Systematic review and economic modelling of the effectiveness and efficiency of non-surgical treatments for women with stress urinary incontinence (SUI)

Urinary incontinence is the involuntary leakage of urine. It can occur as (a) stress urinary incontinence (loss of urine on effort, exertion, coughing or sneezing); (b) urgency urinary incontinence (loss of urine caused by the sudden need to urinate, due to involuntary bladder contraction); (c) mixed urinary incontinence (a combination of (a) and (b)). The classification is based upon a detailed clinical history and examination. Tests of urodynamics such as cystometry may also be performed. Stress urinary incontinence (SUI) is the most common type of incontinence and is most likely in the middle aged women. Although SUI can be treated surgically, non-surgical treatments are generally tried first. Women may also manage their symptoms using containment products (e.g. pads). Non-surgical treatments include the use of lifestyle and behavourial therapies (e.g. pelvic floor muscle training), drugs and mechanical devices. Although research has been conducted there is still uncertainty about their relative effectiveness, safety and cost-effectiveness. The aim of this research is to address these uncertainties and provide guidance to women and the NHS about the use of these different treatments. A systematic review of the existing literature will be performed. Additional focused reviews will be conducted to identify other relevant information (resource use, costs, utilities and natural history of SUI) for a subsequent economic evaluation. These data will be combined along with estimates of relative effectiveness in an economic model to provide estimates o relative effectiveness and cost-effectiveness. From this work we will identify which treatments are most appropriate for women suffering from SUI. Where this is not possible we will identify what further research is required.