Prompted voiding for the management of urinary incontinence in adults

Abstract

Background Prompted voiding is a behavioural therapy used mainly in North American nursing homes. It aims to improve bladder control for people with or without dementia using verbal prompts and positive reinforcement. Objectives To assess the e ects of prompted voiding for the management of urinary incontinence in adults. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register (searched 31 January 2006) and reference lists of relevant articles. We contacted investigators in the field to locate extra studies. Selection criteria All randomised or quasi-randomised trials which addressed prompted voiding for the management of urinary incontinence. The trials included adult men and women, with or without cognitive impairment, diagnosed as having urinary incontinence as identified by the trialists, either by symptom classification or by urodynamic investigation. Data collection and analysis The identified reports were assessed for eligibility. Two reviewers independently reviewed the selected studies for methodological quality. Data describing six pre-specified outcomes were extracted independently by each reviewer and consensus reached when there was disagreement. Trial investigators were consulted when clarification or further detail was required. A third reviewer was recruited to proof read the review at di erent stages. Main results Nine trials were included in the review. These involved 674 elderly people, the majority of whom were women. Prompted voiding was compared with no prompted voiding in nine trials. The limited evidence suggested that prompted voiding increased self-initiated voiding and decreased incontinent episodes in the short-term. There was no evidence about whether these e ects are sustained over a long period of prompted voiding, or persist a er stopping prompted voiding.

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

“…Bowel or bladder incontinence is thought to be preventable and reversible in the nursing home residents [152]. Instituting prompted voiding was found to be effective in reducing daytime incontinence [153][154].…”

Identifying Continence OptioNs after Stroke (ICONS): an evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care

“…A meta-study of systematic reviews of behavioural interventions has called for clarity in the theory underpinning the use of behavioural interventions for UI. 53,54 Systematic reviews of the effectiveness of single behavioural interventions already exist for BT; 25 TV; 26 PV; 27 HT 28 and PFMT. 29 As urge strategies have been shown to be effective in stress urinary incontinence (SUI) 32 and stress strategies in urge urinary incontinence (UUI), 33 a number of trials have tested CBIs for both SUI and UUI, on the premise that combining techniques may be more effective than single techniques.…”

“…In the review of BT, 25 trials tended to favour BT and there was no evidence of adverse effects. The review of PV 27 found evidence of increased self-initiated voiding and decreased incontinent episodes in the short term.…”

“…The most likely pattern of incontinence is urinary frequency, urgency (a sudden compelling desire to pass urine which is difficult to defer) and urge incontinence (involuntary leakage immediately following, or concurrent with, an urgent sensation of needing to void). 6 Urge incontinence is the most common type after stroke, Available conservative interventions for UI include bladder training (BT), 25 timed voiding (TV), 26 prompted voiding (PV), 27 habit retraining (HT) 28 and PFMT. 29 BT is generally used for urge incontinence and aims to increase the time interval between voids so continence is regained.…”

“…51 Strategies then need to be 'tailored' to overcome barriers identified. The intervention in our programme focused on conservative strategies shown to have some effect with participants in studies included in Cochrane systematic reviews, 25,27,29,53,54 but which had not had their effectiveness demonstrated with stroke patients. These strategies included a combined package of BT and (where possible) PFMT and PV.…”