Behavioural Therapy Superior to Pessary for Symptom Relief in Stress Urinary Incontinence: Presented at AUGS
By Charlotte Libov

HOLLYWOOD, Fla -- September 28, 2009 -- Women using behavioural therapy experienced more symptom relief, and were more satisfied, than those using a pessary, or a combination of the 2 methods, according to a study presented here at the 30th Annual Scientific Meeting of the American Urogynecologic Society (AUGS).

Holly E. Richter, MD, PhD, University of Alabama School of Medicine, Birmingham, Alabama, presented the findings on September 24.

The trial was designed to determine whether a pessary, behavioural therapy (such as pelvic muscle training), or a combination of both was more effective in alleviating symptoms of stress urinary incontinence.

The study included 445 women (mean age, 49.8 years), who were stratified according to type of incontinence (stress only versus stress-predominant mixed) and whether they experienced less or more than 14 episodes per 7 days.

Patients were randomised to the use of a pessary, behavioural therapy (including pelvic muscle training), or the combination of both methods.

Outcomes were measured at 3, 6, and 12 months using the Patient Global Impression of Improvement (PGI-I), stress incontinence subscale of the Pelvic Floor Distress Inventory, and patient-reported satisfaction using the validated Patient Satisfaction Questionnaire.

At 3 months, 47% of participants reported that they were "much better" or "very much better" using the PGI-I (combo 53.3%, behavioural 49.3%, and pessary 39.6%).

PGI-I outcomes did not differ between the behavioural and pessary groups (P = .10), but stress symptoms and satisfaction were significantly better in the behavioural group at 3 months. This benefit was not observed at 6 and 12 months.

Pessary users also had the highest attrition rate (26%), versus behavioural therapy (15%) or combined (12%).

Discussing the results, Dr. Richter noted that behavioural therapy outperformed pessary at 3 months. Most notably, she added, combining the 2 methods did not offer any significant benefit.

The research also showed that women who continued with either method reported satisfaction (50% behavioural therapy vs 30% pessary) at 12 months, but that the total number of women using either method declined.

More effort needs to be put into finding ways to encourage women to stick with the treatment, she said.

"I don't think we should throw the pessary out with the bathwater, but I think this study has given us more insight, and will make us better able to counsel women," said Dr. Richter.

Further research is planned to determine what factors can help predict whether women will be more successful using pessary or behavioural therapy.

[Presentation title: Randomized Trial of Pessary Versus Behavioral Therapy Versus Combined Therapy for Treatment of Stress Urinary Incontinence (SUI). Paper 1]