ESTROGEN THERAPY IN THE MANAGEMENT OF URINARY-INCONTINENCE IN POSTMENOPAUSAL WOMEN - A METAANALYSIS - FIRST REPORT OF THE HORMONES-AND-UROGENITAL-THERAPY-COMMITTEE

Objective: To apply a meta-analysis to available data to evaluate the efficacy of estrogen therapy in the management of postmenopausal women with urinary incontinence. Methods: The literature review incorporate d English language articles based on a search of EXCERPTA MEDICA, BIOS IS, and MEDLINE from January 1969 to June 1992. Criteria included: pee r-reviewed original article, confirmed diagnosis of urinary incontinen ce, an estrogen-treated group, and outcome data on subjective improvem ent, quantitation of fluid loss, or maximum urethral closure pressure. In addition, the data had to allow comparison between treated and con trol groups in controlled trials or an estimated change in uncontrolle d series. Meta-analytic methods were applied only to studies considere d to be controlled clinical trials. Results: Of 166 articles reviewed, 143 did not meet the entry criteria; six were considered controlled c linical trials and 17 were uncontrolled series. Meta-analysis found an overall significant effect of estrogen therapy on subjective improvem ent for all subjects (P < .01) and for subjects with genuine stress in continence alone (P < .05). The results showed no significant effect o n quantity of fluid loss but a significant effect (P < .05) on maximum urethral closure pressure. However, the latter result was influenced by only one study showing a large effect. Conclusion: It appears from this analysis that estrogen subjectively improves urinary incontinence in postmenopausal women. However, the studies included nonhomogeneous groups, and the diagnostic criteria, therapeutic interventions, and o utcome assessments varied considerably. (Obstet Gynecol 1994;83:12-8)