = 1,406 56% female Followup 180 

Abdominal rectal resection with preoperative radiotherapy 

Abdominal rectal resection without preoperative radiotherapy 

Fecal incontinence 

12 11 2.01 1.36 1.48 

(0.66, 3.34) 

Bold- significant difference in outcomes at 95% confidence level; Number needed to treat to have avoided or excessive outcome inn1 patien

in the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the control – rate of the group); A - avoided; E - excessive events
F820 

Table F199. Comparative effectiveness of clinical interventions in patients with rectal diseases to reduce risk of fecal incontineseverity scores and instrumental outcomes) 

Author 

Sample Active Control Outcome 

Mean ± STD 

After Active 

Treatment 

Mean STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Mean anal resting pressure 

52.4 ± 26.4 65.5 ± 18.6 -0.6 (-1.3; 0.2) 

Maximal anal squeeze pressure 

172.9 ± 67.9 144.5 ± 57.6 0.5 (-0.3; 1.2) 

Zimmerman, 2003785N = 30 30% female 

Parks retractor during fistula repair 

Scott retractor during fistula repair 

Rockwood fecal continence severity index. 

12.7 ± 12.9 7.5 ± 9.6 0.5 (-0.3; 1.2) 

Ho, 2005786

N = 20 96% female 

Dermal island flap anoplasty with cutaneous advancement flap into the rectum 

Conventional treatment: lay open fistulotomy or seton insertion 

Self-reported fecal incontinence scores 

1.3 ± 4.1 1.3 ± 3.2 0.0 (-0.9; 0.9) 

Richard, 2000783N = 82 59% female 

Application of 0.25% nitroglycerin tid to perianal area 3 times/day 

Internal sphincterotomy 

Fecal incontinence Wexner scores 

0.5 ± 1.3 0.2 ± 0.6 0.3 (-0.1; 0.7) 

Comparative effectiveness of clinical interventions in patients with rectal cancer (self-reported severity scores)

Modified Cleveland Incontinence Score at 3 weeks 

Allgayer, 2005 9.3 ± 2.5 11.5 ± 2.6 -0.9 (-1.3; -0.4

788

N = 95 42% female 

Postoperative irradiation (total dose 50.4±/2.0Gy) applied in split doses (1.8Gy, 5/week). Intensive daily pelvic floor exercise with biofeedback intra-anal electromyogram electrode device 

Intensive daily pelvic floor exercise with biofeedback intra-anal electromyogram electrode device 

Modified Cleveland Incontinence Score at 1 year 

8.1 ± 3.6 10.5 ± 4.4 -0.6 (-1.0; -0.2

Dahlberg, 1998787

N = 171 51% female 

Preoperative high-dose radiotherapy with 25Gy given in 5 fractions for 5-7 days followed by anterior resection of rectal cancer 

Anterior resection of rectal cancer alone 

Fecal urgency, deferring time, minutes 

5.0 ± 76.7 10.0 ± 193.3 0.0 (-0.3; 0.3) 

Bold- significant difference in outcomes at 95%confidence level 
F821 

Table F200. Comparative effectiveness of surgical interventions on fecal incontinence in patients with rectal prolapse (events)

Author 

Sample Active Control Outcome 

Number of 

Cases After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment

Rate (%) 

After 

Control 

Treatment

Relative 

Risk 

(95% CI) 

Complete anal continence 

9 11 27.3 73.3 0.4 (0.2; 0.7) 

Selfreported incontinence for solid stool (grade 3) 

1 1 6.7 6.7 1.0 (0.1; 14.6) 

Luukkonen, 1992790N = 30 33% female 

Posterior sutured abdominal rectopexy combined with sigmoidectomy complete rectal prolapse and end-toend anastomosis made with a circular stapler 

Polyglycolic acid mesh rectopexy without sigmoidectomy for complete rectal prolapse anterior rectal wall free 

Selfreported incontinence for liquid stool (grade 2) 

1 0 6.6 0.1 3.0 (0.1; 68.3) 

Racalbuto, 2004791N = 100 44% female 

Stapled prolapsectomy using Longo circular stapler. 

Traditional Milligan-Morgan Hemorrhoidectomy with exeresis of the haemorrhoidal piles upon low ligature of each vascular pedicle 

Fecal urgency with occasional incontinence to gas and liquid stool (Wexner score 4) 

3 3 6.0 6.0 1.0 (0.2; 4.7) 

Novell, 1994792

N = 63 99% female 

Ivalon sponge with sutured rectangle of sponge placed along the length of the sacrum 

Sutured rectopexy with sutured rectangle of sponge or sutures alone placed along the length of the sacrum 

Selfreported fecal incontinence as fecal soiling or using a pad 

6 2 19.4 6.3 3.1 (0.7; 14.2) 

Bold- significant differences in outcomes at 95% confidence level; A - Number of avoided; E - number of excessive events per 1000 treated 
F822 

Table F201. Effect of surgical procedures on severity of fecal incontinence 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Resting anal pressure (mean), cm/H20 

Luukkonen, 34.5 ± 11.7 30.7 ± 11.5 0.3 (-0.4; 1.1992790N = 30 33% female 

Posterior sutured abdominal rectopexy combined with sigmoidectomy complete rectal prolapse and endto-end anastomosis made with a circular stapler 

Polyglycolic acid mesh rectopexy without sigmoidectomy for complete rectal prolapse anterior rectal wall free 

Maximal squeeze pressure, cm/H20 

53.0 ± 20.7 49.3 ± 15.1 0.2 (-0.5; 0.

Mean basal pressure 

Racalbuto, 82.1 ± 11.5 76.1 ± 13.3 0.5 (0.1; 0.2004791N = 100 44% female 

Stapled prolapsectomy using Longo circular stapler. 

Traditional MilliganMorgan Hemorrhoidectomy with exeresis of the haemorrhoidal piles upon low ligature of each vascular pedicle 

Mean maximal squeeze pressure 

101.0 ± 16.7 95.0 ± 17.3 0.4 (0.0; 0.7

Solomon, 2002793

N = 40 50% female 

Laparoscopic rectopexy 

Open abdominal rectopexy 

Self-reported fecal incontinence scores with visual analog scale 

1.6 ± 6.3 2.0 ± 4.7 -0.1 (-0.7; 0

Impact on social life (1 - unrestricted social life) 

Galili, 1997 0.9 ± 0.3 0.9 ± 0.4 0.1 (-0.6; 0.

794

N = 37 87% female 

Posterior abdominal rectopexy with nonabsorbable mesh (Polypropylene, Prolene, Ethicon Ltd) 

Posterior abdominal rectopexy with absorbable mesh (Polyglycolic acid, Dexon, Davis & Geck) 

Fecal continence scores (as 0 -complete incontinence, 0.5 - incontinence for loose stool only, 1- complete continence) 

0.7 ± 0.3 0.8 ± 0.4 -0.3 (-1.0; 0

Boccasanta, 2006795N = 40 99% female 

Altemeier's procedure with levatorplasty using harmonic scalpel and circular stapler 

Altemeier's procedure with levatorplasty, monopolar electrocautery and hand sewn anastomosis 

Fecal Continence score (Wexner score, ranging from 0 - full continence to 20 - complete incontinence). 

7.9 ± 1.9 8.1 ± 1.8 -0.1 (-0.7; 0
Table F201. Effect of surgical procedures on severity of fecal incontinence (continued) 

F823 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Resting pressure (mm/Hg) 

34.4 ± 5.5 34.2 ± 5.4 0.0 (-0.6; 0.

Squeeze pressure (mm/Hg) 

64.8 ± 12.9 65.4 ± 12.3 0.0 (-0.7; 0.

Threshold volume (ml): Distention 

41.9 ± 7.6 41.5 ± 7.0 0.1 (-0.6; 0.

Threshold volume (ml): desire to defecate 

64.8 ± 9.9 65.1 ± 10.5 0.0 (-0.6; 0.

Sacral reflex latency (millisecond) 

62.9 ± 6.4 63.0 ± 6.7 0.0 (-0.6; 0.

Self-reported fecal incontinence scores from 0 - complete continence to 6 - complete incontinence. 

9.0 ± 2.0 10.0 ± 2.0 -0.5 (-1.4; 0

Basal pressure, mm/Hg 

47.2 ± 22.3 47.2 ± 46.1 0.0 (-0.9; 0.

Squeezing pressure, mm/Hg 

97.4 ± 9.7 98.4 ± 42.2 0.0 (-0.9;0.

Rectal capacity, ml 170.4 ± 10..1 171.4 ± 43.0 0.0 (-0.9; 0.Rectoanal inhibitory reflex, ml 

17.3 ± 3.2 15.3 ± 21.2 0.2 (-0.7; 1.

Threshold volume, ml 

14.9 ± 2.5 15.1 ± 9.6 0.0 (-0.9; 0.

Boccasanta, 1998796N = 21 95% female 

Laparoscopic stapled Well’s rectopexy, perineal physiotherapy, external electric stimulation, and perineal biofeedback 

Well's rectopexy by the open technique without division of lateral rectal ligaments, perineal physiotherapy, external electric stimulation, and perineal biofeedback 

Painful reflex to rectal stretching, ml 

30.9 ± 3.6 31.9 ± 13.9 -0.1 (-1.0; 0

Bold- significant difference in outcomes at 95%confidence level 
F824 

Table F202. Comparative effectiveness of surgical interventions on anal sphincter to prevent incidence of fecal incontinence in adult

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95 %C)I 

N

Selfreported fecal continence 

30 33 100.0 100.0 

Selfreported absence of fecal soiling 

30 33 100.0 100.0 

Parallada, 2004798N = 63 96% female 

Surgical: open lateral internal sphincterotomy and mucose closure with chromic catgut. 

Chemical: local 0.2 percent isosorbide dinitrate - peasize quantity applied manually at the entrance of the anus, 3 times/day immediately after a warm sitz bath, for 6 weeks. 

Selfreported gas incontinence and fecal soiling 

9 0 30.0 0.1 20.8 (1.3; 343.3)

Zbar, 2003801

N = 34 26% female 

Modified cutting seton, which repaired the internal anal sphincter muscle and rerouted the seton through the intersphincteric space. 

Conventional cutting seton 

Selfreported fecal continence 

18 15 100.0 94.0 1.1 (0.9; 1.3) 

Wiley, 2004797

N = 79 54% female 

Closed lateral internal sphincterotomy (Hoffman and Goligher) using a short stab incision and blind division of the internal sphincter guided by the surgeon finger. 

Open lateral sphincterotomy (Parks) via a 1cm radial incision with division of the internal sphincter under direct vision. 

Selfreported major fecal incontinence

1 2 2.6 4.9 0.5 (0.1; 5.7) 
Table F202. Comparative effectiveness of surgical interventions on anal sphincter to prevent incidence of fecal incontinence in adult

F825 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Number of 

Cases 

After 

Active 

Treatment

Number of 

Cases 

After 

Control 

Treatment

Rate (%) 

After 

Active 

Treatment 

Rate (%) 

After 

Control 

Treatment

Relative Risk 

(95 %C)I 

N

Wong, 2002799

N = 112 75% female 

Implantation of Acticon trade mark artificial bowel sphincter - solid silicone elastomer device. 

Baseline condition 

Urge fecal incontinence

22 100 20.0 89.0 0.2 (0.2; 0.3) 

Self-reported fecal incontinence (<4 in Cleveland Clinic Scoring System) at 2 months 

Arroyo, 2 2 5.0 5.0 1.0 (0.1; 6.8) 2005800N = 80 35% female 

Close lateral internal sphincterotomy 

Chemical sphincterotomy with 25 units botulinum toxin injected into the internal sphincter 

Self-reportedfecal incontinence (<4 in Cleveland Clinic Scoring System) at 1-3 years 

1 0 2.5 0.1 3.0 (0.1; 71.5) 

Bold- significant difference in outcomes at 95%confidence level; Number needed to treat to have avoided or excessive outcome inn1 patient 

the control – rate of the outcome in the active group); Number of attributable events = 1000*(rate of the outcome in the control – rate of the ogroup); A - avoided; E - excessive events 
F826 

Table F203. Comparative effectiveness of surgical interventions on anal sphincter to prevent progression of fecal incontinence severity scores) 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean Differenc

(95% CI) 

Wiley, 2004797

N = 79 54% female 

Closed lateral internal sphincterotomy (Hoffman and Goligher) using a short stab incision and blind division of the internal sphincter guided by the surgeon finger. 

Open lateral sphincterotomy (Parks) via a 1cm radial incision with division of the internal sphincter under direct vision. 

Self-reported fecal continence scores (0 - continence, 20 - complete incontinence) 

1.0 ± 1.1 1.0 ± 1.8 0.0 (-0.4; 0.4) 

Wong, 2002799

N = 112 75% female 

Implantation of Acticon trade mark artificial bowel sphincter - solid silicone elastomer device. 

Baseline condition Self-reported fecal 

incontinence using Fecal Incontinence Scoring System (FISS), from 0 - complete continence to 120 - complete incontinence. 

48.0 ± 48.0 106.0 ± 9.3 -1.7 (-2.0; -1.4) 

Self-reported loose stool at 3 months (0 -total continence to 18 - maximum incontinence). 

15.0 ± 13.3 11.0 ± 29.3 0.2 (-0.3; 0.6) 

Self-reported loose stool at 1 year (0 - total continence to 18 - maximum incontinence). 

14.0 ± 14.7 10.0 ± 29.3 0.2 (-0.3; 0.6) 

Osterberg, 2004802N = 70 90% female 

Anterior levatorplasty with mobilization of external sphincter 

Anal (and vaginal in women) plug electrostimulation of the pelvic floor with stimulation frequency was 25Hz and the duration 1.5 seconds, with a pulse-train interval of 3 seconds. Self-reported solid 

fecal incontinence stool at 3 months (0 -total continence to 18 - maximum incontinence). 

32.0 ± 27.3 25.0 ± 50.0 0.2 (-0.3; 0.6) 
Table F203. Comparative effectiveness of surgical interventions on anal sphincter to prevent progression of fecal incontinence 

severity scores) (continued) 

F827 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ±

STD After 

Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean Differenc

(95% CI) 

Self-reported solid fecal incontinence stool at 1 year (0 - total continence to 18 - maximum incontinence). 

30.0 ± 12.7 27.0 ± 40.7 0.1 (-0.4; 0.6) 

Fecal Incontinence score (0–18) at 1 year 

6.0 ± 5.3 8.0 ± 4.0 -0.4 (-0.9; 0.0) 

Wexner’s continence score at 3 months 

7.0 ± 3.3 9.5 ± 3.0 -0.8 (-1.2; -0.3) 

Visual analog quality of life scale at 3 months 

9.0 ± 0.7 9.0 ± 0.7 0.0 (-0.4; 0.4) 

Tjandra, 2004803

N = 82 78% female 

PTP injection into intersphincteric space and internal anal sphincter with guidance by endoanal ultrasound 

PTP injection into intersphincteric space and internal anal sphincter without guidance by endoanal ultrasound Fecal incontinence 

quality of life index at 6 months 

3.7 ± 0.4 3.1 ± 0.8 0.9 (0.5; 1.4) 

Cleveland Clinic Scoring for fecal incontinence 

O'Brien, 2004 4.8 ± 4.0 14.3 ± 4.6 -2.2 (-3.6; -0.8) 

804

N = 14 93% female 

Placement of the artificial bowel sphincter activated at 6 weeks after surgery. 

Usual supportive care: physiotherapy, pelvic floor exercise, dietary advice. 

American Medical Systems quality of life questionnaire specialized on Fecal incontinence 

82.7 ± 14.0 54.7 ± 26.0 1.3 (0.2; 2.5) 

Bold- significant difference in outcomes at 95%confidence level 
F828 

Table F204. Comparative effectiveness of surgical interventions on anal sphincter to prevent perceived progression of fecal inc

(self-reported severity scores and instrumental outcomes) 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

% 

Maximum resting pressure (cm/H2O) 

48.0 ± 16.0 56.0 ± 48.0 -0.2 (-0.7; 0.3) 

Maximum squeezing pressure (cm/H2O) 

136.0 ± 149.3 120.0 ± 160.0 0.1 (-0.4; 0.6) 

Rectal capacity and first sensation: Functional capacity (cm 3 air) 

140.0 ± 213.3 120.0 ± 253.3 0.1 (-0.4; 0.6) 

Rectal capacity (cm 3 air) 

230.0 ± 220.0 280.0 ± 280.0 -0.2 (-0.7; 0.3) 

Rectal capacity and first sensation: slow waves,% 

160.0 ± 0.0 14.0 ± 52.0 

Parellada, 2004798N = 63 96% female 

Surgical: open lateral internal sphincterotomy and mucose closure with chromic catgut. 

Chemical: local 0.2% isosorbide dinitrate - peasize quantity applied manually at the entrance of the anus, 3 times/day immediately after a warm sitz bath, for 6 weeks. 

Rectal capacity and first sensation: ultra-slow waves, % 

30.0 ± 0.0 3.0 ± 11.0 

Maximum resting pressure (cm/H2O) at 1 year 

40.0 ± 32.7 49.5 ± 38.7 -0.3 (-0.7; 0.2) 

Maximum squeeze pressure (cm/H2O) at 1 year 

59.0 ± 60.7 75.5 ± 62.0 -0.3 (-0.7; 0.2) 

Resting pressure (cm/H2O) at 1 year 

44.0 ± 44.0 35.0 ± 32.7 0.2 (-0.2; 0.7) 

Squeeze pressure (cmH2O) 

90.0 ± 60.0 89.0 ± 66.7 0.0 (-0.5; 0.5) 

High-pressure zone (cm) at 1 year 

3.0 ± 0.7 3.0 ± 0.7 0.0 (-0.5; 0.5) 0

Rectoanal inhibitory reflex (cm/H2O) 

20.0 ± 20.0 25.0 ± 6.7 -0.3 (-0.8; 0.1) 

Osterberg, 2004802N = 70 90% female 

Anterior levatorplasty with mobilization of external sphincter 

Anal (and vaginal in women) plug electrostimulation of the pelvic floor with stimulation frequency was 25Hz and the duration 1.5 seconds, with a pulse-train interval of 3 seconds. 

Rectal compliance (ml per 40 cm/H2O) at 1 year 

160.0 ± 56.7 159.5 ± 74.0 0.0 (-0.5; 0.5) 
Table F204. Comparative effectiveness of surgical interventions on anal sphincter to prevent perceived progression of fecal inc

(self-reported severity scores and instrumental outcomes) (continued) 

F829 

Author 

Sample 

Active 

Treatment 

Control 

Treatment Outcome 

Mean 

± STD 

After Active 

Treatment 

Mean 

± STD 

After Control 

Treatment 

Mean 

Difference 

(95% CI) 

% 

Maximum resting pressure (mm/Hg) at 6 months 

Tjandra, 2004 38.0 

± 12.4 35.0 

± 6.5 0.3 (-0.1; 0.7) 

803

N = 82 78% female 

PTP injection into intersphincteric space and internal anal sphincter with guidance by endoanal ultrasound 

PTP injection into intersphincteric space and internal anal sphincter without guidance by endoanal ultrasound 

Maximum squeeze pressure (mm/Hg) at 6 months 

116.0 

± 21.7 121.0 

± 21.2 -0.2 (-0.7; 0.2) 

Conventional cutting seton 

Mean resting anal pressure, mm/Hg 

106.1 

± 3.8 80.0 

± 16.1 2.3 (1.4; 3.2) 

high pressure zone, length, mm 

21.1 

± 6.0 17.0 

± 5.0 0.7 (0.0; 1.4) 

Asymmetry, % 29.9 

± 1.0 39.0 

± 7.1 -1.9 (-2.7;-1.0) 

Mean resting vector volume 

37,800.7 

±

8,010.0 

25,099.9 

±

8,112.9 

1.6 (0.8; 2.4) 

Mean squeeze pressure, mm/Hg 

120.7 

± 20.0 104.0 

± 9.1 1.1 (0.3; 1.8) 

Squeeze manometric parameters: high pressure zone length, mm 

26.1 

± 11.0 21.3 

± 5.0 0.6 (-0.1; 1.2) 

Squeeze manometric parameters: asymmetry, % 

31.1 

± 5.0 34.0 

± 11.1 -0.3 (-1.0; 0.3) 

Zbar, 2003801

N = 34 26% female 

Modified cutting seton, which repaired the internal anal sphincter muscle and rerouted the seton through the intersphincteric space. 

Conventional cutting seton 

Squeeze manometric parameters: mean squeeze vector volume 

50,224.2 

±

17,001.4 

53,806.7 

±

9,108.8 

-0.3 (-0.9; 0.4) 

Bold- significant difference in outcomes at 95%confidence level 
F830 

Table F205. Fecal continence and pad use of 1,85 patients operated on for chronic ulcerative colitis at 1, 5, 10, 15,and 20 years 

Years of followup 1 Year 5 Years 10 Years 15 Years 20 Years 

Fecal continence daytime, % 71 70 60 59 59 Fecal continence night time, % 43 40 33 25 32 Pad use, % 34 29 31 43 50 
F831 

 Table F206.Functional outcome of 1,885 patients operated on for chronic ulcerative colitis by time period of operation824

 1981-1985 1986-1990 1991-1995 1996-2000 

Number of patients 431 557 470 427 Mean age at surgery (years) 31·2 33·7 35·4 36·3 Mean followup (years) 16·8 13·1 8·8 5·0 Mean stool frequency after ileal pouch-anal anastomosis 

Per day 6·4 6·1 6·2 6·4 Per night 2·1 2·0 2·0 2·1 

Incontinence during day (%) 

Never 57 54 64 70 Occasional 31 35 26 21 Frequent 11 11 10 9 

Incontinence during night (%) 

Never 30 29 34 37 Occasional 48 48 48 41 Frequent 21 23 18 22 

Stool consistency (% of patients) 

Liquid 12 11 12 12 Semi liquid 70 72 70 69 Solid 18 17 17 19 

Can distinguish gas from stool (%) 77 74 67 67 Pad use (%) 46 44 39 44 Medication use (%) 50 45 43 51 
F832 

Table F207. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (self-reported sever

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ± STD 

After Active 

Treatment 

Mean ±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% )CI) 

Number of fecal urgency episodes 

Furst, 2003 3.5 ± 2.3 2.0 ± 2.8 0.6 (0.0; 1.

814

N = 40 32% female 

5cm colonic J-pouch constructed with a linear stapler 

8cm coloplasty pouch sutures horizontally with minimal extension effect. 

Self-reported number of straining episodes 

4.5 ± 2.8 5.0 ± 1.5 -0.2 (-0.8; 0

Hallbook, 1996808N = 100 45% female 

Low anterior resection with total mesorectal excision with straight anastomosis 6 to 8cm in length. 

Low anterior resection with total mesorectal excision colonic J pouch anastomosis 6 to 8cm in length. 

Composite score of incontinence, 0-18 

5.0 ± 2.7 2.0 ± 2.2 1.2 (0.8; 1.

European Organization for Research and Treatment of Cancer, Defecation or stoma scores, 100-poor quality 

23.0 ± 21.0 26.0 ±

19.0 

-0.1 (-0.6; 0

Disease-specific scale (EORTC QLQ-CR38) scales: 0-36 (perfect continence) 

32.0 ± 6.0 32.0 ± 3.0 0.0 (-0.5; 0.

Urge to defecate, 0-36 (perfect continence) 

1.9 ± 0.2 2.0 ± 0.1 -0.6 (-1.1; -0

Fecal incontinence, 0-36 (perfect continence) 

4.8 ± 1.9 4.8 ± 1.5 0.0 (-0.5; 0.

Sailer, 2002816

N = 64 38% female 

Total mesorectal excision and coloanal J pouch anastomosis by folding the descending colon to the form of a `J', 5 ± 6cm in length. 

Total mesorectal excision and straight anastomosis with descending colon anastomosed in endto-end fashion to the anal canal. 

Anal incontinence to gas, 0-36 (perfect continence) 

5.3 ± 1.7 5.2 ± 1.4 0.1 (-0.4; 0.
Table F207. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (self-reported sever

F833 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean 

± STD 

After Active 

Treatment 

Mean 

±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% )CI) 

Ho, 2001806

N = 42 60% female 

Standardized ultra-low anterior resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6cm in length 

Standardized ultralow anterior resection with straight coloanal anastomosis, the descending colon was anastomosed to the anorectal stump 

Fecal continence Wexner scale from 0 - continence to 24 – complete incontinence. 

0.4 

± 0.3 0.1 

± 0.1 1.3 (0.5; 2.

Self-reported fecal continence scores 

Ho, 2002 1.3 

± 2.7 3.2 

± 8.0 -0.3 (-0.7; 0

809

N = 88 40% female 

Standardized total mesorectal excision with at least 2 cm of distal tumor clearance. J-pouch was constructed from descending colon 6cm in length using an Autosuture ILA 75 linear cutting stapler. 

Standardized total mesorectal excision with at least 2cm of distal tumor clearance. Coloplasty pouch was anastomosed to stapled anorectal stump. 

Fecal incontinence specific quality of life scoring: lifestyle 

3.5 

± 1.3 3.0 

± 2.0 0.3 (-0.1; 0.

Number of fecal urgency episodes 

2.6 

± 1.7 3.6 

± 1.2 -0.7 (-1.2; -0

Number of incomplete evacuations 

4.3 

± 1.3 5.0 

± 1.2 -0.6 (-1.1; -0

Furst, 2002818

N = 74 26% female 

The standardized total mesorectal excision with preaortal lymph node dissection, autonomic nerve preservation, and short (5cm) colonic J-pouch anastomosis. 

The standardized total mesorectal excision with preaortal lymph node dissection, autonomic nerve preservation, and straight coloanal anastomosis. 

Number of straining episodes 

4.8 

± 1.5 3.0 

± 1.4 1.3 (0.8; 1.

Fecal Incontinence Severity Index (FISI) 

Park, 2005 18.6 

± 2.0 27.7 

± 2.0 -4.6 (-5.6; -3

825

N = 50 22% female 

Ultralow anterior resection including upper sphincter excision colonic Jpouch anastomosis with a temporary diverting-loop ileostomy 

Ultralow anterior resection including upper sphincter excision with a straight anastomosis and temporary diverting-loop ileostomy. 

Fecal Incontinence Quality of Life (FIQL) scale, lifestyle 

3.4 

± 1.0 2.7 

± 1.0 0.7 (0.1; 1.

Combined functional bowel rank scores 

Machado, 33.0 

± 6.0 37.6 

± 9.6 -0.6 (-1.1; -0

2005810N = 71 22% female 

Low anterior resection and total mesorectal excision with a colonic J-pouch anastomosis 

Low anterior resection and total mesorectal excision with a colonic Jpouch or a side-toend anastomosis. Fecal incontinence scores (0-18) 5.0 

± 1.3 6.0 

± 1.3 -0.8 (-1.2; -0
Table F207. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (self-reported sever

F834 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean 

± STD 

After Active 

Treatment 

Mean 

±

STD After 

Control 

Treatment 

Mean 

Difference 

(95% )CI) 

Number of stools/night 

0.0 

± 0.0 0.3 

± 0.1 

Fecal continence 

Laurent, 2005811

N = 37 19% female 

Total mesorectal excision and hand sewn colonic J-pouchanal anastomosis (6cm) 

Total mesorectal excision and stapled colonic J-pouch-anal anastomosis (6cm) using PI-30 stapling instrument 

Cleveland Clinic Fecal Incontinence Score 

0.6 

± 3.6 1.0 

± 5.3 -0.1 (-0.7; 0

Patients with ulcerative colitis 

Number of stools at night 

Reilly, 1997 1.0 

± 1.0 2.0 

± 2.0 -0.6 (-1.3; 0

820

N = 41 34% female 

Abdominal colectomy excising anal transition zone and hand sewing the pouch to the anal canal (Ileal Pouch-Anal Anastomosis) 

Abdominal colectomy preserving anal transition zone and double stapling the pouch to the anal canal (Ileal PouchAnal Anastomosis) 

Quality of life scores: 1-severely restricted performance to 5-improved performance. 

3.6 

± 1.3 3.2 

± 1.6 0.3 (-0.4; 1.

Self-reported number of bowel evacuations at 1 month 

Oresland, 7.1 

± 1.7 7.0 

± 2.3 0.0 (-0.6; 0.

1988823N = 40 50% female 

Anal balloon dilatation with step-wise increasing pressure (5-80cm/H20), distention ~60 seconds for 50-60 minutes. 

Sphincter training with visual feedback for 50-60 minutes daily. 

Self-reported number of bowel evacuations at 6 months 

4.9 

± 1.6 5.4 

± 1.8 -0.3 (-0.9; 0

Patients with sphincteric trauma Hasegawa, 2000815N = 27 96% female 

Fecal diversion with defunctioning stoma (closed at 4 months after surgery) for sphincter repair with standard overlapping technique 

Sphincter repair with standard overlapping technique with no stoma 

Cleveland Clinic Scoring System (0 - perfect continence to 20 - complete incontinence). 

7.8 

± 5.5 9.6 

± 6.8 -0.3 (-1.0; 0

Bold- significant difference in outcomes at 95%confidence level 
F835 

Table F208. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (instrumental outco

Author 

Sample Active Treatment Control Treatment Outcome 

Mean ±

After Active 

Treatment 

Mean ± STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Resting pressure, mm/Hg 

45.0 ± 9.0 46.0 ± 15.0 -0.1 (-0.7; 0.5) 

Squeeze pressure, mm/Hg 

219.0 ±

100.0 

216.0 ± 86.0 0.0 (-0.6; 0.7) 

Rectal threshold volume, ml 

46.0 ± 13.0 36.0 ± 28.0 0.5 (-0.2; 1.1) 

Furst, 2003814

N = 40 32% female 

5cm colonic J-pouch constructed with a linear stapler 

8cm coloplasty pouch sutures horizontally with minimal extension effect. 

Maximum rectal volume, ml 

89.0 ± 18.0 77.0 ± 21.0 0.6 (0.0; 1.2) 

Duplicated (J) pelvic ileal reservoirs in restorative proctocolectomy constructed with 30cm of ileum 

Quadruplicated (W) reservoir pelvic ileal reservoirs in restorative proctocolectomy, constructed with 30cm of ileum 

Maximum resting anal pressures 

Johnston, 58.0 ± 21.3 57.0 ± 4.7 0.1 (-0.4; 0.6) 1996821N = 60 57% female 

Duplicated (J) pelvic ileal reservoirs in restorative proctocolectomy constructed with 40cm of ileum 

Quadruplicated (W) reservoir pelvic ileal reservoirs in restorative proctocolectomy, constructed with 40cm of ileum 

Maximum resting anal pressure, mmH20 

71.0 ± 11.3 73.0 ± 5.3 -0.2 (-0.7; 0.3) 

Maximum tolerated anal volume, ml 

292.3 ± 68.8 334.2 ± 79.7 -0.6 (-1.4; 0.3) 

Maximum anal resting pressure, mm/Hg 

64.7 ± 16.5 64.8 ± 16.4 0.0 (-0.8; 0.8) 

Selvaggi, 2000822N = 24 58% female 

Ileal pouch-anal anastomosis including total colectomy, total rectal excision, and two-limb J reservoir 

Ileal pouch-anal anastomosis including total colectomy, total rectal excision, and four-limb W reservoir 

Maximum voluntary contraction, mm/Hg 

159.1 ± 37.3 159.6 ± 29.8 0.0 (-0.8; 0.8) 
Table F208. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (instrumental outco

F836 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean 

±

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Maximum resting pressure, H20 

Hasegawa, 67.3 

± 28.9 71.3 

± 12.1 -0.2 (-0.9; 0.6) 

2000815N = 27 96% female 

Fecal diversion with defunctioning stoma (closed at 4 months after surgery) for sphincter repair with standard overlapping technique 

Sphincter repair with standard overlapping technique with no stoma Maximum 

squeezing pressure, H20 

106.4 

± 29.9 100.7 

± 24.1 0.2 (-0.5; 1.0) 

Resting anal pressure anal pressure (mm/Hg) 

55.0 

± 23.0 68.0 

± 36.0 -0.4 (-0.9; 0.1) 

Squeeze pressure (mm/Hg) 

116.0 

± 47.0 109.0 

± 74.0 0.1 (-0.4; 0.6) 

Sailer, 2002816

N = 64 38% female 

Total mesorectal excision and coloanal J pouch anastomosis by folding the descending colon to the form of a `J', 5 ± 6cm in length. 

Total mesorectal excision and straight anastomosis with descending colon anastomosed in endto-end fashion to the anal canal. 

Rectal compliance (ml/mm/Hg) 

3.1 

± 1.4 3.1 

± 1.8 0.0 (-0.5; 0.5) 

Change from baseline in mean resting anal pressure (mm/Hg) 

23.7 

± 7.8 16.5 

± 8.3 0.9 (0.2; 1.6) 

Change from baseline in maximum anal squeeze pressure (mm/Hg) 

80.7 

± 35.0 102.4 

± 31.7 -0.7 (-1.3; 0.0) 

Change from baseline in rectal volume of initial sensation: barostat phasic program (ml) 

24.8 

± 14.8 13.5 

± 23.8 0.6 (-0.1; 1.2) 

Ho, 2001806

N = 42 60% female 

Standardized ultralow anterior resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6cm in length 

Standardized ultralow anterior resection with straight coloanal anastomosis, the descending colon was anastomosed to the anorectal stump 

Change from baseline in rectal compliance: barostat (ml/mm/Hg) 

-7.1 

± 5.9 -14.0 

± 6.2 1.1 (0.4; 1.9) 
Table F208. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (instrumental outco

F837 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean 

±

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Change from baseline in rectosphincteric inhibitory reflex, % 

50.0 52.6 

Mean resting anal pressure, mm/Hg 

31.1 

± 15.2 32.3 

± 9.8 -0.1 (-1.2; 1.0) 

Maximum anal squeeze pressure, mm/Hg 

182.0 

± 87.0 159.0 

± 73.7 0.3 (-0.9; 1.4) 

Volume of initial rectal urge, ml 

42.7 

± 76.9 30.3 

± 56.6 0.2 (-1.0; 1.3) 

Maximum tolerable rectal volume, ml 

51.3 

± 118.3 43.0 

± 46.3 0.1 (-1.0; 1.2) 

Ho, 2002817

N = 12 17% female 

Standardized ultralow anterior resection with J pouch anastomosis by folding the descending colon to the form of a `J', 6cm in length 

Standardized ultralow anterior resection with straight coloanal anastomosis. Descending colon was anastomosed to the anorectal stump 

Rectal compliance, ml/mm/Hg 

1.8 

± 1.7 1.2 

± 2.2 0.3 (-0.8; 1.4) 

Fecal urge: stool deferment time (minutes) 

16.1 

± 17.2 16.3 

± 23.2 0.0 (-0.4; 0.4) 

Mean resting anal pressure (mm/Hg) 

50.4 

± 29.8 46.0 

± 33.8 0.1 (-0.3; 0.6) 

Maximum anal squeeze pressure (mm Hg) 

119.5 

± 58.3 122.2 

± 85.5 0.0 (-0.5; 0.4) 

Rectal volume of initial sensation (ml) 

59.7 

± 72.9 32.6 

± 75.6 0.4 (-0.1; 0.8) 

Maximum tolerable rectal volume (ml) 

108.3 

± 87.5 123.1 

±

214.8 

-0.1 (-0.5; 0.3) 

Ho, 2002809

N = 88 40% female 

Standardized total mesorectal excision with at least 2cm of distal tumor clearance. J-pouch was constructed from descending colon 6cm in length using an Autosuture ILA 75 linear cutting stapler. 

Standardized total mesorectal excision with at least 2cm of distal tumor clearance. Coloplasty pouch was anastomosed to stapled anorectal stump. 

Rectal compliance 

1.7 

± 2.7 3.1 

± 8.0 -0.2 (-0.7; 0.2) 
Table F208. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (instrumental outco

F838 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean 

±

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Internal anal sphincter thickness (mm) 

2.6 

± 11.9 2.3 

± 1.3 0.0 (-0.4; 0.5) 

External anal sphincter thickness (mm) 

7.7 

± 5.3 9.8 

± 6.6 -0.3 (-0.8; 0.1) 

Resting anal pressure, mm/Hg 

57.0 

± 23.0 57.0 

± 17.0 0.0 (-0.5; 0.5) 

Squeeze pressure, mm/Hg 

181.0 

± 65.0 215.0 

±

71.0 

-0.5 (-1.0; 0.0) 

Neorectal sensation, ml 

40.0 

± 20.0 33.0 

± 20.0 0.4 (-0.1; 0.8) 

Furst, 2002818

N = 74 26% female 

The standardized total mesorectal excision with preaortal lymph node dissection, autonomic nerve preservation, and short (5cm) colonic J-pouch anastomosis. 

The standardized total mesorectal excision with preaortal lymph node dissection, autonomic nerve preservation, and straight coloanal anastomosis. Maximal 

neorectal volume, ml 

107.0 

± 42.0 120.0 

± 60.0 -0.3 (-0.7; 0.2) 

Anal resting pressure, mm/Hg 

42.0 

± 15.3 47.0 

± 10.7 -0.4 (-0.8; 0.1) 

Resting pressure volume, mm Hg2cm 

12,722.0 

±

8,110.7 

11,342.0 

±

8,508.7 

0.2 (-0.3; 0.6) 

Anal squeeze pressure, mm/Hg 

106.0 

± 16.7 106.0 

± 14.0 0.0 (-0.5; 0.5) 

Squeeze pressure volume, mm Hg2cm 

48,765.0 

±

43,961.3 

55,650.0 

±

26,946.0 

-0.2 (-0.7; 0.3) 

Maximum neorectal volume, ml 

178.0 

± 32.0 126.0 

± 16.0 2.0 (1.5; 2.6) 

Neorectal compliance 

4.2 

± 0.8 3.2 

± 0.7 1.4 (0.8; 1.9) 

Machado, 2005810N = 71 22% female 

Low anterior resection and total mesorectal excision with a colonic Jpouch anastomosis 

Low anterior resection and total mesorectal excision with a colonic Jpouch or a side-toend anastomosis. 

Neorectal mobility 

8.0 

± 4.7 13.0 

± 4.0 -1.1 (-1.7; -0.6) 
Table F208. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (instrumental outco

F839 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean 

±

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Neorectal sensitivity, mm/Hg, initial sensation 

10.0 

± 0.8 10.0 

± 3.3 0.0 (-0.5; 0.5) 

Neorectal sensitivity, mm/Hg, urge 

15.0 

± 3.3 20.0 

± 0.0 

Side-to-end anastomosis after low anterior resection 

Colonic J-pouch reconstruction after low anterior resection 

maximal resting pressure 

63.3

±23.0 54.0

±24.5 0.4(-0.2;1.0) 

Side-to-end anastomosis after low anterior resection 

Colonic J-pouch reconstruction after low anterior resection 

maximal contraction pressure 

207.1

±104.3 148.5

±66.6 0.7(0.1;1.3) 

Side-to-end anastomosis after low anterior resection 

Colonic J-pouch reconstruction after low anterior resection 

squeeze pressure 

143.8

±95.0 94.4

±58.8 0.6(0.0;1.2) 

Jiang, 2005819

N=44 48% female 

Side-to-end anastomosis after low anterior resection 

Colonic J-pouch reconstruction after low anterior resection 

Continence 1.3

±1.0 1.3

±1.0 0.0(-0.6;0.6) 

Patients with ulcerative colitis 

Maximum resting pressure (mm/Hg) 

49.4 

± 18.5 78.3 

± 24.5 -1.3 (-2.1; -0.5) 

Maximum average squeeze pressure (mm/Hg) 

144.0 

± 44.1 195.0 

± 63.5 -0.9 (-1.7; -0.2) 

Scintigraphic outcome: rest 

116.0 

± 14.3 119.0 

± 21.7 -0.2 (-0.9; 0.5) 

Reilly, 1997820N = 41 34% female 

Abdominal colectomy excising anal transition zone and hand sewing the pouch to the anal canal (Ileal PouchAnal Anastomosis) 

Abdominal colectomy preserving anal transition zone and double stapling the pouch to the anal canal (Ileal PouchAnal Anastomosis) 

Scintigraphic outcome: squeeze 

130.0 

± 14.0 135.0 

± 19.3 -0.3 (-1.0; 0.4) 
Table F208. Comparative effectiveness of surgical interventions (diversion) on fecal incontinence in adults (instrumental outco

F840 

Author 

Sample Active Treatment Control Treatment Outcome 

Mean 

±

After Active 

Treatment 

Mean 

± STD 

After 

Control 

Treatment 

Mean 

Difference 

(95% CI) 

Scintigraphic outcome: perineal descent (cm) 

60.0 

± 19.8 56.1 

± 18.0 0.2 (-0.5; 0.9) 

Pudendal nerve terminal motor latency (ms), right 

1.9 

± 0.4 2.1 

± 1.2 -0.2 (-0.9; 0.5) 

Pudendal nerve terminal motor latency (ms), left 

1.9 

± 0.3 1.5 

± 0.6 0.7 (0.0; 1.4) 

Maximum resting anal pressure, mm/Hg 

56.0 

± 13.0 40.0 

± 6.0 1.6 (0.5; 2.7) 

Volume to first sensation, ml 

115.0 

± 32.0 143.0 

± 23.0 -1.0 (-2.0; 0.0) 

Volume at first leak, ml 

467.0 

± 187.0 383.0 

± 185.0 0.5 (-0.5; 1.4) 

McKee, 1992813

N = 18 50% female 

Abdominal rectopexy without zigmoidectomy 

Abdominal rectopexy with zigmoidectomy of redundant sigmoid colon and end-toend anastomosis of colon and rectum made in pelvic brim 

Rectal compliance, mm/Hg 

0.2 

± 0.0 0.1 

± 0.0 7.0 (4.4; 9.6) 

Oresland, 1988823N = 40 50% female 

Anal balloon dilatation with stepwise increasing pressure (5-80cm/H20), distention ~60 seconds for 50-60 minutes. 

Sphincter training with visual feedback for 50-60 minutes daily. 

Resting anal pressure at 1 year, mm/Hg 

56.0 

± 17.0 50.0 

± 15.0 0.4 (-0.3; 1.0) 

Bold- significant difference in outcomes at 95%confidence level 
F841 

Table F209 Evidence tables of diagnostic values of the tests to identify UI and FI in adults .

Author, Year, 

Study Design 

Level of 

Evidence 

Settings 

Purpose/Aim of Study 

Population: 

Subject Age, 

Gender, Race, 

Ethnicity, 

Residency 

Urodynamic Criteria of UI 

Definition of Incontinence, 

De Muylder, 

1992826

Prospective Observational II-2 Community 

To evaluate diagnostic value of careful history taking compared to urodynamic evaluation in the diagnosis of female patients with micturition disorders 

408 women with symptoms of UI, 18-78 years old; 202 postmenopausal 

ICS. A UD diagnosis of detrusor instability was made if urethrocystometry demonstrated a rise in true detrusor pressure of 15cm water or more. A diagnosis of detrusoinstability was also made if a true detrusor rise of more 5cm water was associated with urethral relaxation and incontinence. Genuine stress incontinence was diagnoswhen UI occurred in the absence of a detrusor contractassociated with a rise in intra-abdominal pressure. 

Cundiff, 1997827

Retrospective Observational II-2 Community 

To characterize historic and clinical parameters in incontinent women to determine the predictive value for urodynamic diagnoses 

535 Women Mean age: 55.7 Range:21-95 SD:13.5 USA 

Occurrence of UI coincident with coughing, sneezing, lifand walking was recorded as symptoms of stress urinarincontinence. UI occurring with symptoms of urgency wdocumented as urge urinary incontinence. ICS 

Holtedahl, 

2000828

RCT I Community 

To test the usefulness of urodynamic examination in female urinary incontinence 

698 Women Age range: 50-74 Norway 

ICS. Leakage was objectively demonstrated in at least othree ways: visible leakage on coughing during the gynecological examination; a positive 48 hour pad test; recording of “wet” on a 48 hour frequency/volume chartdiagnoses were based on both symptoms and signs: USwhen there was a positive stress test with pad weight inand/or negative maximal urethral closure pressure on coughing; UUI when there was leakage together with murgency in the form of detrusor contractions associated strong desire to void during the filling phase (definite urgwhen there were signs of sensory urgency (such as a subjective maximal capacity <400ml and/or >7 voids/24 as shown in the frequency/volume chart brought along bwoman) associated with a history of involuntary leakage together with a strong desire to void (presumed urge); Mincontinence if criteria of stress as well as urge were fulmaximal urethral closing pressure of <25cm/H2O when patient was resting was interpreted as a sign of urethral insufficiency, although there is no precise cut-off for this condition. 

Yalcin, 2004829

RCT I Community 

To assess the accuracy with which a clinical diagnostic algorithm for SUI based on symptoms and signs without including urodynamics predicted the observation of 

1,455 women Mean age: 51.3 Range: 28-81.7 SD: 11.2 USA 

Subjects must have reported a predominant symptom owith a weekly incontinent episode frequency ≥4 in the P

study and an incontinent episode frequency of ≥7 in 2 Pstudies, in which an episode was defined as easily noticurine leakage that wet a pad or clothing and occurred w
Table F209 Evidence tables of diagnostic values of the tests to identify UI and FI in adults (clinical history vs. multi channel uro

F842 

Author, Year, 

Study Design 

Level of 

Evidence 

Settings 

Purpose/Aim of Study 

Population: 

Subject Age, 

Gender, Race, 

Ethnicity, 

Residency 

Urodynamic Criteria of UI 

Definition of Incontinence, 

urodynamic SUI and the condition of SUI 

physical stress such as coughing, sneezing or exercisinICS 

Diokno, 1987830

Prospective Observational II-2 Community 

To characterize urinary incontinence observed in elderly women and to assess the importance of various parameters used to evaluate urinary incontinence 

200 women Mean: 68.5 Range age: 55-90 SD:8.6 USA 

A clinical diagnosis of SUI was made when patient descloss of urine while straining, coughing, bending over, anprovided objective evidence of stress loss during the ph

exam. The loss of urine was clinically considered UUI wfollowed an immediate toilet need and nocturia of three more times was reported. ICS 

Diokno, 1990831

RCTI Community 

To determine the value of various tests used to evaluate UI 

456 women Age range:60-86 USA 

SUI when urine loss was associated with physical exertUUI when urine loss was preceded by an urge to void. A diagnosis of incompetent urethral sphincter was made wof the 3 findings was observed: Positive stress test, posurine loss on stress cystography, positive findings on dy

urethral profilometry. A diagnosis of competent urethral sphincter made if none of the criteria was satisfied, 

Fitzgerald, 

2002832

CT II-1 Community 

To determine whether scores on two validated urinary incontinence symptom scales predicted eventual urodynamic diagnoses. 

293 women Mean age: 57 Range: 15-87 USA 

ICS 

Ishiko, 2000833

CT II-1 Community 

Purpose was to determine whether the urinary incontinence (UI) score is significantly useful in evaluating the clinical status of UI 

198 women Mean age: 59.1 Range: 27-73 SD: 12.2 Japan 

Gaudenz questionnaire partially modified to make it mosuitable for a Japanese population was used in this studconsisted of 15 questions. The answers to each questioassigned a certain number of points, and depending on answer, included in the stress-score s-s or urge-score utotal s-s and u-s points were added up separately, and a diagnosis was made based on the zones into which eacthe scores fell. ICS 

Korda, 1987834CT II-1 Community 

To evaluate the diagnostic potential of careful history taking 

566 women Mean age: 49 Australia 

ICS 

Kujansuu, 

1982835

Prospective Observational II-2 

To evaluate the diagnostic accuracy of a scored urological questionnaire in the differential diagnosis of female urinary incontinence 

121 women 
Table F209 Evidence tables of diagnostic values of the tests to identify UI and FI in adults (clinical history vs. multi channel uro

F843 

Author, Year, 

Study Design 

Level of 

Evidence 

Settings 

Purpose/Aim of Study 

Population: 

Subject Age, 

Gender, Race, 

Ethnicity, 

Residency 

Urodynamic Criteria of UI 

Definition of Incontinence, 

Lagro-janssen, 

1991836

CT II-1 Community 

To assess the diagnostic potential of the patient's medical history in distinguishing between genuine USI, detrusor instability and mixed incontinence in primary care. 

103 women Age range: 20-65 Netherlands 

Incontinence was defined as the involuntary loss of urinor more times a month. SUI is the loss of urine during coughing and /or sneezing. UUI is the involuntary loss oassociated with a strong desire to void. ICS 

Niecestro, 

1992837

Prospective Observational II-2 Community 

To evaluate the ability of stresscath to detect bladder neck incompetence in patients referred for urodynamics 

66 women USA 

Ouslander, 

1987838(Prospect

ive 

Observational II-2 Community 

To compare the clinical presentation of incontinence to diagnoses based on urological and urodynamic evaluation 

135 women Age >65years USA 

ICS 

Ramsay, 1993839

Retrospective Observational II-2 Community 

To define the symptomatology of those patients with detrusor instability, and those with genuine stress incontinence, looking particularly at the severity of urinary incontinence; and to devise a model to more accurately predict the diagnosis from the history alone. 

200 women Mean age: 50.3 SD: 11.15 UK 

Assessment of the severity made by asking 4 questions1. The frequency of urinary leakage (from 0 = never, 1 = <1/monthly, to 6 = ≥6/day) 

2. The severity of urinary leakage was assessed by degprotection required (ranging from 0 = none, 1 = minimal continuous sanitary protection) 3. The number of pads used per day 4. The social restriction their incontinence caused (this was graded 0 = none, 1 = restricted, and 2 = houseboun

Sand, 1988840

CT II-1 Community 

To assess the value of history in assessing in establishing the etiology of UI. 

218 women Mean age: 51.8 Range: 18-80 USA 

ICS 

Sandvik, 1995841

CT II-1 Community 

To validate simple diagnostic questions concerning female urinary incontinence, for the subsequent implementation in an epidemiological survey. 

785 women Norway 

A positive answer to the following question was presumbe an indication of SUI: “Do you lose urine during suddephysical exertion, lifting, coughing or sneezing?’ UUI wapresumed to be indicated by a positive answer to the qu“Do you experience such a strong and sudden urge to vthat you leak before reaching the toilet?” A positive answboth questions was registered as mixed incontinence. ICS 

Sunshine842 Clinical correlation of urodynamic 

testing in patients with UI 

109 
Table F209 Evidence tables of diagnostic values of the tests to identify UI and FI in adults (clinical history vs. multi channel uro

F844 

Author, Year, 

Study Design 

Level of 

Evidence 

Settings 

Purpose/Aim of Study 

Population: 

Subject Age, 

Gender, Race, 

Ethnicity, 

Residency 

Urodynamic Criteria of UI 

Definition of Incontinence, 

Cantor, 1980843

Prospective Observational II-2 

 214 women 

Weidner, 2001844

Prospective Observational II-2 Community 

To determine the predictive value of the symptom of stress urinary incontinence and to evaluate the ability of other factors suggested by a published Agency for Health Care Policy and Research guideline for the discrimination of patients unlikely to require urodynamic testing before surgical management 

950 women Mean age: 55.8 SD: 13.3 USA 

The diagnosis of genuine SUI was made if the subject hsymptom of stress incontinence and had observable leaproduced by stress without concurrently demonstrable detrusor activity during urethrocystometry or urethral profilometry or had a positive result of a direct visualizattest immediately after the catheters were removed in the absence of detrusor instability during previous urethrocystometry. The diagnosis of detrusor instability made if the subject had a detrusor contraction in associwith urgency and leakage. The diagnosis of intrinsic sphincteric deficiency was made on the basis of combinhistorical, physical, urodynamic, and endoscopic param16. ICS 

Bergman, 1990845

Prospective Observational II-2 Community 

To evaluate prospectively the reliability of the history in the evaluation of female UI 

154 women Mean age: 48.7 France 

Genuine SUI was urodynamically diagnosed when there visible loss of urine during coughing with pressure equabetween bladder and urethra and in the absence of bladcontraction. ICS 

Le Coutour, 

1990846

Prospective Observational II-2  Community 

To assess the diagnostic value of history and UD investigation in female urinary incontinence 

113 women Mean age: 50 Sweden 

Petros, 1992847Retrospective Observational II-2 Community 

To test the proposition that the history of urge UI was accurate, by direct observation of events occurring during a provocative hand washing test. 

Age range: 35-71 ICS 

van Waalwijk van 

Doorn, 1997848

Prospective Observational II-2  Community 

To investigate the usefulness of ambulatory UD to quantify detrusor activity, and develop a parameter to quantify the grade of detrusor overactivity. 

228 women Mean age:44.4 Range: 9-75 Netherlands 

 ICS 
Table F209 Evidence tables of diagnostic values of the tests to identify UI and FI in adults (clinical history vs. multi channel uro

F845 

Author, Year, 

Study Design 

Level of 

Evidence 

Settings 

Purpose/Aim of Study 

Population: 

Subject Age, 

Gender, Race, 

Ethnicity, 

Residency 

Urodynamic Criteria of UI 

Definition of Incontinence, 

Ficazzola, 

1998849

Prospective/Obse

rvational 

II-2 Community 

To determine the incidence of intrinsic sphincter deficiency and bladder dysfunction, and the contribution of each to incontinence. 

60 men Mean age: 64.8 Range: 48-73 USA 

Detrusor instability was defined as any involuntary bladdcontraction of 15 cm. water, according to the InternationContinence Society, or involuntary contraction of any magnitude associated with urge. ICS 

Ding, 1997850

Prospective/Obse

rvational 

II-2 

To study the usefulness of lower urinary tract symptoms and postvoid residual urine volume in the diagnosis of voiding dysfunction in elderly men 

126 men 

Porru, 1994851

Prospective/Obse

rvational 

II-2 Community 

To evaluate bladder behavior in patients with DI correlated incontinence and micturition disorders by performing both a conventional UD investigation and extramural ambulatory monitoring during normal daily activity. 

46 Men and women Mean age: 48.4 Range: 22-80 Italy 

ICS 

Digesu, 2003852

CT I 

To determine whether the urodynamic diagnosis is useful in the management of women with symptoms of an overactive bladder (OAB). 

4,500 women Mean age: 55.4 Range: 22-73 UK 

Genuine stress incontinence was classified as mild, moand severe if leakage of urine occurred following five, thone coughs, respectively. Detrusor instability was diagnosed when detrusor contra

were seen in the presence of urgency or urinary leakagattempting to inhibit micturition. ICS 

Clarke, 1997853 To characterize historic and clinical 

parameters in incontinent women to determine the predictive value for urodynamic diagnoses 

1,000 women Mean age: 53 Australia 

Kong, 1990854

Retrospective/Ob

servational 

II-2 

 269 women 

Mean age: 77 Range: 59-94 UK 
F846 

Table F210. Recommended questionnaires for UI and lower urinary tract symptoms/overactive bladder 

(adapted from the Symptom and Quality of Life Committee of the International Consultation on 

Incontinence)855

Combined symptoms and quality of life impact of UI 

Men and women International Consultation on Incontinence Questionnaire856

Bristol Female Lower Urinary Tract Symptoms Questionnaire-Short Form857 Women 

Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ)858

Men International Continence Society male questionnaire, short form859

Combined symptoms and quality of life of overactive bladder 

Men and women Overactive Bladder Questionnaire 860

UI symptoms 

Urogenital Distress Inventory861

Urogenital Distress Inventory-6862

Incontinence Severity Index863

Women 

Bristol Female Lower Urinary Tract Symptoms Questionnaire864

International Continence Society male, lower urinary tract symptoms primarily865 Men 

Danish Prostatic Symptom Score, lower urinary tract symptoms primarily866

Quality of life impact of UI 

Men and women Quality of Life in Persons with UI Questionnaire867

 Incontinence Classification System868

King’s Health Questionnaire869

Incontinence Impact Questionnaire870 

Incontinence Impact Questionnaire -7862

UI Severity Score (UISS)871,872

Women 

CONTILIFE—Urinary Incontinence-specific Measure of Quality of Life873

Men None 
F847 

Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence855

International Consultation on Incontinence Questionnaire856 

Consists of four questions and numeric scales: 

1. How often do you leak urine? (0-5); never - all the time 

2. How much urine do you usually leak? (0-6); none - large amount 

3. Overall, how much does leaking urine interfere with your everyday life? (0-10); not at all - a great deal 

4. When does urine leak? Multiple choices. 

ICIQ score is the sum of questions 1-3. 

Bristol Female Lower Urinary Tract Symptoms Questionnaire-short form857

BFLUTS questionnaire symptom items: numbers, labels, and response categories 

Question Symptom Response Categories 

1 +P Frequency (times daily) 1-6, 7-8, 9-10, 11-12, 13+ 

2 +P Nocturia 0, 1, 2, 3, 4+ 

3 +P Urgency Never, occasionally, sometimes, most of the time, all of the time 

4 +P Urge incontinence Never, occasionally, sometimes, most of the time, all of the time 

5 +P Bladder pain Never, occasionally, sometimes, most of the time, all of the time 

6 +P Frequency incontinence Never, ≤1/week, 2-3/week, 1/day, several times a day 

7 +P Stress incontinence Never, occasionally, sometimes, most of the time, all of the time 

8 +P Unpredictable miscellaneous 

incontinence 

Never, occasionally, sometimes, most of the time, all of the time 

9 Volume of leakage No leakage, drops/pants damp, dribble/pants wet, floods: soaking 

through to outer clothing, floods: running down 

12 +P Hesitancy Never, occasionally, sometimes, most of the time, all of the time 

13 +P Strain to start Never, occasionally, sometimes, most of the time, all of the time 

14 +P Intermittency Never, occasionally, sometimes, most of the time, all of the time 

15 +P Nocturnal incontinence Never, occasionally, sometimes, most of the time, all of the time 

16 +P Reduced stream Not reduced, reduced a little, quite reduced, reduced a great deal, 

no stream 

17 Acute retention No, yes once, yes twice, yes more than twice 

18 +P Burning Never, occasionally, sometimes, most of the time, all of the time 

19 +P Incomplete emptying Never, occasionally, sometimes, most of the time, all of the time 

20 Stopping flow Yes easily, yes with difficulty, no cannot stop the flowing 

25 +P Frequency (hours between voiding) Every 4 hours or more, every 3 hours, every 2 hours, hourly 

Sexual functioning 

21 +P Pain due to dry vagina Not at all, a little, somewhat, a lot 

22 +P Sex life spoiled Not at all, a little, somewhat, a lot 

23 +P Pain during intercourse Not at all, a little, somewhat, a lot 

24 +P Leakage during intercourse Not at all, a little, somewhat, a lot 

Quality of life 

10a Change underclothes/wear 

protection 

No, change underclothes, panty liners/mini pads, maxi/super 

sanitary towels, nappies/incontinence products 

10b Number of changes No change, 1, 2-3, 4-5, more than 5 times 

11 Change outer clothing Never, occasionally, sometimes, most of the time, all of the time 

26 +P Cut down fluid Never, occasionally, sometimes, most of the time, all of the time 

27 +P Affect daily tasks Never, occasionally, sometimes, most of the time, all of the time 

28 +P Avoidance of situations where no 

toilet 

Never, occasionally, sometimes, most of the time, all of the time 

29 +P Interfere with physical activity Never, occasionally, sometimes, most of the time, all of the time 

30 +P Interfere with social life Never, occasionally, sometimes, most of the time, all of the time 

31 Overall interference with life Never, occasionally, sometimes, most of the time, all of the time 

32 How long symptoms bothered <1 year, 1-2 years, 2-3 years, more than 3 years 

33 Spend rest of life with no change Perfectly happy, pleased, mostly satisfied, mixed feelings, mostly 

dissatisfied, very unhappy, desperate 

+P indicates a linked question on the degree of the problem caused. 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F848 

Confidential BFLUTS-SF Questionnaire 

We would like to find out about your urinary symptoms and we are very grateful that you can help us by filling in this 

questionnaire. Please answer each question, thinking about the symptoms you have experienced in the last month. 

You will see that some questions ask how often you have a symptom: 

Occasionally = less than one third of the time 

Sometimes = between one and two thirds of the time 

Most of the time = more than two thirds of the time 

Please put a tick in one box for each question □ 

F1 During the night, how many times do you have to get up to urinate, on average? 

None - 0 

1 - 1 

2 - 2 

3 - 3 

4 or more - 4 

F2 Do you have to rush to the toilet to urinate? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

F3 Do you have pain in your bladder? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

F4 How often do you pass urine during the day? 

Every 4 hours or more - 0 

Every 3 hours - 1 

Every 2 hours - 2 

Hourly - 3 

BFLUTS-FS: sum scores F1-F4 - - 

V1 Is there a delay before you can start to urinate? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

V2 Do you have to strain to urinate? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

V3 Do you stop and start more than once while you urinate? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

BFLUTS-VS: sum scores V1-V3 - - 

I1 Does urine leak before you can get to the toilet? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F849 

I2 How often do you leak urine? 

Never - 0 

Once or less per week - 1 

2-3 times per week - 2 

Once per day - 3 

Several times per day - 4 

I3 Does urine leak when you are physically active, exert yourself, cough, or sneeze? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

I4 Do you ever leak for no obvious reason and without feeling that you want to go? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

I5 Do you leak urine when you are asleep? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

BFLUTS-IS: sum scores 11-15 - - 

S1 To what extent do you feel that your sex life has been spoiled by your urinary symptoms? 

Not at all - 0 

A little - 1 

Somewhat - 2 

A lot - 3 

S2 Do you leak urine when you have sexual intercourse? 

Not at all - 0 

A little - 1 

Somewhat - 2 

A lot - 3 

BFLUTS-sex: sum scores S1 & S2 - - 

QoL1 Do you need to change your outer clothing during the day because of urine leakage? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

QoL2 Do you cut down on the amount of fluid you drink so that your urinary symptoms improve, and you can do the 

things that you want to do? 

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 

QoL3 To what extent have your urinary symptoms affected your ability to perform daily tasks (eg, cleaning, DIY, lifting 

objects)? 

Not at all - 0 

A little - 1 

Somewhat - 2 

A lot - 3 

QoL4 Do you avoid places and situations where you know a toilet is not nearby (eg, shopping, traveling, theater, church)?

Never - 0 

Occasionally - 1 

Sometimes - 2 

Most of the time - 3 

All of the time - 4 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F850 

QoL5 Overall, how much do your urinary symptoms interfere with your life? 

Not at all - 0 

A little - 1 

Somewhat - 2 

A lot - 3 

BFLUTS-QoL: Sum scores QoL1-QoL5 - - 

Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ)858

The Stress Incontinence Index consists of 9 questions on activities that cause leakage (when the woman coughs, 

sneezes, laughs, walks up or down stairs, rises from the bed, lifts heavy objects and during physical activity, sports 

and intercourse). 

- Frequency of stress incontinence episodes: never, 1-4 times a month, 1-6 times a week, once a day, and more 

than once daily) 

- Amount of leakage: nothing, drops/moist underwear, dripping/wet underwear, running/passes through all clothes, 

and running down the legs or down to the floor). 

The Urge Incontinence Index consists of two questions: how often and to what extent urge incontinence is 

experienced. 

The Quality of Life Index: (1) the number of incontinence diapers used (none, 1-3 per week, 4-6 per week, 1-4 per 

day, and more than 4 per day), (2) how often activities are avoided due to fear of leakage (never, seldom, sometimes, 

often, always), (3) how often places or situations are avoided due to fear of leakage (never, seldom, sometimes, 

often, always), and (4) how leakage influences holidays, family life, social life and sleep during the night. These last 

four questions are marked ‘yes’, ‘no’ or ‘not relevant’. Except for the first stress incontinence item, therefore, all items 

are expressed in a scale of five categories, with scores of 0-4. The nine questions from the first stress item have 

possible choices ‘yes’, ‘no’ and ‘not relevant’. The sum score from the nine stress incontinence questions are 

recalculated into five categories (0, 1-3, 4-5, 6-7 and 8-9) to give this item the same relative weight as the others. 

The International Continence Society male questionnaire, short form859

We would like to find out about your urinary symptoms and we are very grateful that you can help us by filling in this 

questionnaire. Please answer each question, thinking about the symptoms you have experienced in the last month. 

You will see that some questions ask how often you have a symptom: 

Occasionally - less than one-third of the time 

Sometimes - between one and two-thirds of the time 

Most of the time - more than two-thirds of the time 

Is there a delay before you can start to urinate? 

Do you have to strain to continue urinating? 

Would you say that the strength of your urinary stream is. . . 

normal 

occasionally reduced 

sometimes reduced 

reduced most of the time 

reduced all of the time 

Do you stop and start more than once while you urinate? 

How often do you feel that your bladder has not emptied properly after you have urinated? 

ICS male VS: sum scores V1–V5 

Do you have to rush to the toilet to urinate? 

Does urine leak before you can get to the toilet? 

Does urine leak when you cough or sneeze? 

Do you ever leak for no obvious reason and without feeling that you want to go? 

Do you leak urine when you are asleep? 

How often have you had a slight wetting of your pants a few minutes after you had finished urinating and had dressed yourself? 

ICS male IS: sum scores I1-I6 

Frequency 

How often do you pass urine during the day? 

hourly 

every 2 hours 

every 3 hours 

every 4 hours or more 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F851 

Nocturia During the night, how many times do you have to get up to urinate, on average? 

none 

one 

two 

three 

four or more 

QoL Overall, how much do your urinary symptoms interfere with your life? 

not at all 

a little 

somewhat 

a lot 

The International Continence Society male questionnaire, short form859

1 1P Frequency (times daily) 1-6, 7-8, 9-10, 11-12 1 131 

2 1P Nocturia 0, 1, 2, 3 1 41 

3 1P Urgency Never, occasionally, sometimes, most of time, all of time 

4 1P Urge incontinence Never, occasionally, sometimes, most of time, all of time 

5 1P Bladder pain Never, occasionally, sometimes, most of time, all of time 

6 1P Stress incontinence Never, occasionally, sometimes, most of time, all of time 

7 1P Unpredictable miscellaneous incontinence Never, occasionally, sometimes, most of time, all of time 

8 1P Hesitancy Never, occasionally, sometimes, most of time, all of time 

9 1P Starting strain Never, occasionally, sometimes, most of time, all of time 

10 1P Continuing strain Never, occasionally, sometimes, most of time, all of time 

11 1P Urination seated Standing, seated 

12 1P Decreased stream (words) Normal, decreased, never, occasionally, sometimes, most of 

time, all of time 

13 Weak stream always Yes, no 

14 Decreased stream (picture) 4 Distances 

15 1P Intermittency Never, occasionally, sometimes, most of time, all of time 

16 1P Dysuria Never, occasionally, sometimes, most of time, all of time 

17 1P Incomplete emptying Never, occasionally, sometimes, most of time, all of time 

18 1P Terminal dribbling Never, occasionally, sometimes, most of time, all of time 

19 1P Post-void dribbling Never, occasionally, sometimes, most of time, all of time 

20 1P Nocturnal incontinence Never, occasionally, sometimes, most of time, all of time 

22 1P Repeat urination Never, occasionally, sometimes, most of time, all of time 

23 Acute retention No, 1, 2, more than 2 

28 1P Frequency (hrs. between voidings) 4, 3, 2 hours., hourly 

Possible responses for the following questions: 

Occasionally - less than one third of the time 

Sometimes - between one and two thirds of the time 

Most of the time - more than two thirds of the time 

-Is there a delay before you can start to urinate? 

- Do you have to strain to continue urinating? 

- Would you say that the strength of your urinary stream is 

 normal 

occasionally reduced 

sometimes reduced 

reduced most of the time 

reduced all of the time. 

-Do you stop and start more than once while you urinate? 

-How often do you feel that your bladder has not emptied properly after you have urinated? 

-Do you have to rush to the toilet to urinate? 

-Does urine leak before you can get to the toilet? 

-Does urine leak when you cough or sneeze? 

-Do you ever leak for no obvious reason and without feeling that you want to go? 

-Do you leak urine when you are asleep? 

-How often have you had a slight wetting of your pants a few minutes after you had finished urinating and had 

dressed yourself? 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F852 

Frequency 

-How often do you pass urine during the day? 

hourly 

every 2 hours 

every 3 hours 

every 4 hours or more 

-During the night, how many times do you have to get up to urinate, on average? 

none 

one 

two 

three 

four or more 

-Overall, how much do your urinary symptoms interfere with 

your life? 

not at all 

a little 

somewhat 

a lot 

Overactive bladder symptom and health-related quality of life questionnaire860

This questionnaire asks about how much you have been bothered by selected bladder symptoms during the past 4 

weeks. Please circle the number that best describes the extent to which you were bothered by each symptom during 

the past 4 weeks. There are no right or wrong answers. Please be sure to answer every question using possible 

responses: not at all, a little bit, somewhat, quite a bit, a great deal, a very great deal 

During the past 4 weeks, how bothered were you by: 

1. Frequent urination during the daytime hours 

2. An uncomfortable urge to urinate 

3. A sudden urge to urinate with little or no warning 

4. Accidental loss of small amounts of urine 

5. Nighttime urination 

6. Waking up at night because you had to urinate 

7. An uncontrollable urge to urinate 

8. Urine loss associated with a strong desire to urinate 

During the past 4 weeks, how often have your bladder symptoms: none of the time, a little of the time, some of the 

time, a good bit of the time, most of the time, all of the time 

9. Made you carefully plan your commute? 

10. Caused you to feel drowsy or sleepy during the day? 

11. Caused you to plan ‘escape routes’ to restrooms in public places? 

12. Caused you distress? 

13. Frustrated you? 

14. Made you feel like there is something wrong with you? 

15. Interfered with your ability to get a good night’s rest? 

16. Caused you to decrease your physical activities (exercising, sports, etc.)? 

17. Prevented you from feeling rested upon waking in the morning? 

18. Frustrated your family and friends? 

19. Caused you anxiety or worry? 

20. Caused you to stay home more often than you would prefer? 

21. Caused you to adjust your travel plans so that you are always near a restroom? 

22. Made you avoid activities away from restrooms (i.e., walks, running, hiking)? 

23. Made you frustrated or annoyed about the amount of time you spend in the restroom? 

24. Awakened you during sleep? 

25. Made you worry about odor or hygiene? 

26. Made you uncomfortable while traveling with others because of needing to stop for a restroom? 

27. Affected your relationships with family and friends? 

28. Caused you to decrease participating in social gatherings, such as parties or visits with family or friends? 

29. Caused you embarrassment? 

30. Interfered with getting the amount of sleep you needed? 

31. Caused you to have problems with your partner or spouse? 

32. Caused you to plan activities more carefully? 

33. Caused you to locate the closest restroom as soon as you arrive at a place you have never been? 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F853 

Urogenital Distress Inventory861

Please indicate which symptoms you are now experiencing, and how bothersome they are for you. Be sure to answer 

all items. 

Do you experience frequent urination? If yes, how much does it bother you? not at all; slightly; moderately; greatly 

Do you experience a strong feeling of urgency to empty your bladder? 

Do you experience urine leakage related to the feeling of urgency? 

Do you experience urine leakage related to physical activity, coughing or sneezing? 

Do you experience general urine leakage not related to urgency or activity? 

Do you experience small amounts of urine leakage (that is, drops)? 

Do you experience large amounts of urine leakage? 

Do you experience nighttime urination? 

Do you experience bedwetting? 

Do you experience difficulty emptying your bladder? 

Do you experience a feeling of incomplete bladder emptying? 

Do you experience lower abdominal pressure? 

Do you experience pain when urinating? 

Do you experience pain in the lower abdominal or genital area? 

Do you experience heaviness or dullness in the pelvic area? 

Do you experience a feeling of bulging or protrusion in the vaginal area? 

Do you experience bulging or protrusion you can see in the vaginal area? 

Do you experience pelvic discomfort when standing or physically exerting yourself? 

Do you have to push on the vaginal walls to have a bowel movement? 

Other symptoms 

Incontinence impact questionnaire

Some women find that accidental urine loss and/or prolapse may affect their activities, relationships, and feelings. 

The questions below refer to areas in your life which may have been influenced or changed by your problem. For 

each question, check the response that best describes how much your activities, relationships, and feelings are 

being affected by urine leakage and/or prolapse. Responses: not at all; slightly; moderately; greatly 

Has urine leakage and/or prolapse affected your: 

 Ability to do household chores (cooking, housecleaning, laundry) 

 Ability to do usual maintenance or repair work done in home or yard 

 Shopping activities 

 Hobbies and pastime activities 

 Physical recreational activities such as walking, swimming, or other exercise 

 Entertainment activities such as going to a movie or concert 

 Ability to travel by car or bus for distances less than 20 minutes away from home 

 Ability to travel by car or bus for distances greater than 20 minutes away from home 

 Going to places if you are not sure about available restrooms 

 Going on vacation 

 Church or temple attendance 

 Volunteer activities 

 Employment (work) outside the home 

 Having friends visit you in your home 

 Participating in social activities outside your home 

 Relationship with friends 

 Relationship with family excluding husband/companion 

 Ability to have sexual relations 

 Way you dress 

 Emotional health 

 Physical health 

 Sleep 

 Does fear of odor restrict your activities? 

 Does fear of embarrassment restrict your activities? 

In addition, does your problem cause you to experience any of the following feelings? 

 Nervousness or anxiety 

 Fear 

 Frustration 

 Anger 

 Depression 

 Embarrassment 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F854 

Incontinence Severity Index863

How often do you experience urinary leakage? 

Less than once a month 

One or several times a month 

Every day and/or night 

How much urine do you lose each time? 

Drops 

Small splashes 

More 

The severity index is created by multiplying the results of questions 1 and 2: 

1-2 = slight 

3-4 = moderate 

6-8- = severe 

In the three-level severity index, responses to the second question are first aggregated into drops (1) and more (2), 

and then multiplied with the frequency, resulting in the following index values (1–8): 

1–2 = slight 

3–4 = moderate 

6–8 = severe 

The four-level severity index is based on the following index values (1–12): 

1–2 = slight 

3–6 = moderate 

8–9 = severe 

12 = very severe 

International Continence Society male, lower urinary tract symptoms primarily865

During the day, how many times do you urinate, on average? 

1 to 6 times 

7 to 8 times 

9 to 10 times 

11 to 12 times 

13 or more times 

How much of a problem is this for you? 

Not a problem 

A bit of a problem 

Quite a problem 

A serious problem 

During the night, how many times do you have to get up to urinate, on average? 

None 

One 

Two 

Three 

Four or more 

How much of a problem is this for you? 

Would you say that the strength of your urinary stream is.... 

Normal 

Occasionally reduced 

Sometimes reduced 

Reduced most of the time 

Reduced all of the time 

How much of a problem is this for you? 

Please ring the number that corresponds with the strength of your urinary stream over the past month. 

How often do you pass urine during the day? 

Hourly 

Every 2 hours 

Every 3 hours 

Every 4 hours or more 

How much of a problem is this for you? 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F855 

Incontinence Quality of Life (in persons with UI) questionnaire867

I worry about not being able to get to the toilet on time. 

I worry about coughing and sneezing. 

I have to be careful about standing up after sitting down. 

I worry where the toilets are in new places. 

I feel depressed. 

I don’t feel free to leave my home for long periods of time. 

I feel frustrated because my UI prevents me from doing what I want. 

I worry about others smelling urine on me. 

Incontinence is always on my mind. 

It’s important for me to make frequent trips to the toilet. 

Because of my incontinence, it is important to plan every detail in advance. 

I worry about my incontinence getting worse as I grow older. 

I have a hard time getting a good night’s sleep. 

I worry about being embarrassed or humiliated be cause of my incontinence. 

My incontinence makes me feel like I’m not a healthy person. 

My UI makes me feel helpless. 

I get less enjoyment out of life because of my UI. 

I worry about wetting myself. 

I feel like I have no control over my bladder. 

I have to watch what I drink. 

My UI limits my choice of clothing. 

I worry about having sex. 

All items use the following response scale: 

1 = Extremely 

2 = Quite a bit 

3 = Moderately 

4 = A little 

5 = Not at all 

Subscale structure: 

Avoidance and limiting behavior: items 1, 2, 3, 4, 10, 11, 13, and 20 

Psychosocial impacts: items 5, 6, 7, 9, 15, 16, 17, 21, and 22 

Social embarrassment: items 8, 12, 14, 18, and 19 

Incontinence Classification System868

Domain Nature of the Questions

Social interactions Relationships with friends 

 Relationships with spouse/companions 

 Difficulty establishing new relationships 

Personal strain Interference with the ability to perform usual daily tasks 

 Ability to engage in physical recreation 

 Ability to engage in non strenuous recreation 

 Nervousness or anxiety related to incontinence 

Global health and quality of life Effect on overall health 

 Effect on overall level of energy 

 Feelings of being less useful 

 Overall quality of life 

 Impact on quality of life if there was no incontinence 

Satisfaction Overall satisfaction with life 

Financial Effect on financial situation 

Sexuality Interference with sexual activity 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F856 

King’s Health Questionnaire869

How would you describe your health at present? very good; good; fair; poor; very poor 

How much do you think your bladder problem affects your life? not at all; a little; moderately; a lot 

What are your bladder problems and how much do they affect you? 

Frequency: (going to the toilet very often) 

Nocturia: (getting up at night to pass urine) 

Urgency: (a strong and difficult to control desire to pass urine) 

Urge Incontinence: (urinary leakage associated with a strong desire to pass urine) 

Stress Incontinence: (urinary leakage with physical activity e.g. coughing, sneezing or running) 

Nocturnal Enuresis: (wetting the bed at night) 

Intercourse Incontinence: (urinary leakage with sexual intercourse) 

Frequent waterworks infections 

Bladder pain 

Difficulty passing urine 

Below are some daily activities that can be affected by bladder problems. How much does your bladder problem 

affect you? 

a. To what extent does your bladder problem affect your household tasks (e.g. cleaning, shopping) 

b. Does your bladder problem affect your job or your normal activities outside the home 

Physical Limitations (Tick the box that applies to you) 

a. Does your bladder problem affect your physical activities (e.g. going for a walk, run, sport, gym etc.)? 

b. Does your bladder problem limit your ability to travel? 

Social Limitations 

a. Does your bladder problem affect your social life? 

b. Does your bladder problem affect your ability to see/visit friends? 

Personal Relationships 

a. Does your bladder problem affect your relationship with your partner? 

b. Does your bladder problem affect your sex life? 

c. Does your bladder problem affect your family life? 

Emotions 

a. Does your bladder problem make you feel depressed? 

b. Does your bladder problem make you feel anxious or nervous? 

c. Does your bladder problem make you feel bad about yourself? 

Sleep/ Energy 

a. Does your bladder problem affect your sleep? 

b. Do you feel worn out/tired? 

Do you do any of the following? If so how much? 

a. Wear pads to keep dry? 

b. Be careful how much fluid you drink? 

c. Change you underclothes when they get wet? 

d. Worry in case you smell? 

e. Get embarrassed because of your bladder problem? 

Incontinence Impact Questionnaire-7862

Some people find that accidental urine loss may affect their activities, relationships, and feelings. The questions below 

refer to areas in your life that may have been influenced or changed by your problem. For each question, circle the 

response that best describes how much your activities, relationships, and feelings are being affected by urine leakage. 

Has urine leakage affected your: not at all=1; slightly=1; moderately=2; greatly=3 

Ability to do household chores (cooking, housecleaning, laundry)? 

Physical recreation such as walking, swimming, or other exercise? 

Entertainment activities (movies, concerts, etc.)? 

Ability to travel by car or bus more than 30 minutes from home? 

Participation in social activities outside your home? 

Emotional health (nervousness, depression, etc.)? 

Feeling frustrated? 

Items 1 and 2 = physical activity 

Items 3 and 4 = travel 

Item 5 = social/relationships 

Items 6 and 7 = emotional health 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F857 

Scoring. Item responses are assigned values of 0 for "not at all," 1 for "slightly," 2 for "moderately," and 3 for "greatly." 

The average score of items responded to is calculated. The average, which ranges from 0 to 3, is multiplied by 33 1/3 

to put scores on a scale of 0 to 100. 

UI Severity Score (UISS)871 872

The UISS questionnaire consists of 10 questions designed to quantify the amount of leakage, the degree to which UI 

affects aspects of a woman’s daily life, and need to use pads. The responses are scored from 0 to 2, yielding a total 

score between 0 and 20. The lower scores reflect better quality of life. Marking the most appropriate alternative: not 

at all=0; sometimes=1; often=2. 

1. Do you experience urine leakage not related to effort or position (for example lying down)? 

2. Do you experience urine leakage related to minor physical activity (e.g. walking or rising)? 

3. Do you experience urine leakage related to sudden, strong physical activity or even coughing or sneezing? 

4. Has urine leakage disturbed your daily chores (shopping, cooking, housecleaning etc.)? 

5. Has urine leakage disturbed your employment (client service, work performance etc)? 

6. Are you afraid that others will notice your problem (fear of your odour or wetness etc.)? 

7. Do you have to restrict or give up social activities (such as visiting friends, physical activity, theatre, church 

etc.)? 

8. Do your incontinence symptoms disturb your sex life? 

9. Does incontinence cause irritation of your external genital organs? 

10. How often must you use a protective nappy or pad? 

CONTILIFE- Urinary Incontinence-Specific Measure of Quality of Life873

The following questions are about your health over the last 4 weeks. Choose the answer which best describes what 

you feel or have felt over the last 4 weeks giving only one answer per line. If certain activities do not apply (e.g. 

embarrassment when using public transport because you do not use public transport), put a tick in the "not 

applicable" box. Please answer this questionnaire on your own, without help. To answer, tick the box which applies to 

you: not at all; a little; moderately; a lot; extremely 

DAILY ACTIVITIES 

Over the last 4 weeks, how much have your urinary problems bothered you: 

1. When you were away from your home? 

2. When you were driving or being a passenger? 

3. When going up or down stairs? 

4. When shopping? 

5. When queuing (bus stop, cinema, supermarket)? 

Over the last 4 weeks, because of your urinary problems: none; a few; some; many; very many 

6. Have you had to take frequent breaks during your work or daily activities? 

Over the last 4 weeks, because of your urinary problems, how often: never; rarely; sometimes; often; all the time 

7. Have you woken up having wet yourself? 

EFFORT 

Over the last 4 weeks, how much have your urinary problems bothered you: not at all; a little; moderately; a lot; 

extremely 

8. When lifting or carrying heavy objects? 

9. When doing sport (running, dancing, keep-fit)? 

10. When blowing your nose, sneezing or coughing? 

11. After a fit of laughter? 

SELF IMAGE 

Over the last 4 weeks, because of your urinary problems, how often: never; rarely; sometimes; often; all the time 

12. Have you felt less attractive? 

13. Were you afraid of giving off unwanted odors? 

14. Were you afraid that other people might become aware of your problems? 

15. Were you afraid of leaving stains at other people’s homes or at work? 

16. Did you have to change your clothes? 

Over the last 4 weeks, in spite of your urinary problems, how often: never; rarely; sometimes; often; all the time 

17. Have you felt at ease with yourself? 

Over the last 4 weeks, because of your urinary problems: I never wear pads; not at all; a little; moderately; a lot; 

extremely 

18. Have you been bothered by having to wear pads? 
Table F211. Questionnaires with rigorous validity, reliability and responsiveness highly recommended by the 

Symptom and Quality of Life Committee of the International Consultation on Incontinence (continued) 

F858 

EMOTIONAL CONSEQUENCES 

Over the last 4 weeks, because of your urinary problems, how often: never; rarely; sometimes; often; all the time 

19. Have you felt discouraged? 

20. Have you lost patience? 

21. Have you been worried that you might have a urinary “accident”? 

22. Have you felt that you are losing self-control? 

23. Have you felt obsessed by your urinary problems? 

24. Did you need to think about taking pads with you before going out? 

SEXUALITY 

Over the last 4 weeks, because of your urinary problems, how much: not at all; a little; moderately; a lot; extremely 

25. Have you felt anxious at the thought of having sexual intercourse? 

26. Have you changed your sexual practices? 

27. Have you been afraid of having urine leaks during sexual intercourse? 

OVERALL QUALITY OF LIFE 

28. Taking your urinary problems into account, how would you currently assess your quality of life? From Poor to 

Excellent (5 scores) 
F859 

Table F212. Association between sample size of studies and diagnostic values of tests 

Questionnaires and Scales Intercept Slope R2, % 

Sensitivity, % 75.1 0.01 2.4 

Specificity, % 68.9 0.02 1.1 

Positive predictive likelihood 12.4 -0.02 4.1 

Clinical history for stress UI 

Sensitivity 93.6 -0.02 19.5 

Specificity 57.8 0.00 0.3 

Positive predictive likelihood 70.9 0.03 21.7 

Positive likelihood ratio 4.0 0.00 4.9 

Clinical history for urge UI 

Sensitivity, % 55.3 -0.01 7.2 

Specificity 77.3 0.00 0.1 

PPV+ 66.5 0.00 0.1 

LR+ 7.0 0.00 1.7 

Ultrasound 

Sensitivity, % 85.9 -0.05 10.2 

Specificity, % 89.6 -0.04 8.2 

Positive predictive likelihood 1.0 0.00 52.2 

Positive likelihood ratio 7.8 0.03 2.3 
F860 

Table F213. Scales that provided the largest positive likelihood ratio to detect UI 

Author, positive 

likelihood ratio Questions 

Sandvik, 1995841

LR+ 14 

A positive answer to the following question was presumed to be an indication of stress 

incontinence: 

 “Do you lose urine during sudden physical exertion, lifting, coughing or sneezing?’ 

Urge incontinence was presumed to be indicated by a positive answer to the question: 

 “Do you experience such a strong and sudden urge to void that you leak before reaching 

the toilet?” 

A positive answer to both questions was registered as mixed incontinence. 

Kirschner-Hermanns, 

1998874

LR+ 15 

How long can you usually hold urine once you feel an urge to urinate? 

 More than 5 minutes 

 1 to 5 minutes 

 Less than 1 minute, or I have an urge but I can't hold it 

 I have no urge or warning 

Do you ever lose urine when you laugh, cough, sneeze or bend over? 

Is the only time that you lose urine when you laugh, cough, sneeze or bend over? 

When you are awake, can you usually go for half an hour without leaking urine? 

When you lose urine, how much usually leaks? 

 A few drops 

 Enough to wet your underwear 

 Enough to wet your outer clothes, or enough to wet the floor 

Diokno, 1999875

LR+ 62 

The Medical, Epidemiologic and Social Aspects of Aging Urinary Incontinence Questionnaire

Please check the appropriate box 

1. Over the past 12 months, have you had urine loss beyond your control? 

 [ ] Yes [ ] No 

2. How long ago did your urine loss start? years, months, days 

3. When does the urine loss usually occur: 

 [ ] Daytime only 

 [ ] Nighttime only 

 [ ] Both daytime and nighttime 

Questions for Urge Incontinence symptoms: 

Please check the appropriate box: [ ] Often (3); [ ] Sometimes (2); [ ] Rarely (1); [ ] Never (0) 

1. Some people receive very little warning and suddenly find that they are losing, or about to 

lose, urine beyond their control. How often does this happen to you? 

2. If you can’t find a toilet or find that the toilet is occupied, and you have an urge to urinate, 

how often do you end up losing urine and wetting yourself? 

PREDICTING TYPE II STRESS INCONTINENCE 

Please check the appropriate box: [ ] Often (3); [ ] Sometimes (2); [ ] Rarely (1); [ ] Never (0) 

3. Do you lose urine when you suddenly have the feeling that your bladder is very full? 

4. Does washing your hands cause you to lose urine? 

5. Does cold weather cause you to lose urine? 

6. Does drinking cold beverages cause you to lose urine? 

Total urge score: 

Urge score ratio: 

Questions for Stress Incontinence symptoms: 

1. Does coughing gently cause you to lose urine? 

2. Does coughing hard cause you to lose urine? 

3. Does sneezing cause you to lose urine? 

4. Does lifting things cause you to lose urine? 

5. Does bending over cause you to lose urine? 

6. Does laughing cause you to lose urine? 

7. Does walking briskly or jogging cause you to lose urine? 

8. Does straining, if you are constipated, cause you to lose urine? 

9. Does getting up from a sitting to standing position cause you to lose urine? 

Total stress score: 

Stress score ratio: 

Moore, 1996876

LR+ 17.8 

Screening Measure (2 parts) 

Ask: “In the last year, have you ever lost your urine gotten wet? 

If yes, then ask: “Have you lost urine on at least 6 separate days? 
F861 

Figure F2. Association between sample size and sensitivity (%) of clinical history versus multichannel 

urodynamics to detect stress UI 

y = -0.017x + 93.605

R2 = 0.1949

35

45

55

65

75

85

95

0 500 1000 1500

sample size

%

Sensitivity,% Linear (Sensitivity,%)
F862 

Figure F3. Association between sample size and positive predictive value (%) of clinical history versus 

multichannel urodynamics to detect stress UI 

y = 0.0282x + 70.851

R2 = 0.217

40

50

60

70

80

90

100

0 200 400 600 800 1000

Sample size

%

Positive Predictive Value, % Linear (Positive Predictive Value, %)
F863 

Table F214. Diagnostic value of different tests to detect persons at risk and patients with UI 

Author 

Sample UI Type Index Method vs. “Gold Standard” Sensitivity (%) Specific

(%) 

Urethral pressure profile vs. urodynamics 86 58 Urethral pressure profile vs. multichannel UD, supine 32 93 

Richardson, 1986877

N = 144 

Stress 

Urethral pressure profile vs. multichannel UD, standing 41 92 

Schick, 2004878

N = 369 

Stress Urethral pressure profile vs. urodynamics 53.8 75.9 

Romanzi, 1999879

N = 57 

Pelvic muscle strength 

Pelvic scale scores vs. clinical history 68 71 

Fischer-Rasmusen, 1986 Pelvic scale scores vs. clinical history 72 46 

880

N = 212 

Stress 

Cystoscopy, cystometry, stress test for urine loss, uroflowmetry, and colpo-cysto-urethrography vs. clinical 

history 

52 85 

Resnick, 1996 Urge Minimum data sgorithm vs. urodynamics 76 71 

881

N = 102 Stress Minimum data sgorithm vs. urodynamics 76 97 

Stress 94 84 Urge 71 96 

Summit, 1992882

N = 90 

Mixed 

Cough stress test and single-channel medium-fill cystometry vs. urodynamics 

94 84 

Creighton, 1991883

N = 133 

Mixed Urethral electrical conductance vs. urodynamics 64 86 

Davis, 1998884

N = 60 

Stress Ambulatory urodynamic monitoring vs. multichannel UD 78 7 

Rosario, 1999885

N = 63 

Bladder outlet obstruction 

Ambulatory urodynamic monitoring vs. multichannel UD 25 88 

Mclnerney, 1991886

N = 20 

Urge Ambulatory urodynamic monitoring vs. multichannel UD 100 58 

Bhatia, 1982887

N = 26 

Urge Ambulatory urodynamic monitoring vs. multichannel UD 43 58 

Swift, 1995888N = 108 

Stress Urethral pressure profile vs. multichannel UD 49 98 

Versi, 1990889

N = 172 

Stress Urethral pressure profile vs. multichannel UD 77 79 

Pajoncini,1999 Stress Urethral pressure profile vs. multichannel UD, VLPP 84 60 

890

N = 119 Stress Urethral pressure profile vs. multichannel UD, MUCP 63 52 

Versi, 1991891

N = 303 

Stress Urethral pressure profile vs. multichannel UD 48 84 

Cucchi, 1990892

N = 40 

Urge Flow rate acceleration vs. multichannel UD 75 75 

Swift, 1997893N = 66 

Urge Cystometry by fetal monitor vs. multichannel UD 91 86 
Table F214. Diagnostic value of different tests to detect persons at risk and patients with UI (continued) 

F864 

Author 

Sample UI Type Index Method vs. “Gold Standard” Sensitivity (%) Specific

(%) 

Bergman, 1988894

N = 35 

Urge Cystometry by fetal monitor vs. multichannel UD 100 96 

Petersen, 1997895N = 130 

Urge Ice water test vs. multichannel UD 85 65 Stress Fluid bridge test to detect the entry of urine into the 

proximal urethra during cough vs. standing cystometry, supine 

Sutherst, 1981 86 42 

896

N = 126 

Stress Fluid bridge test to detect the entry of urine into the 

proximal urethra during cough vs. standing cystometry, standing 

100 24 

Hanzal, 1991897

N = 981 

Stress Urethral pressure profile vs. clinical stress test 93 83 

Frigerio, 1981898

N = 112 

Urge Voiding stop tests vs. single channel cystometry 95 66 
F865 

Table F215. Diagnostic value of different tests compared to multichannel urodynamics to detect UI in adults 

Author 

Sample 

Sensitivity 

(%) 

Specificity 

(%) 

Positive Predictive 

Likelihood 

X-ray

Pelsang, 1996899

N = 159 

100% female 

61 70 2.03 

Scotti, 1990900

N = 204 

100% female 

60 79 2.86 

Grischke, 1991901

N = 84 

100% female 

59 60 1.48 

Bergman. 1988902

N = 59 

100% female 

100 44 1.79 

Rose, 1983903

N = 1,584 

69% female 

91 91 10.11 

Digesu, 2004904

N = 4,500 

100% female 

45 83 2.65 

Full bladder clinical test

Hsu, 1999905

N = 41 

100% female 

94 90 9.40 

Kadar, 1988906

N = 37 

100% female 

78 74 3.00 

Scotti, 1993907

N = 145 

100% female 

84 84 5.25 

Resnik, 1996 908

N = 97 

100% female 

67 98 33.50 

Lobel, 1996909 

N = 304 

100% female 

49 95 9.80 

Single channel urodynamics for stress UI 

Swift, 1997893

N = 66 

100% female 

49 98 24.50 

Ouslander,1988910

N =164 

78% female 

73 61 1.87 

Resnick, 1996908

N = 97 

100% female 

86 86 6.14 

Scotti, 1993907

N = 145 

100% female 

49 95 9.80 

Single channel urodynamics 

for urge UI

 

Swift, 1997893

N = 66 

100% female 

49 98 24.50 

Ouslander, 1988910

N =164 

78% female 

73 61 1.87 
Table F215. Diagnostic value of different tests compared to multichannel urodynamics to detect UI in adults 

(continued) 

F866 

Author 

Sample 

Sensitivity 

(%) 

Specificity 

(%) 

Positive Predictive 

Likelihood 

Resnick, 1996908

N = 97 

100% female 

86 86 6.14 

Scotti, 1993907

N = 145 

100% female 

49 95 9.80 

Q-tip test

Bergman, 1987911

N =105 

100% female 

75 58 1.79 

Montz, 1986912

N = 100 

100% female 

53 53 1.13 

Thomakos, 2005913

N = 539 

100% female 

91 35 1.40 

Noblett, 2005 94 91 10.44 914

N = 134 

100% female 

96 84 6.00 
F867 

Table F216. Number needed to screen and number of tests to detect 1 case of UI in men 915,916

Prevalence of 

Undiagnosed UI 

Clinical History to Diagnose Detrusor 

Overactivity 

Scale to Diagnose Detrusor 

Overactivity 

Population 

Categories 

Number Needed to 

Screen 

Number of 

Tests 

Number Needed to 

Screen 

Number of 

Tests 

All 0.782 24 5 8 6 Race/ethnicity Black 0.73 20 4 9 7 Hispanic 0.868 33 6 8 6 White 0.788 26 5 8 6 Age group 30–39 0.962 16 4 7 5 40–49 0.822 29 5 8 6 50–59 0.904 31 6 7 6 60–79 0.621 27 5 11 8 Socioeconomic status Low 0.614 30 6 11 8 Middle 0.782 24 5 8 6 High 0.828 24 5 8 6 Medical insurance Any private 0.797 24 5 8 6 Public only 0.717 26 5 9 7 None 0.916 24 5 7 6 
F868 

Table F217. Recommended questionnaires for symptoms and quality of life impact of anal incontinence (adapted from the Sy

Life Committee of the International Consultation on Incontinence)855

Grade Questionnaire 

Grade A (highly recommended): validity, reliability and responsiveness established with rigor 

None Fecal Incontinence QOL Scale917Manchester Health Questionnaire918

Grade B (recommended): validity and reliability established with rigor or validity, reliability and responsiveness indicated Birmingham Bowel and Urinary Symptoms 

Questionnaire919
F869 

Table F218 . Questionnaires with rigorous validity, reliability, and responsiveness highly recommended by the Symptom and Q

of the International Consultation on Incontinence for anal incontinence855

Fecal Incontinence QOL Scale917

In general, would you say your health is: excellent; very good; good; fair; poor For each item, please indicate how much of the time the issue is a concern for you due to accidental bowel leakage. (If it is a concern for 

than accidental bowel leakage, then check the box under Not Apply, (N/A).) Most of the time; Some of the time; A little of the time; None Q1. Due to accidental bowel leakage 

a. I am afraid to go out b. I avoid visiting friends c I avoid staying overnight away from home d. It is difficult for me to get out and do things like going to a movie or to church e. I cut down on how much I eat before I go out f. Whenever I am away from home, I try to stay near a restroom as much as possible g. It is important to plan my schedule (daily activities) around my bowel pattern h. I avoid traveling i. I worry about not being able to get to the toilet in time j. I feel I have no control over my bowels k. I can't hold my bowel movement long enough to get to the bathroom 1. I leak stool without even knowing it m. I try to prevent bowel accidents by staying very near a bathroom 

Q2: Due to accidental bowel leakage, indicate the extent to which you AGREE or DISAGREE with each of the following items. (If it is a c

other than accidental bowel leakage then check the box under Not Apply, N/A). Strongly agree; Somewhat agree; Somewhat disagree; S

Q3. Due to accidental bowel leakage: 

a. I feel ashamed b. I can not do many of things I want to do c. I worry about bowel accidents d. I feel depressed e. I worry about others smelling stool on me f. I feel like I am not a healthy person g. I enjoy life less h. I have sex less often than I would like to i. I feel different from other people j. The possibility of bowel accidents is always on my mind k. I am afraid to have sex 1. I avoid traveling by plane or train m. I avoid going out to eat n. Whenever I go someplace new, I specifically locate where the bathrooms are 

Q4: During the past month, have you felt so sad, discouraged, hopeless, or had so many problems that you wondered if anything was woto the point that I have just about given up; Very much so; Quite a bit; Some - enough to bother me; A little bit; Not at all 
Table F218 . Questionnaires with rigorous validity, reliability, and responsiveness highly recommended by the Symptom and Q

of the International Consultation on Incontinence for anal incontinence (continued) 

F870 

Manchester Health Questionnaire918

1. How do you describe you health at the present? Very good; Good; Fair; Poor; Very poor 2. How much you think your bowel problem affects your life? Not at all; A little bit; Moderately; Quite a bit; Extremely 

We would like to know what your bowel problems are and how much they affect you. Responses: Never; Occasionally; Sometimes; Most of the time; All of the time 3. How often do you have a strong desire to move your bowels which makes you rush to the toilet? 4. How often your bowels leak when coughing or sneezing? 5. How often your bowels leak when walking? 6. Do your bowels leak during the rest of the day or at night? 7. Do you have difficulties wiping clean after you have opened your bowels? 8. Do you have difficulties controlling wind? 9. Is the leakage from your bowels loose? 10. Is the leakage from your bowels solid? 11. How often do you move your bowels every day? 12. Do your bowels leak during or after sexual intercourse? How much does the bowel problem you described in the previous page affect you? Role limitation 13. Does your bowel problem affect you doing your jobs within the home? 14. Does your bowel problem affect your job or your normal daily activities outside the home? Physical limitations 15. Does your bowel problem affect your ability to travel? 16. Does your bowel problem affect your physical activities (going for a walk, running, sport, gym, etc.? 17. Does your bowel problem limit your social life? 18. Does your bowel problem limit your ability to see and visit friends? Personal relationships 19. Does you bowel problem affect your relationship with your partner? 20. Does you bowel problem affect your sex life? 21. Does you bowel problem affect your family life? Emotions 22. Does you bowel problem make you feel depressed? 23. Does you bowel problem make you feel anxious or nervous? 24. Does your bowel problem make you feel bad about yourself? Sleep/energy 25. Does your bowel problem affect your sleep? 26. Does your bowel problem make you feel worn out and tired? Do you do any of following ? If so how much? 27. Wear pads to keep clean? 28. Be careful how much food you eat? 29. Change your underclothes because they get dirty? 30. Worry in case you smell? 31. Get embarrassed because of you bowel problem? 
Table F218 . Questionnaires with rigorous validity, reliability, and responsiveness highly recommended by the Symptom and Q

of the International Consultation on Incontinence for anal incontinence (continued) 

F871 

Modified Manchester Health Questionnaire

SECTION A Responses: Never, Occasionally, Sometimes, Most of the time, All of the time A1. How often do you have a strong desire to move your bowels that makes you rush to the toilet? 

A2. How often in the past month have you experienced any amount of accidental bowel leakage that consisted of solid stool? 

B1. Do you lose any solid stool when coughing or sneezing? B2. Do you lose any solid stool when walking? B3. Besides coughing, sneezing, and walking, do you lose any solid stool during the rest of the day or night? 

A3. How often in the past month have you experienced any amount of accidental bowel leakage that consisted of liquid stool? 

B4. When you leak stool, how often is it liquid or watery? B5. Do you lose any liquid stool when coughing or sneezing? B6. Do you lose any liquid stool when walking? B7. Besides coughing, sneezing, and walking, do you lose any liquid stool during the rest of the day or night? 

A4. How often in the past month have you experienced any amount of accidental bowel leakage that consisted of mucus? 

A5. How often in the past month have you experienced any amount of accidental bowel leakage that consisted of gas? 

B8. Do you lose any gas when coughing or sneezing? B9. Do you lose any gas when walking? SECTION C: If the answers to A1, A2, A3, A4, and A5 are all “Never,” skip this section. C1. How much do you think your bowel problem affects your life? C2. How often do you move your bowels each day? C3. Do you have difficulty wiping clean after you have moved your bowels? C4. What percent of your bowel movements are hard or little balls? C5. What percent of your bowel movements are loose or watery? Role limitations C6. Do you have a problem with your bowels that affects doing jobs within the home? C6a. If so, how often does it affect you? C7. Do you have a problem with your bowels that affects your job, or your normal daily activities outside the home? C7a. If so, how often does it affect you? Physical/social limitations C8. Do you have a problem with your bowels that affects your ability to travel? C8a. If so, how often does it affect you? C9. Do you have a problem with your bowels that affects your physical activities (such as going for a walk, running, sport, gym, etc.)? 

C9a. If so, how often does it affect you? C10. Do you have a problem with your bowels that limits your social life? C10a. If so, how often, does it affect you? C11. Do you have a problem with your bowels that limits your ability to see and visit friends? C11a. If so, how often does it affect you? Personal relationships C12. Do you have a problem with your bowels that affects your relationship with your partner? C12a. If yes, how often does it affect your relationship? C13. Do you have a problem with your bowels that affects your family life? C13a. If so, how often does it affect your family life? Emotions C14. Do you have a problem with your bowels that makes you feel depressed? C14a. If yes, how often does it affect you? 
Table F218 . Questionnaires with rigorous validity, reliability, and responsiveness highly recommended by the Symptom and Q

of the International Consultation on Incontinence for anal incontinence (continued) 

F872 

C15. Do you have a problem with your bowels that makes you feel anxious or nervous? C15a. If yes, how often does it affect you? C16. Do you have a problem with your bowels that makes you feel bad about yourself? C16a. If yes, how often does it affect you? Sleep/energy C17. Do you have a problem with your bowels that affects your sleep? C17a. If so, how often does it affect your sleep? C18. Do you have a problem with your bowels that makes you feel worn out and tired? C18a. If yes, how often does it affect you? Sexual Activity For general audience, skip questions C19a to C19b. C19. Have you resumed sexual activity since delivery? C19a. If “Yes,” when did you resume sexual activity? __ __ weeks after delivery C19b. If “No,” why have you not resumed sexual activity? C20. Do you have a problem with your bowels that affects your sex life? C20a. If so, how often does it affect your sex life? C21. Do you lose any gas during or after sexual activity? C22. Do you lose any stool during or after sexual activity? C23. Do you lose any urine during or after sexual activity? Lifestyle Adaptation C24. Do you wear pads to keep clean because of a problem with your bowels? C24a. If yes, how often do you wear pads? C25. Are you careful about how much food you eat because of a problem with your bowels? C25a. If yes, how often are you careful about how much food you eat? C26. Do you change your underclothes because they get dirty due to a problem with your bowels? C26a. If yes, how often do you change your underclothes for this reason? C27. Do you worry about odor because of a problem with your bowels? C27a. If yes, how often do you worry about it? C28. Do you get embarrassed because of a problem with your bowels? C28a. If yes, how often do you get embarrassed? Medical C29. Did you bring any of your bowel symptoms to the attention of your clinician? C30. Have you received treatment for your bowel symptoms? C30a. If “Yes,” please specify: 
Table F218 . Questionnaires with rigorous validity, reliability, and responsiveness highly recommended by the Symptom and Q

of the International Consultation on Incontinence for anal incontinence (continued) 

F873 

Birmingham Bowel and Urinary Symptoms Questionnaire919

1. How often do you open your bowels? 2. What form are your motions usually? 3. Can you hold onto your motions for more than five minutes? 4. Do you ever have to rush to the toilet to open your bowels? 5. Does stool leak before you can get to the toilet? 6. Do you leak stool for no obvious reason and without feeling that you want to go to the toilet? 7. Do you have to strain to open your bowels? 8. How long do you spend on the toilet, on average, for each bowel action? 9. Do you feel that you cannot completely empty your bowels? 10. Do you use a finger or pressure to help open your bowels? 11. Do you use a finger in your vagina to help open your bowels? 12. Do you have the urge to open your bowels but are unable to pass a motion? 13. Do you find it painful to have your bowels open? 15. Do you use laxatives? 16. During the day, how many times do you urinate, on average? 17. During the night, how many times do you have to get up to urinate, on average? 18. Do you have to rush to the toilet to urinate? 

19. Do you have difficulty completely emptying your bladder? 20. Does urine leak before you can get to the toilet? 21. Does urine leak when you are active, exert yourself, cough, or sneeze? 22. Does urine leak for no obvious reason and without feeling that you want to go to the toilet? 
F874 

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