Urinary Incontinence Treatment Network (UITN) Continence Treatment Centers
Background
Urinary incontinence is a complex condition that affects females and males of all
ages; however, prevalence of the condition is significantly higher in women than
in men. Factors that influence a patient's decision to seek care are not well-described
and the criteria by which a clinician selects therapy are not uniform. Diagnostic
criteria that delineate the various categories and subcategories of urinary incontinence
are neither well defined nor used by many physicians. In addition, factors that
may predict a successful outcome of treatment have not been examined systematically.
Numerous options are available for treating urinary incontinence, including surgery,
pharmaceuticals, behavioral modification, and prostheses. These therapies are frequently
combined. Much of the literature pertaining to surgical intervention suggests that
continence markedly improves during the immediate and short-term post-operative
period.
However, very few well-designed, clinical trials have been conducted to document
the outcomes of invasive interventions over a longer period of follow-up. The clinical
trials reported to date suffer from a number of methodological shortcomings, including
short follow-up period, inadequate sample size (and thus, low statistical power),
uncertain diagnostic criteria for patient selection, inadequate measurement of quality
of life, uncertainty about the relevance of reported clinical and patient-related
outcomes, absence of documentation of post-operative complications, and high rates
of patients lost to follow-up (thus introducing possible bias into results). Despite
the frequent use of surgery for urinary incontinence, consensus is lacking on which
procedure(s) offers the optimal long-term improvement and greatest patient satisfaction.
No rigorously conducted long-term studies using accepted outcomes measures that
evaluate the most commonly performed surgical procedures have been performed to
date. In addition, although the use of pharmacological therapy and behavioral interventions
before and after surgery for urinary incontinence is common, these adjunctive interventions
have not been evaluated in a standardized fashion. The UITN seeks to address these
shortcomings in the literature in order to improve the care of all patients with
urinary incontinence.
Urinary Incontinence Treatment Network
The Urinary Incontinence Treatment
Network (UITN) was established in 1999 as a result of a 1998 workshop on
urinary incontinence sponsored by the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK) in collaboration with the National Institute of Child
Health and Human Development (NICH). Workshop participants focused on current knowledge
of urinary incontinence, including epidemiology, clinical treatment strategies,
prognosis, and outcomes. They concluded that urinary incontinence is a significant
health care burden for the entire U.S. population and a major burden for the adult
female population. Participants also concluded that there were few well-designed
studies upon which physicians could base their decisions on treating patients with
urinary incontinence.
The purpose of the network is to establish a group of collaborating investigators
who will conduct long-term studies, including clinical trials, of the most commonly
used surgical, pharmacological, and behavioral approaches to the management of urinary
incontinence in women diagnosed with stress and mixed incontinence.
The UITN clinical centers are located at the following institutions: University
of California, San Diego; University of Pittsburgh; University of Texas, Southwestern;
University of Maryland; University of Utah; University of Texas, San Antonio; William
Beaumont Hospital, Royal Oak, Michigan and Oakwood Hospital, Dearborn, Michigan
; Loyola University, Maywood, Illinois; and the University of Alabama at Birmingham.
The biostatistical center is located at the New England Research Institute in Watertown,
Massachusetts.
The UITN has completed recruitment for its first clinical trial, Stress Incontinence
Surgical Treatment Efficacy Results (SISTEr), a randomized controlled clinical trial
comparing two surgical procedures commonly used to treat women with stress urinary
incontinence; the procedures are the autologous rectus fascial sling procedure and
the Burch urethropexy.
The UITN is now recruiting for a second clinical trial, the Behavior Enhances
Drug Reduction of Incontinence (BE-DRI). This trial will compare effects of two
interventions, drug therapy alone and combination drug therapy and behavioral treatment,
on the frequency of urinary incontinence and success in withdrawing patients from
drug therapy. Women with pure or predominant urge incontinence interested in participating
in this trial should go to www.clinicaltrials.gov
and enter the key word urinary incontinence.
Program Officer: Leroy Nyberg, M.D., Ph.D., 301-594-7717
Last Update: 7/6/2005
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