BERKELEY, CA (UroToday Inc.) - A significant number of women over the age of 70 suffer from stress urinary incontinence (SUI) and undergo surgery for correction of this problem. Whether or not this group of women has been adequately represented in SUI treatment studies is not known

Morse and colleagues from the University of Massachusetts sought to determine the extent to which elderly women were included in published randomized clinical trials (RCT) on the surgical treatment of SUI. They searched the Medline database from January 1966 to December 2003 as well as citations from the Cochrane review and database on SUI. They eventually found 20 studies that met their inclusion criteria. These were RCT articles on the surgical treatment of SUI, published in English, French, German, Italian, or Spanish, which had sufficient demographic data to estimate the participation of women aged 70 or older.

Their results were published in the September 2004 edition of Obstetrics & Gynecology. The median percentage of women aged 70 or older within studies was 3.8%. There was no significant difference in the proportion of elderly women in the studies when stratified by year of publication. When classified by type of surgery, the percentage of women 70 or older was 0.53%, 9.0%, 0.25%, and 14% for abdominal bladder neck suspension (BNS), vaginal BNS, laparoscopic BNS, and periurethral injections respectively. There were statistically significant greater numbers of elderly women in vaginal BNS studies compared with all other approaches

This review suggests that elderly women may be underrepresented in clinical trials for surgical management of SUI. As this group of women makes up approximately 16% of those actually undergoing surgery, and will likely grow as the population ages, every effort should be made to include them in these studies so that the studies may be generalizeable and applicable to the population as a whole.

Obstet Gynecol 2004; 104(3):498-503