Adrenergic drugs for urinary incontinence in adults

Urinary incontinence is the leakage of urine, and when caused by coughing or exercising it is called stress incontinence. It may be caused by damage to muscles either holding up the bladder or holding the bladder neck closed. Adrenergic agonist drugs may help the bladder neck muscle to contract more strongly. This review of 22 trials involving 673 women and seven different adrenergic drugs found weak evidence that adrenergic agonists may help stress urinary incontinence. Side effects do occur but are usually minor. Rarely, more serious adverse effects such as high blood pressure can occur. More evidence is needed to compare adrenergic drugs with other drugs for stress incontinence and also with pelvic floor muscle exercises.

Authors' conclusions: 

There was weak evidence to suggest that use of an adrenergic agonist was better than placebo treatment. There was not enough evidence to assess the effects of adrenergic agonists when compared to or combined with other treatments. Further larger trials are needed to identify when adrenergics may be useful. Patients using adrenergic agonists may suffer from minor side effects, which sometimes cause them to stop treatment. Rare but serious side effects, such as cardiac arrhythmias and hypertension, have been reported.

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Background: 

Adrenergic drugs have been used for the treatment of urinary incontinence. However, they have generally been considered to be ineffective or to have side effects which may limit their clinical use.

Objectives: 

To determine the effectiveness of adrenergic agonists in the treatment of urinary incontinence in adults.

Search strategy: 

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 15 September 2010) and the reference lists of relevant articles.

Selection criteria: 

Randomised or quasi-randomised controlled trials in adults with urinary incontinence which included an adrenergic agonist drug in at least one arm of the trial.

Data collection and analysis: 

Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions.

Main results: 

Twenty-two eligible randomised trials were identified, of which 11 were crossover trials. The trials included 1099 women with 673 receiving an adrenergic drug (phenylpropanolamine in 11 trials, midodrine in two, norepinephrine in three, clenbuterol in another three, terbutaline in one, eskornade in one and Ro 115-1240 in one). No trials included men.

The limited evidence suggested that an adrenergic agonist drug is better than placebo in reducing the number of pad changes and incontinence episodes, as well as improving subjective symptoms. In two small trials, the drugs also appeared to be better than pelvic floor muscle training, possibly reflecting relative acceptability of the treatments to women but perhaps due to differential withdrawal of women from the trial groups. There was not enough evidence to evaluate the use of higher compared to lower doses of adrenergic agonists nor the relative merits of an adrenergic agonist drug compared with oestrogen, whether used alone or in combination.

Over a quarter of women reported adverse effects. There were similar numbers of adverse effects with adrenergics, placebo or alternative drug treatment. However, when these were due to recognised adrenergic stimulation (insomnia, restlessness and vasomotor stimulation) they were only severe enough to stop treatment in 4% of women.

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