AUA 2017: Is a Group Learning Behavioral Modification Program Effective and Safe in Reducing Geriatric Urinary Incontinence? A Multi-Center Randomized Controlled Trial

Boston, MA ( This was a multi-center randomized controlled trial of women > 55 yrs who had stress, urgency or mixed urinary incontinence (UI) for at least 3 months and a reported ICIQ-UI SF score of 3 or more (1 or more score for leakage frequency, 2 or more score for volume loss).  Study objective was to establish the effectiveness & safety of a Group-administered Behavioral Treatment (GBT) by comparing it to no treatment.

Women were excluded for pelvic organ prolapse, pelvic cancers, bladder surgery. They also had to be naïve to any OAB treatments including drug therapy and/or behavioral treatment.  The GBT group attended a 2-hr class of information on bladder health and self-management that included education on anatomy & physiology basis for continence, pelvic floor muscle (PFM) identification and training with knack/stress strategy, bladder training/urge suppression strategies and left the class with an informational brochure.  The control group only received the brochure and at the end of the 12-month study were offered referral to specialist or the 2-hr class.  Primary outcome was the ICIQ-UI SF.  Secondary outcomes included 3 day voiding diary (VD); 24hr pad weighing; provocative cough stress test; PGII, IQOL, and the Brink PFM strength test.  Evaluators were blinded to participant’s assignment. Data was collected five times over a 12 months period.  463 women were randomized (GBT=232; Control=231), 34 (7.3%) withdrew.  There were no difference between the control and GBT groups for the following variables: age, race, education, and income, living with a partner, BMI, medical & surgical histories.   Results were impressive as there was no significant differences in both primary and secondary outcomes between the two groups seen at 3, 6, 9 & 12 months favored the GBT group except there was no significant increase in the Brink PFM strength in either group.  Significant improvement in favor of GBT over Control occurred in: # of leaks on 3-day voiding dairy (p 0.0002), 24-hr pad weight test (p 0.0007), provocative cough stress test (p 0.0008), MESA questionnaire score (p<0.0001), Incontinence QOL (p<0.0001), and the Patient Global Impression-Improvement (p<0.0001).  This GBT bladder health education program was safe and effective in reducing UI frequency, severity & bother, improving QOL for older women in the community regardless of lack of PFM strength improvement.  Intervention has the opportunity to reach larger populations.

Presented by: Ananias Diokno, Lisa Low, Diane Newman & The GLADIOLUS Research Team

Written by: Diane K. Newman, DNP, FAAN, BCB-PMD, Perelman School of Medicine, University of Pennsylvania

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA