We compared a large group of US women with severe urgency urinary incontinence (UUI) who received sacral neuromodulation (InterStim) or onabotulinumtoxinA (Botox A) therapy during a 2-yr period. We found that both therapies had similar success in reducing UUI symptoms, and adverse events were low. However, women in the BotoxA group had higher satisfaction and endorsement with their treatment, but with a higher chance of a urinary tract infection. We conclude that both therapies offer sustained reduction in daily incontinence over 2 yr.
Objective
To compare the effectiveness of non-surgical abnormal uterine bleeding (AUB) treatments for bleeding control, quality of life, pain, sexual health, patient satisfaction, additional treatments needed, and adverse events.
Data Sources
MEDLINE and Cochrane databases from inception to May 2012. We included randomized controlled trials of non-surgical treatments for AUB. Interventions included the levonorgestrel intrauterine system, combined oral contraceptives, progestins, nonsteroidal anti-inflammatory drugs, and antifibrinolytics. Gonadotropin releasing hormone agonists, danazol, and placebo were allowed as comparators.
Study selection
Two reviewers independently screened the 5846 citations and extracted eligible trials. Studies were assessed for quality and strength of evidence.
Tabulation, Integration, and Results
Twenty-six trials of eight different interventions met inclusion criteria. For the reduction of menstrual bleeding in women with AUB-E, the levonorgestrel intrauterine system, combined oral contraceptives, extended cycle oral progestins, tranexamic acid, and nonsteroidal anti-inflammatory drugs were all effective treatments. The levonorgestrel intrauterine system, combined oral contraceptives, and antifibrinolytics were all superior to luteal phase progestins. The levonorgestrel intrauterine system was superior to combined oral contraceptives and nonsteroidal anti-inflammatory drugs. Antifibrinolytics were superior to nonsteroidal anti-inflammatory drugs for menstrual bleeding reduction. Data were limited on other important outcomes for women with AUB-E and on women with AUB-O.
Conclusion
Many non-surgical treatments for AUB are effective for reducing menstrual bleeding in women with AUB-E. Additional research is necessary to determine the effectiveness of treatments for other essential quality of life outcomes, and for other populations, including women with AUB-O.
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